BAUMGARTNER Margot

The Point- and 2D-Shear-Wave Elastography for Non-Invasive Diagnosis of Liver Fibrosis and Portal Hypertension

Ultrasound-based elastography is a non-invasive method to quantify the stiffness of tissue. Vibration-controlled transient elastography (VCTE) is currently recommended by guidelines and used in clinical practice to assess the presence and severity liver fibrosis non-invasively. Since the development of VCTE, new techniques of ultrasound-based elastography have been developed. Different point-shear wave (P-SWE) and real-time 2D (2D-SWE) elastography methods have been implemented in several high-end ultrasound platforms, as opposed to VCTE which requires a dedicated machine. Even though these methods all measure the same physical tissue properties, the results of liver stiffness measurements (LSM) vary between different liver disease etiologies, and P-SWE and 2D-SWE techniques as well as ultrasound platforms.
Importantly, next to LSM for the non-invasive diagnosis of liver fibrosis, measurement of the stiffness of the spleen (SSM) seems promising for the non-invasive diagnosis of portal hypertension.
The first aim of the proposed study is to evaluate the accuracy and applicability of P-SWEP-SWE and 2D-SWE for the diagnosis of significant fibrosis (fibrosis stage ≥F2) and cirrhosis (F4) by defining sensitive rule-out and specific rule-in cutoffs. The well evaluated VCTE will be used as a reference gold standard against novel P-SWE and 2D-SWE methodologies.
The second aim of the study is to evaluate the values of combined LSM and SSM by novel P-SWE and 2D-SWE methodologies for the non-invasive diagnosis and grading of portal hypertension, as well as for the prediction of varices and varices needing treatment. Invasive measurements of portal pressure by the hepatic venous pressure gradient (HVPG) will be used as the reference gold standard. 

Methods and Skills: 

Clinical studies; R programming; animal experimentation

Publications:

Mandorfer M, Schwabl P., Paternostro R., K. Pomej, Bauer D, Thaler J, C. Ay, Quehenberger P, Fritzer-Szekeres M, Peck-Radosavljevic M, Trauner M, Reiberger T, Ferlitsch A and on behalf of the Vienna Hepatic Hemodynamic Lab. Von Willebrand factor indicates bacterial translocation, inflammation, and procoagulant imbalance and predicts complications independently of portal hypertension severity. Aliment Pharmacol Ther 47: 980-988, 2018

Schwabl P, Brusilovskaya K, Supper P, Bauer D, KönigshoferP, Riedl F, Hayden H, Fuchs C, Stift J, Oberhuber G, Aschauer S, Bonderman D, Gnad T, Pfeifer A, Uschner FE, Trebicka J, Rohr-Udilova N, Podesser BK, Peck-Radosavljevic M, Trauner M & Reiberger T. The soluble guanylate cyclase stimulator riociguat reduces fibrogenesis and portal pressure in cirrhotic rats. Sci Rep 8: 9372, 2018

Unger L. W., Forstner B, Schneglberger S, Bauer D JM, Muckenhuber M, Eigenbauer E, Scheiner B, Mandorfer M, Trauner M, and Reiberger T. Guideline-conform statin use reduces overall mortality in patients with compensated liver disease. Sci Rep 9: 11674, 2019

Mandorfer M, Scheiner B, Stättermayer AF, Schwabl P, Paternostro R, Bauer D, Schaefer B, Zoller H, Peck-Radosavljevic M, Trauner M, Reiberger T, Ferenci P, Ferlitsch A. Impact of patatin-like phospholipase domain containing 3 rs738409 G/G genotype on hepatic decompensation and mortality in patients with portal hypertension. Aliment Pharmacol Ther 48: 451-459, 2018