Ultrasound and Elastography for Detection of Portal Hypertension in Common Variable Immunodeficiency

Background and Aims: Porto-sinusoidal vascular liver disease (PSVD) is a serious complication occurring in patients with CVID. Currently, there is a lack of well-defined non-invasive markers for early detection. This study aimed to assess the diagnostic accuracy of ultrasound and elastography for predicting clinically significant portal hypertension (CSPH) caused by PSVD in patients with CVID.

Methods: Patients from the outpatient clinic at the CCI, University of Freiburg, were included from 03/22 to 09/24. Exclusion criteria were liver cirrhosis, portal vein thrombosis and history of TIPS-implantation. All participants underwent a standardized abdominal ultrasound protocol, including duplex sonography of liver and spleen, and liver (LSM) and spleen stiffness measurement (SSM) using transient elastography.

Results: 17 patients with and 50 without PSVD were included. Varices were observed in 15 and ascites in 8 patients with PSVD. LSM and SSM were significantly elevated in patients with CSPH (LSM: 12.1kPa [9.4;15.7] vs. 4.9kPa [3.8;6.4], p<0.001; SSM: 74.8kPa [62.1;75.0] vs. 26.5kPa [16.3;39.6], p<0.001) compared to those without. The portal congestion index, measured as ratio between cross sectional area (cm2) and blood flow velocity (cm/sec) of the portal vein, was higher in patients with CSPH (0.17 [0.11;0.22] vs. 0.08 [0.06;0.11], p<0.001). Optimal cut-offs determined by AUC analysis were 7.95kPa for LSM (AUC 0.948) and 42.9kPa for SSM (AUC 0.959).

Conclusion: LSM and SSM demonstrate high diagnostic accuracy for distinguishing patients with and without PSVD. Incorporating elastography into routine evaluation for CVID patients could facilitate timely diagnosis and management of complications.

Publication History

Article published online:
20 January 2025