Portal Venous Pulsatility Index: A Novel Biomarker for Diagnosis of High-Risk Nonalcoholic Fatty Liver Disease - PubMed (original) (raw)

Observational Study

. 2020 Apr;214(4):786-791.

doi: 10.2214/AJR.19.21963. Epub 2020 Jan 15.

Affiliations

Observational Study

Portal Venous Pulsatility Index: A Novel Biomarker for Diagnosis of High-Risk Nonalcoholic Fatty Liver Disease

Masoud Baikpour et al. AJR Am J Roentgenol. 2020 Apr.

Abstract

OBJECTIVE. The purpose of this study was to assess the accuracy of portal vein pulsatility for noninvasive diagnosis of high-risk nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS. This retrospective study included patients with biopsy-proven diagnosis of NAFLD who underwent duplex Doppler ultrasound assessment of the main portal vein within 1 year of liver biopsy (January 2014 to February 2018). Doppler ultrasound images were reviewed. The spectral waveform was used to measure the maximum (Vmax) and minimum (Vmin) velocity of blood in the portal veins. Venous pulsatility index (VPI) defined as (Vmax - Vmin) / Vmax was calculated. ROC curve analysis was used to calculate AUC as a measure of accuracy to determine the value of this index for diagnosis of high-risk NAFLD and compared with that of the following four clinical decision aids: NAFLD fibrosis score (FS), fibrosis-4 index (FIB-4), BARD score (body mass index, aspartate aminotransferase [AST]-to-alanine aminotransferase ratio, diabetes mellitus), and AST-to-platelet ratio index (APRI). The value of adding VPI to these indexes was also investigated. RESULTS. Of 123 study subjects, 33 (26.8%) had high-risk NAFLD and were found to have a lower VPI than the other 90 subjects (0.19 vs 0.32; p < 0.001). VPI, NAFLD FS, FIB-4, and APRI had statistically significant diagnostic values for high-risk NAFLD. VPI had the highest optimism-corrected AUC (VPI, 0.84 [95% CI, 0.77-0.91]; NAFLD FS, 0.74 [95% CI, 0.63-0.83]; FIB-4, 0.81 [95% CI, 0.72-0.89]; APRI, 0.73 [95% CI, 0.61-0.82]). Addition of VPI to any of the four scoring systems significantly improved the diagnostic value of the score for high-risk NAFLD. CONCLUSION. VPI may be an accurate noninvasive biomarker for diagnosis of high-risk NAFLD.

Keywords: biomarker; duplex Doppler ultrasound; high-risk nonalcoholic fatty liver disease; portal venous pulsatility index.

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Figures

Fig. 1—

Fig. 1—

Calculation of portal venous pulsatility index (VPI). A, 47-year-old man with nonalcoholic fatty liver disease (NAFLD) with fibrosis stage of F0. B-mode sonographic image at level of main portal vein (MPV) with superimposed color Doppler and spectral Doppler ROIs shows how maximum (V max) and minimum (V min) velocity are calculated from spectral waveform. Calculated VPI of 0.61 is elevated and would be unlikely to reflect NAFLD. B, 59-year-old man with NAFLD with fibrosis stage of F4. Duplex ultrasound image shows spectral Doppler waveform measured in MPV has minimal temporal variation. Low calculated VPI of 0.06 corresponds to high-risk NAFLD.

Fig. 2—

Fig. 2—

Box plot shows that higher fibrosis stages are associated with lower venous pulsatility index (VPI). In particular, VPI in high-risk nonalcoholic fatty liver disease (NAFLD) (≥ F2) appears less than VPI in low-risk NAFLD (F0–F1). Upper and lower limits of whiskers are defined as highest and lowest values within 1.5 interquartile range of upper (75th percentile) and lower (25th percentile) limits of box. Circles denote outliers.

Fig. 3—

Fig. 3—

Graph shows ROC curves of univariable models of venous pulsatility index (VPI), fibrosis-4 index (FIB-4), and nonalcoholic fatty liver disease fibrosis score (NAFLD FS) and multivariable models of VPI + NAFLD FS and VPI + FIB-4 for diagnosis of high-risk NAFLD.

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