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

• Published in: American journal of roentgenology (1976) Vol. 214; no. 4; pp. 786 - 791
• Main Authors: Baikpour, Masoud, Ozturk, Arinc, Dhyani, Manish, Mercaldo, Nathaniel D., Pierce, Theodore T., Grajo, Joseph R., Samir, Anthony E.
• Format: Journal Article
• Language: English
• Published: United States 01.04.2020
• Subjects: Adult; Aged; Biomarkers - analysis; Biopsy; Female; Humans; Male; Middle Aged; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Portal Vein - physiopathology; Pulsatile Flow; Retrospective Studies; Ultrasonography, Doppler, Duplex; duplex Doppler ultrasound; high-risk nonalcoholic fatty liver disease; biomarker; portal venous pulsatility index
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.19.21963

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). 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 ( ) and minimum ( ) velocity of blood in the portal veins. Venous pulsatility index (VPI) defined as ( - ) / 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. 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; < 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. VPI may be an accurate noninvasive biomarker for diagnosis of high-risk NAFLD.