Prognostic value of CEUS-derived intrahepatic transit times for predicting short-term decompensation in compensated cirrhosis.

AIMS: To assess whether contrast-enhanced ultrasound (CEUS)-derived intrahepatic transit times predict short-term hepatic decompensation in patients with compensated cirrhosis and to determine whether they provide incremental prognostic value over noninvasive markers. MATERIALS AND METHODS: In this prospective study, 46 patients with compensated cirrhosis underwent CEUS with time-intensity curve analysis to determine hepatic artery-to-hepatic vein (HA-HVTT) and portal vein-to-hepatic vein (PV-HVTT) transit times. Liver stiffness and clinical scores (MELD, MELD 3.0, Child-Pugh, ALBI, FIB-4) were recorded. Patients were followed for 180 days to assess decompensation (ascites, variceal bleeding, or encephalopathy). Diagnostic performance was evaluated using ROC analysis, and prognostic value was assessed using Cox regression. RESULTS: Twenty-three patients developed decompensation. PV-HVTT and HA-HVTT were significantly shorter in patients who decompensated (p<0.001). PV-HVTT showed excellent discrimination (AUC 0.928), outperforming liver stiffness and clinical scores (all p<0.01). A PV-HVTT cutoff of 2.38 seconds identified high-risk patients with a 6-month decompensation rate of 83.3%, compared with 13.6% in low-risk patients. PV-HVTT independently predicted decompensation (HR 0.37 per 0.5 s increase, p<0.001). HA-HVTT showed moderate performance. CONCLUSIONS: CEUS-derived transit times predict short-term decompensation in compensated cirrhosis and outperform established noninvasive markers. CEUS provides a functional assessment of intrahepatic hemodynamics and may improve risk stratification.