Is the spleen stiffness value acquired using acoustic radiation force impulse (ARFI) technology predictive of the presence of esophageal varices in patients with cirrhosis of various etiologies?

Abstract

Aim: This study's aim was to determine the accuracy of the spleen stiffness value acquired using acoustic radiation force impulse (ARFI) technology, to predict the presence of esophageal varices (EVs) in patients with liver cirrhosis of various etiologies. Material and methods: Of the 366 enrolled patients, 192 had hepatitis B virus, 74 had hepatitis C virus, and 100 had alcohol-related cirrhosis. All patients underwent biochemical tests, gastrointestinal endoscopy, and liver and spleen elastography by ARFI. We evaluated the correlation between the presence of EVs and factors including liver and spleen stiffness measured by ARFI, biochemical tests, and other noninvasive measurements, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), platelet count (PLT), spleen diameter (SD), PLT to SD ratio, AST to ALT ratio (AAR) score, the AST to PLT ratio index (APRI) score. Result: A univariate analysis revealed that the AAR score, APRI score, PLT, PLT/SD ratio, and spleen elastography variables were all independently associated with EVs (p<0.05). On multivariate analysis, only spleen elastography was associated with EVs (p=0.001). However, in cases of alcohol-induced liver cirrhosis, spleen stiffness was not reliable for the prediction of EVs. Conclusion: Spleen elastography measured using ARFI may serve as a non-invasive method for determining the presence of EVs. However, it is not an appropriate predictor for EVs in alcoholic cirrhosis.

Spleen Stiffness as Predictor of Esophageal Varices in Cirrhosis of Different Etiologies

“…However, SSM was indisputably the strongest predictor for all endoscopic aspects of EV, from their presence, to the detection of varices needing treatment. Other studies also found ARFI-SSM to be a unique independent parameter for EV prediction, according to multivariate analysis 48,49 .…”

“…One concern was raised regarding SSM as a complementary method in evaluating the existence of EVs in patients suffering from cirrhosis: the loss of correlation in alcohol induced cirrhosis 49 . Without a clear reason for this result, the authors have considered the smaller dimension of the spleen that characterized alcoholic cirrhosis to be a probable cause, as compared to viral or non-alcoholic steatohepatitis-cirrhosis.…”

Clinical applications of spleen ultrasound elastography – a review

“…However, Park et al demonstrates that the usefulness of spleen elastography in detecting esophageal varices depends on the cause of cirrhosis. According to this study spleen elastography is not a reliable predictor of esophageal varices induced by alcoholic cirrhosis (33) . According to available studies, spleen elastography is not useful in assessing the grade of esophageal varices (27,(33)(34)(35) .…”

“…According to this study spleen elastography is not a reliable predictor of esophageal varices induced by alcoholic cirrhosis (33) . According to available studies, spleen elastography is not useful in assessing the grade of esophageal varices (27,(33)(34)(35) . Single studies show that spleen stiffness correlates with clinical history of variceal bleeding (36)(37) , but its utility in determining the risk of bleeding from esophageal varices requires further investigation.…”

Elastography for the Evaluation of Portal Hypertension

“…There are several studies that evaluated VTQ for the assessment of SS, alone [35,56,57] or in comparison with TE [58]. Studies considering HVPG as a reference for evaluating SSM performance revealed a remarkable accuracy of SSM in predicting CSPH [59,60].…”