Alanine aminotransferase and spleno-portal dynamics affect spleen stiffness measured by point shear-wave elastography in patients with chronic hepatitis C in the absence of significant liver fibrosis

Abstract

Background Spleen stiffness (SS) has gained a lot of interest in the context of liver cirrhosis and portal hypertension stratification. However, there is a paucity of data on confounding factors that may alter SS values. Methods Between January 2018 and October 2019, we enrolled 120 healthy subjects and 117 patients with hepatitis C virus (HCV) infection who did not have significant liver fibrosis (i.e., F0-1). Abdominal ultrasound evaluation was performed on each individual to measure portal vein diameter, portal flow velocity, spleen bipolar diameter, and splenic area. We also performed liver and spleen elastography. Results HCV patients had higher SS (p < 0.001), portal vein diameter (p = 0.031), portal flow velocity (p = 0.035), spleen bipolar diameter (p = 0.042) and area (p = 0.025), and ALT levels (p < 0.001). Linear regression models showed that SS increased by 3.220 kPa for each mm of portal vein diameter, by 0.7 kPa for each cm/s of portal flow velocity, by 2.239 kPa for each cm of spleen bipolar diameter, and by 0.233 kPa for each cm 2 of spleen area. Patients with HCV infection were stratified according to median ALT levels (i.e. 32 IU/L). SS and spleno-portal axis parameters were significantly higher in patients with an ALT level > 32 IU/L. Besides, the relationship between SS and ALT was described by cubic polynomial regression according to the following equation: 11.735 + 0.404 (ALT) 1 − 0.002 (ALT) 2 + 4.26 × 10 -6 (ALT) 3 . Conclusions Our results bring new light to the role of inflammation as a confounding factor for SS measurement. Therefore, particular attention should be paid to serum transaminase for a correct evaluation of spleen elastography.

Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery

“…LSM was performed with pSWE technology and ElastPQ evaluation protocol, using two different Philips (Philips Healthcare, Best, Netherlands) ultrasound systems: IU22 (machine 1) and Affiniti 70 (machine 2), with a 1–5 MHz convex probe. The exact acquisition of LSM, patients’ preparation and reliability criteria were already explained elsewhere [ 18 , 19 , 20 ]. Of notice, the region of interest (ROI) was always positioned at two centimeters from the liver capsule.…”

Sinistral portal hypertension associated with pancreatic pseudocysts - ultrasonography findings: A case report

“…Considering spleen vein was oppressed by pancreatic pseudocysts, disorder of blood flow in the splenic vein may lead to spleen congestion, which increased its stiffness[ 17 ]. Other authors had said that spleen stiffness may serve as a surrogate for the dynamic component of esophageal varices, which pointed out that spleen stiffness has been considered markers of esophageal varices, life-threatening upper gastrointestinal bleeding[ 18 - 20 ]. In short, sonographers should pay another attention to the stiffness of spleen when sinistral portal hypertension was diagnosed.…”

Chemerin Is a Valuable Biomarker in Patients with HCV Infection and Correlates with Liver Injury

“…Moreover, fibrosis scoring by liver elastography in patients with HCV was influenced by serum transaminase levels [ 29 ]. Measurement of spleen stiffness by point shear-wave elastography was also affected by serum transaminase levels in patients with HCV infection [ 30 ]. These studies showed that serum transaminase levels, which are related to inflammation and virus-induced cytolysis, are confounding factors in noninvasive techniques to measure tissue stiffness [ 29 , 30 ].…”

“…Measurement of spleen stiffness by point shear-wave elastography was also affected by serum transaminase levels in patients with HCV infection [ 30 ]. These studies showed that serum transaminase levels, which are related to inflammation and virus-induced cytolysis, are confounding factors in noninvasive techniques to measure tissue stiffness [ 29 , 30 ]. The decline of the ARFI score three months after the end of DAA therapy is most likely a consequence of lower serum transaminase levels rather than an improvement in liver stiffness.…”