Overview

This is an open-label, non-randomized trial that will be conducted at three clinical sites, Thomas Jefferson University (TJU), the Hospital of the University of Pennsylvania (HUP) and University of Bern (UB). Enrollment will be allocated into one of 4 different cohorts depending on the inclusion criteria for each cohort.

Cohort 1:

Patients scheduled for hepatic vein pressure gradient (HVPG) measurements will subsequently undergo two consecutive SHAPE (subharmonic aided pressure estimation) procedures using different ultrasound contrast agents (Definity [Lantheus Medical Imaging, N Bilerica, MA, USA] and Sonazoid [GE Healthcare, Oslo, Norway] in randomized order) to estimate portal pressures with a Logiq E10 scanner (GE Healthcare, Waukesha, WI, USA) and determine the reproducibility of the SHAPE algorithm.

Cohort 2:

Patients identified as having clinically significant portal hypertension (CSPH) will be monitored by SHAPE with Sonazoid for the duration of this project (18-24 months on average). These subjects will have follow-up ultrasound scans every 6 ± 2 months to check for hepatocellular carcinoma (HCC) (using the Barcelona-Liver Cancer staging system) as well as ascites and at those times a repeat SHAPE examination will be performed. Liver stiffness values will be measured with elastography as well. This cohort will examine if serial SHAPE can accurately predict development of ascites and other liver related events in patients with compensated cirrhosis undergoing routine HCC surveillance in a multi-center setting.

Cohort 3:

Subjects newly diagnosed with portal hypertension and starting treatment with non-selective β-blockers will be monitored with SHAPE and results compared to elastography measurements of liver stiffness with standard assessments (e.g., serum liver function tests and measurement of spleen size as well as platelet count). This cohort will establish if SHAPE can be used to monitor treatment response in patients identified with portal hypertension.

Cohort 4:

Patients with compensated advanced chronic liver disease scheduled for an endoscopy examination for screening of varices relative to the Baveno VI and the expanded-Baveno VI criteria as well as the AST to Platelet Ratio Index will undergo a SHAPE examination. This cohort will compare the predictive ability of SHAPE for allocating patients with compensated advanced chronic liver disease to screening of varices compared to the current standard of care.

Eligibility

Inclusion Criteria:

All subjects accepted for this trial must fulfill all the following criteria:

• Be at least 18 years of age.
• Be medically stable.
• If a female of child-bearing potential, must have a negative pregnancy test.
• Be conscious and able to comply with study procedures.
• Have read and signed the IRB-approved Informed Consent form for participating in the study.

Also there are specific inclusion criteria for each cohort:

Cohort 1:

• Be scheduled for transjugular liver biopsy where HVPG measurements will be obtained

Cohort 2:

• Have clinically significant portal hypertension undergoing routine HCC surveillance

Cohort 3:

        • Have a diagnosis of portal hypertension and starting treatment with non-selective
        β-blockers
        Cohort 4:
        • Have clinically significant portal hypertension and be scheduled for endoscopy to screen
        for varices
        Exclusion Criteria:
          -  Females who are pregnant or nursing.
          -  Patients with pulmonary hypertension or unstable cardiopulmonary conditions
          -  Patients currently on chemotherapy or with other primary cancers requiring systemic or
             hepatic loco-regional treatment.
          -  Patients who are medically unstable, patients who are seriously or terminally ill, and
             patients whose clinical course is unpredictable. For example:
               -  Patients on life support or in a critical care unit.
               -  Patients with unstable occlusive disease (e.g., crescendo angina)
               -  Patients with clinically unstable cardiac arrhythmias, such as recurrent
                  ventricular tachycardia.
               -  Patients with uncontrolled congestive heart failure (NYHA Class IV)
               -  Patients with recent cerebral hemorrhage.
               -  Patients who have undergone surgery within 24 hours prior to the study
                  sonographic examination.
          -  Patients with a history of anaphylactic allergy to eggs or egg products, manifested by
             one or more of the following symptoms: generalized urticaria, difficulty in breathing,
             swelling of the mouth and throat, hypotension, or shock. (Subjects with
             nonanaphylactic allergies to eggs or egg products may be enrolled in the study, but
             must be watched carefully for 1 hour following the administration of Sonazoid).
          -  Patients with congenital heart defects.
          -  Patients with severe emphysema, pulmonary vasculitis, or a history of pulmonary
             emboli.
          -  Patients with respiratory distress syndrome
          -  Patients with thrombosis within the hepatic, portal, or mesenteric veins.
          -  Patients with grade 2 and above of hepatic encephalopathy within the last 3 months
        Also there is one additional exclusion criteria for cohort 1:
        • Patients with a history of anaphylactic allergy to perflutren (PEG) or any other
        components of Definity