Clinical Utility of Transient Elastography in the Management of Patients with Budd-Chiari Syndrome undergoing Endovascular Intervention.

PURPOSE To quantify liver stiffness measure (LSM) changes after endovascular intervention for Budd-Chiari syndrome (BCS) and evaluate whether liver LSM changes predict restenosis after endovascular intervention. METHODS BCS patients who underwent endovascular intervention and had at least two LSM values available after intervention were included. ΔLSM was the difference between LSM estimated at the last and second last hospital visit. In patients with restenosis, two LSM values before restenosis were included. ΔLSM% was calculated as the ratio of ΔLSM to the LSM at second last visit and expressed as a percentage. Odds ratio (OR) with confidence interval(CI) and area under the receiver operating curves (AUROC) were calculated for the predictors of restenosis. RESULTS The median baseline and post-intervention 1-week, 3-months, 6-months, and 12-months LSM were 47.2 (33.8-68.4)kPa, 29.2 (24.5-43.0)kPa, 26.2 (18.6-38.9)kPa, 20.9 (13.3-29.8)kPa, and 17.3 (11.8-25.4)kPa, respectively. Of 118 patients, including 67 males, 10 developed restenosis after a median(interquartile range) duration of 19 (11 - 46) months. ΔLSM% was higher (more positive) in patients with restenosis [44.7 (8.3 - 134.3) vs. -6.6 (-19.4 to 14.9), p=0.001]. ΔLSM% was a significant predictor of restenosis with an OR of 1.032 (95%CI 1.015 - 1.050, p<0.001). The AUROC for ΔLSM% was 0.831 (95% CI: 0.750 - 0.893, p=0.001), and a ΔLSM% increment of 13.2% predicted restenosis with a sensitivity and specificity of 80.0% and 74.1%, respectively. CONCLUSION LSM gradually decreases after endovascular intervention and transient elastography is a promising test for detecting restenosis after endovascular treatment of patients with BCS.