Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease

Morisaka, Hiroyuki; Motosugi, Utaroh; Ichikawa, Shintaro; Sano, Katsuhiro; Ichikawa, Tomoaki; Enomoto, Nobuyuki

doi:10.1002/jmri.24505

Cited by 50 publications

(39 citation statements)

References 44 publications

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“…Talwalkar et al [25] evaluated hepatic and splenic stiffness in 12 healthy volunteers and 38 patients with liver disease, and found that in patients with esophageal varices the SS was above 10.5 kPa. Similarly, Morisaka et al [26] found that SS had highest correlation with gastroesophageal varices observed at endoscopy, and found 93% sensitivity for diagnosing severe varices when using a SS threshold value of 7.1 kPa. A recent retrospective study using 3D EPI sequence also demonstrated that HS-MRE and SS-MRE are strongly associated with the presence of esophageal varices [27], and may be a better marker than spleen size for assessing the presence of esophageal varices.…”

Section: Discussionmentioning

confidence: 91%

“…Talwalkar et al performed MRE-based SS measurement in 38 patients with chronic liver disease and found that patients with esophageal varices demonstrated higher SS [25]. Morisaka et al [26] compared multiple noninvasive techniques and found that SS best correlated with the presence of gastroesophageal varices observed at endoscopy in 93 patients. A recent retrospective study confirmed that HS and SS measured with MRE are strongly associated with the presence of esophageal varices [27].…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous measurement of hepatic and splenic stiffness using MR elastography: preliminary experience

et al. 2014

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Purpose To compare MR elastography (MRE) using a single and a dual driver excitation for the quantification of hepatic and splenic stiffness (HS and SS), and to investigate the performance of HS and SS measured with single or dual driver excitation for the detection of liver cirrhosis in subjects with liver disease. Patients and Methods This prospective HIPAA compliant and IRB approved study involved 49 subjects who underwent MRE at 3.0T, comparing 3 different acquisition methods (single driver on the liver, single driver on the spleen and dual driver acoustic excitation). A Mann-Whitney test was used to assess changes in stiffness values. Bland-Altman analysis was used to compare single and dual driver configurations for each organ. Performance for detection of liver cirrhosis was assessed using ROC analysis. Pearson correlation was used to estimate the dependence of HS and SS on spleen size. Results There were 40 noncirrhotic and 9 cirrhotic patients. There was good agreement between stiffness values measured with a single or a dual driver (Bland-Altman limits of agreement -14.3%–18.9 % and -18.1%–29.7 %, CV 6.4 % and 9.4 %, for HS and SS respectively). HS and SS were higher in subjects with liver cirrhosis (p <0.001), with excellent detection performance (AUROC range 0.87–0.93). SS correlated strongly with spleen size (r=0.69, p<0.001) while HS showed weak correlation (r=0.38, p=0.006). Conclusion Using a dual acoustic driver configuration, hepatic and splenic stiffness can be simultaneously estimated with good concordance with single driver measurement.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Simultaneous measurement of hepatic and splenic stiffness using MR elastography: preliminary experience

et al. 2014

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“…From the current studies, LS is considered not to correlate with the grades of EV [40,41], whereas the SS measurement may be possible to identify severe EV, but the accuracy is not high [42]. Certainly, additional studies are needed to verify the diagnostic performance of LS and SS in predicting severe EV.…”

Section: Discussionmentioning

confidence: 99%

Spleen Stiffness Is Superior to Liver Stiffness for Predicting Esophageal Varices in Chronic Liver Disease: A Meta-Analysis

Wang

et al. 2016

PLoS ONE

117

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Background and AimsLiver stiffness (LS) and spleen stiffness (SS) are two most widely accessible non-invasive parameters for predicting esophageal varices (EV), but the reported accuracy of the two predictors have been inconsistent across studies. This meta-analysis aims to evaluate the diagnostic performance of LS and SS measurement for detecting EV in patients with chronic liver disease (CLD), and compare their accuracy.MethodsPubmed/Medline, Embase, Cochrane Library and Ovid were searched for all studies assessing SS and LS simultaneously in EV diagnosis. A total of 16 studies including 1892 patients were included in this meta-analysis, and the pooled statistical parameters were calculated using the bivariate mixed effects models.ResultsIn detection of any EV, for LS measurement, the summary sensitivity was 0.83 (95% confidence interval [CI]: 0.78–0.87), and the specificity was 0.66 (95% CI: 0.60–0.72). While for SS measurement, the pooled sensitivity and specificity was 0.88 (95% CI: 0.83–0.92) and 0.78 (95% CI: 0.73–0.83). The summary receiver operating characteristic (SROC) curve values of LS and SS were 0.81 (95% CI: 0.77–0.84) and 0.88 (95% CI: 0.85–0.91) respectively, and the results had statistical significance (P<0.01). The diagnostic odds ratio (DOR) of SS (25.73) was significantly higher than that of LS (9.54), with the relative DOR value was 2.48 (95%CI: 1.10–5.60), P<0.05.ConclusionsUnder current techniques, SS is significantly superior to LS for identifying the presence of EV in patients with CLD. SS measurement may help to select patients for endoscopic screening.

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“…The relationship between MRE and the presence and severity of oesophageal varices 77,80 and hepatic decompensation 81 has also been positive: larger scale studies will help define formal clinical applications in these contexts.…”

Section: Approaches To Mr Haemodynamic Imaging In the Livermentioning

confidence: 99%

“…82 Correlation between post-prandial PCMRI PV flow and MRE stiffness change (Spearman's ρ = 0.48, p = 0.013) was unimpressive, 53 but composite MRE/DCE MRI and MRE/PCMRI parameters have demonstrated improved sensitivity/specificity to the severity of oesophageal varices. 57,80 …”

Section: Approaches To Mr Haemodynamic Imaging In the Livermentioning

confidence: 99%

Vascular assessment of liver disease—towards a new frontier in MRI

Chouhan

Lythgoe

Mookerjee

et al. 2016

BJR

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Complex haemodynamic phenomena underpin the pathophysiology of chronic liver disease. Non-invasive MRI-based assessment of hepatic vascular parameters therefore has the potential to yield meaningful biomarkers for chronic liver disease. In this review, we provide an overview of vascular sequelae of chronic liver disease amenable to imaging evaluation and describe the current supportive evidence, strengths and the limitations of MRI methodologies, including dynamic contrast-enhanced, dynamic hepatocyte-specific contrast-enhanced, phase-contrast, arterial spin labelling and MR elastography in the assessment of hepatic vascular parameters. We review the broader challenges of quantitative hepatic vascular MRI, including the difficulties of motion artefact, complex post-processing, long acquisition times, validation and limitations of pharmacokinetic models, alongside the potential solutions that will shape the future of MRI and deliver this new frontier to the patient bedside.

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Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease

Abstract: Liver and spleen stiffness and spleen volume are associated with GEVs in patients with chronic liver disease. Compared with liver stiffness and spleen volume, spleen stiffness is more strongly associated with severe GEVs.

Cited by 50 publications

References 44 publications

Simultaneous measurement of hepatic and splenic stiffness using MR elastography: preliminary experience

Simultaneous measurement of hepatic and splenic stiffness using MR elastography: preliminary experience

Spleen Stiffness Is Superior to Liver Stiffness for Predicting Esophageal Varices in Chronic Liver Disease: A Meta-Analysis

Vascular assessment of liver disease—towards a new frontier in MRI

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