Measurement of Spleen Stiffness to Evaluate Portal Hypertension and the Presence of Esophageal Varices in Patients With HCV-Related Cirrhosis

Colecchia, Antonio; Montrone, Lucia; Scaioli, Eleonora; Bacchi-Reggiani, M.L.; Colli, Agostino; Casazza, Giovanni; Schiumerini, Ramona; Turco, Laura; Biase, Anna Rita Di; Mazzella, Giuseppe; Marzi, Luca; Arena, Umberto; Pinzani, Massimo; Festi, Davide

doi:10.1053/j.gastro.2012.05.035

Cited by 463 publications

(457 citation statements)

References 32 publications

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“…19 New transient elastography probes (XL probe), as well as new sonoelastography methods, might overcome this limitation of transient elastography, 34 with the added advantage of improving the applicability of measurement of spleen stiffness, which is emerging as a novel noninvasive parameter closely correlating with HVPG and presence of EVs. 35,36 Second, the prevalence of EVs in our population of compensated patients was relatively low, which might represent a bias for the generalizability of our results 37 ; however, the prevalence of varices in the validation cohort was exactly as anticipated. It should also be noted that patients included in the training set and in the validation set differed in a number of characteristics; however, the similar results obtained by applying our models in the validation set further confirms the robustness of our findings.…”

Section: Clinical Livermentioning

confidence: 76%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

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BACKGROUND & AIMS:Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS ϫ spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824 -0.943; P Ͻ .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872Ϫ0.965; P Ͻ .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P Ͻ .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841Ϫ0.954 and 0.882; 95% CI, 0.810 -0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV.

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Section: Clinical Livermentioning

confidence: 76%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

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“…Also, Colecchia et al (10) concluded that SSM and LSM were more accurate than other non-invasive parameters in identifying patients with EV. In their study, LSM could predict EV with cut-off ≥ 25 with sensitivity 56% and specificity 97%, while SSM could predict EV with cut-off value ≥ 55 with sensitivity 71% and specificity 95%.…”

Section: Discussionmentioning

confidence: 99%

“…The tip of the probe transducer was placed on the skin between the rib bones at the level of the right lobe of the liver. Results were expressed in KiloPascals (kPa) and corresponded to the median of 10 validated measurements (10) . The examination was considered reliable if more than ≥ 10 valid measurements were acquired, the success rate (number of valid acquisitions divided by the number of attempts) was over 60%, and the ratio of the interquartile range to the median of 10 measurements (IQR / M) was less than or equal 0.3 (11) .…”

Section: Liver Stiffness Measurement (Lsm)mentioning

confidence: 99%

Measurement of Liver and Spleen Stiffness by Fibroscan in Comparison to other Validated Indices for Non-Invasive Assessment of Esophageal Varices in Egyptian Patients with HCV-Related Cirrhosis

2016

Int. J. Adv. Res. Biol. Sci.

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Background and Aim: Several investigators have devised non-invasive predictors for presence of esophageal varices (EV) in cirrhotic patients, thus avoiding unnecessary endoscopic screening. This work aimed at evaluating the role of liver and spleen stiffness measurements by Fibroscan in comparison to other validated indices for non-invasive assessment of EV in Egyptian patients with HCV-related cirrhosis. Methods and Material: This cross-sectional study included sixty patients with HCV-related cirrhosis who underwent complete clinical evaluation, laboratory investigations, abdominal ultrasonography, liver and spleen stiffness measurements (LSM and SSM) using Fibroscan and upper gastrointestinal endoscopy. Also, non-invasive predictive scores were calculated: AST-to-ALT ratio (AAR), platelet count/spleen diameter ratio (PSR) and AST-to-platelet ratio index (APRI). The diagnostic performance of each parameter was assessed using receiver operating characteristic (ROC) curves. Results: Patients were classified into two groups; Group 1: 33 patients (55%) with EV, and Group 2: 27 patients (45%) with no EV. There was a highly significant difference between the two groups regarding spleen diameter, PSR, APRI, LSM and SSM (P < 0.01). SSM showed a good performance as regards EV detection in comparison to LSM. At cut-off value ≥ 29 for SSM, sensitivity was 94.4%, specificity 86.4%, PPV 85% and NPV 95% (AUROC 0.934). Conclusion: Spleen stiffness measurement is a sensitive and reliable tool for detection of EV.

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“…Spleen stiffness has recently received considerable attention as an indicator of portal hypertension 79 because it can be examined by non-invasive imaging systems such as transient elastrography 80 and acoustic radiation force impulse imaging. 79,81 Some studies also suggest that spleen stiffness could predict the presence of varices [79][80][81] or ascites.…”

Section: Splenomegalymentioning

confidence: 99%

“…79,81 Some studies also suggest that spleen stiffness could predict the presence of varices [79][80][81] or ascites. 82 An experimental model of cirrhosis with portal hypertension has demonstrated that portal pressure positively correlated with the spleen size.…”

Section: Splenomegalymentioning

confidence: 99%

Pathophysiology of Portal Hypertension

Iwakiri¹,

Groszmann²

2014

Variceal Hemorrhage

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Portal hypertension is a major complication of liver disease, which results from a variety of pathological conditions that increase the resistance to the portal blood flow into the liver. The primary cause of portal hypertension in cirrhosis is an increase in intrahepatic vascular resistance due to massive structural changes associated with fibrosis and increased vascular tone in the hepatic microcirculation. As portal hypertension develops, the formation of collateral vessels and arterial vasodilation progress, which results in increased blood flow to the portal circulation. Eventually the hyperdynamic circulatory syndrome develops, leading to esophageal varices or ascites. This review article will summarize the factors that increase 1) intrahepatic vascular resistance and 2) the blood flow in the splanchnic and systemic circulations in liver cirrhosis. Finally, the future directions of basic/clinical research in portal hypertension will be discussed.

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Measurement of Spleen Stiffness to Evaluate Portal Hypertension and the Presence of Esophageal Varices in Patients With HCV-Related Cirrhosis

Abstract: Measurement of SS can be used for noninvasive assessment and monitoring of PH and to detect EV in patients with hepatitis C virus-induced cirrhosis.

Cited by 463 publications

References 32 publications

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

Measurement of Liver and Spleen Stiffness by Fibroscan in Comparison to other Validated Indices for Non-Invasive Assessment of Esophageal Varices in Egyptian Patients with HCV-Related Cirrhosis

Pathophysiology of Portal Hypertension

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