A New Sampling Method for Spleen Stiffness Measurement Based on Quantitative Acoustic Radiation Force Impulse Elastography for Noninvasive Assessment of Esophageal Varices in Newly Diagnosed HCV-Related Cirrhosis

Abstract

In our study, we evaluated the feasibility of a new sampling method for splenic stiffness (SS) measurement by Quantitative Acoustic Radiation Force Impulse Elastography (Virtual Touch Tissue Quantification (VTTQ)).We measured SS in 54 patients with HCV-related cirrhosis of whom 28 with esophageal varices (EV), 27 with Chronic Hepatitis C (CHC) F1–F3, and 63 healthy controls. VTTQ-SS was significantly higher among cirrhotic patients with EV (3.37 m/s) in comparison with controls (2.19 m/s, P < 0.001), CHC patients (2.37 m/s, P < 0.001), and cirrhotic patients without EV (2.7 m/s, P < 0.001). Moreover, VTTQ-SS was significantly higher among cirrhotic patients without EV in comparison with both controls (P < 0.001) and CHC patients (P < 0.01). The optimal VTTQ-SS cut-off value for predicting EV was 3.1 m/s (AUROC = 0.96, sensitivity 96.4%, specificity 88.5%, positive predictive value 90%, negative predictive value 96%, positive likelihood ratio 8.36, and negative likelihood ratio 0.04). In conclusion, VTTQ-SS is a promising noninvasive and reliable diagnostic tool to screen cirrhotic patients for EV and reduce the need for upper gastrointestinal endoscopy. By using our cut-off value of 3.1 m/s, we would avoid endoscopy in around 45% of cirrhotic subjects, with significant time and cost savings.

Shear wave elastography (SWE) of the spleen in patients with hepatitis B and C but without significant liver fibrosis

“…The study did not aim to compare healthy controls with patients with HCV-related hepatitis without cirrhosis, but it shows a relatively small difference between those groups. 19 At the moment, it is not possible to predict whether the results of our study and the extrahepatic "existence" of viruses are connected. The main limitation of this study is a lack of information about the level of viraemia.…”

“…Also, an overlap in SWE of the spleen between F0, F1, F2 and healthy control subjects was observed. Another study which is worth mentioning was performed by Rizzo et al 19 Although they used acoustic radiation force impulse elastography for the assessment of stiffness of the liver and spleen, they found that in healthy subjects, patients with chronic hepatitis C (fibrosis stages F1-F3), patients with cirrhosis without oesophageal varices and for those with varices, splenic stiffness was 2.19, 2.37, 2.7 and 3.37, respectively. The study did not aim to compare healthy controls with patients with HCV-related hepatitis without cirrhosis, but it shows a relatively small difference between those groups.…”

Usefulness of virtual touch quantification for staging liver fibrosis in patients with hepatitis C, and factors affecting liver stiffness measurement failure compared with liver biopsy

“…Several studies suggest that assessment of focal liver lesion (FLL) tissue stiffness using VTQ is helpful to make a differential diagnosis of FLL . Additionally, in liver cirrhosis, it has been suggested that measurement of liver or spleen stiffness using VTQ may be useful in diagnosing portal hypertension and predicting esophageal varices . Virtual touch quantification is also useful as a non‐invasive diagnostic technique for liver cirrhosis.…”

“…[29][30][31][32] Additionally, in liver cirrhosis, it has been suggested that measurement of liver or spleen stiffness using VTQ may be useful in diagnosing portal hypertension and predicting esophageal varices. [33][34][35][36] Virtual touch quantification is also useful as a non-invasive diagnostic technique for liver cirrhosis.…”

The role of spleen stiffness using ARFI in predicting esophageal varices in patients with Hepatitis B and C virus-related cirrhosis

“…Liver stiffness evaluated by ARFI elastography has already proven to possess excellent diagnostic accuracy in diagnosing liver cirrhosis [14]. The ARFI technique used to measure SS appears to be efficient in predicting EV when compared with upper endoscopy in a small number of studies and it is also accurate in diagnosing clinically significant PH when compared with invasive hepatic vein pressure gradient [12,[15][16][17][18]. Consequently we assessed the capability of SS using ARFI in predicting esophageal varices (EV) in patients with cirrhosis caused by Hepatitis B and C.…”