Diagnostic accuracy of contrast-enhanced ultrasound for detecting clinically significant portal hypertension and severe portal hypertension in chronic liver disease: a meta-analysis

Contrast-enhanced ultrasound (CEUS) has been proposed for detecting clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH) in patients with chronic liver diseases (CLD).
Studies were selected that investigated the diagnostic performance of CEUS in patients with CLD up to 10 October 2022. The summary area under the receiver operating characteristic curve (AUROC), the summary diagnostic odds ratios, and the summary sensitivities and specificities were used to assess the performance of CEUS for detecting CSPH and SPH.
A total of 7 studies were included in this meta-analysis. The summary sensitivity and specificity of this method for CSPH were 92% (95% confidence interval (CI), 76%–97%) and 78% (95% CI, 67%–86%), respectively, and the summary AUROC was 0.89 (95% CI, 0.86–0.92). Those for SPH were 81% (95% CI, 60%-93%), 82% (95% CI, 76%-86%), and 0.82 (95% CI, 0.79–0.85), respectively. A subgroup analysis of 3 subharmonic aided pressure estimation (SHAPE) studies revealed similar diagnostic performance (sensitivity: 95%; specificity: 74%; AUROC: 0.93) for detecting CSPH.
CEUS shows good performance in diagnosing CSPH as well as SPH. SHAPE technique may play a more important role in evaluating CSPH in the future.
The meta-analysis was not registered.

已有研究提出，对比增强超声（Contrast-enhanced ultrasound, CEUS）可用于检测慢性肝病（chronic liver diseases, CLD）患者的临床显著性门静脉高压（clinically significant portal hypertension, CSPH）与重度门静脉高压（severe portal hypertension, SPH）。本研究筛选了截至2022年10月10日发表的、探究CEUS对CLD患者诊断效能的相关文献，并采用综合受试者工作特征曲线下面积（area under the receiver operating characteristic curve, AUROC）、综合诊断比值比、综合灵敏度与特异度，评估CEUS检测CSPH与SPH的诊断性能。本荟萃分析共纳入7项相关研究。该方法检测CSPH的综合灵敏度与特异度分别为92%（95%置信区间（confidence interval, CI）：76%~97%）与78%（95% CI：67%~86%），综合AUROC为0.89（95% CI：0.86~0.92）；检测SPH的综合灵敏度、特异度与AUROC分别为81%（95% CI：60%~93%）、82%（95% CI：76%~86%）与0.82（95% CI：0.79~0.85）。对3项次谐波辅助压力评估（subharmonic aided pressure estimation, SHAPE）相关研究进行亚组分析后发现，其检测CSPH的诊断效能相近（灵敏度：95%；特异度：74%；AUROC：0.93）。CEUS在CSPH与SPH的临床诊断中表现良好，SHAPE技术未来或可在CSPH评估中发挥更为重要的作用。本荟萃分析未进行注册。