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.