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Master Thesis

Intérêt de l’élasticité hépatique mesurée par élastographie impulsionnelle ultrasonore (FibroScan™) pour le diagnostic non invasif de la maladie vasculaire porto-sinusoïdale avec hypertension portale

Abstract : Background and aims : portosinusoidal vascular liver disease (PSVD) is a rare cause of intrahepatic portal hypertension. PSVD is still often misdiagnosed as cirrhosis, emphasizing the need to improve PSVD diagnosis strategies. Data on liver stiffness measurement (LSM) in PSVD are limited. The aims of this study were to evaluate the accuracy (a) of LSM, using transient elastography, to discriminate PSVD from cirrhosis in patients with signs of portal hypertension, (b) of Baveno VI criteria to rule-out varices needing treatment in patients with PVSD.
Methods : this retrospective study included patients with PSVD, according to VALDIG criteria, and compared them with patients with compensated, histologically proven, cirrhosis, related to alcohol or hepatitis C virus infection. All patients with PSVD or cirrhosis had signs of portal hypertension and had reliable LSM.
Results : the 88 patients with PSVD had lower LSM than the 117 patients with alcoholrelated and the 110 patients with HCV-related cirrhosis (median LSM: 8.2 vs. 33.8 vs. 18.2 kPa, respectively; p<0.001 for both comparisons). LSM <10 kPa was able to diagnose PSVD when compared with alcoholic or viral cirrhosis with a specificity of 97% and 95%, respectively. LS>20 kPa was able to rule-out PSVD with a specificity of 93% when compared to alcoholic or viral cirrhosis. In patients with PSVD, Baveno VI criteria would potentially spare 36% of endoscopies, but with an unacceptable risk of missing varices needing treatment of 29%.
Conclusion : in patients with signs of portal hypertension, LSM <10 kPa strongly suggests PSVD as the cause of portal hypertension. Baveno VI criteria should not be applied to patients with PSVD.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03467322
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Submitted on : Monday, December 6, 2021 - 2:38:47 PM
Last modification on : Thursday, April 7, 2022 - 2:28:02 PM
Long-term archiving on: : Monday, March 7, 2022 - 6:58:52 PM

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Marie Lazareth. Intérêt de l’élasticité hépatique mesurée par élastographie impulsionnelle ultrasonore (FibroScan™) pour le diagnostic non invasif de la maladie vasculaire porto-sinusoïdale avec hypertension portale. Médecine humaine et pathologie. 2020. ⟨dumas-03467322⟩

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