Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE)

Fofiu, Renata; Bende, Felix; Lupușoru, Raluca; Şirli, Roxana; Popescu, Alina; Sporea, Ioan

doi:10.1155/2021/6622726

Cited by 11 publications

(7 citation statements)

References 43 publications

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“…Third, the high exclusion rate of SS measurement visits, up to 26.9% (627/2331), reflects the challenging clinical practice of SS measurement, which can be compromised by several factors, especially in patients without advanced chronic liver disease, 12,13 with a small spleen, or with a high body mass index. 31,32 Therefore, stratified analyses were implemented in the present study (Tables S1-S3). Fourth, fewer stiffness measurement visits were made after than before PW24 in the present study despite the effort made to invite patients to attend all visits.…”

Section: Discussionmentioning

confidence: 99%

“…Future studies should implement earlier and more frequent follow‐ups to identify this early time point. Third, the high exclusion rate of SS measurement visits, up to 26.9% (627/2331), reflects the challenging clinical practice of SS measurement, which can be compromised by several factors, especially in patients without advanced chronic liver disease, 12,13 with a small spleen, or with a high body mass index 31,32 . Therefore, stratified analyses were implemented in the present study (Tables S1–S3).…”

Section: Discussionmentioning

confidence: 99%

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Liver and Spleen Stiffness Surveillance Through Elastography During and After Direct‐Acting Antiviral Therapy in Patients With Chronic Hepatitis C

Chen

Lai

et al. 2021

J of Ultrasound Medicine

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Objectives-Direct-acting antiviral agents achieve a high cure rate, resulting in early hepatic necroinflammatory resolution and sustained fibrosis regression. This study aimed to obtain longitudinal, concurrent within-subject measurements of liver stiffness (LS) and spleen stiffness (SS) and their correlates over time. Methods-Participants with hepatitis C (n = 592) receiving direct-acting antiviralbased therapy were monitored through point shear-wave elastography from the treatment baseline (TW0) across follow-up visits in terms of LS and SS. Results-Generalized linear mixed modeling indicated that all LS values (2301 visits) were negatively correlated with the follow-up times (all P < .05) from TW0 to 24 weeks (PW24) after the end of treatment (EOT) and positively correlated with baseline LS values (P < .001). The slopes of declines (preceding minus next) differed significantly (P < .001) between TW0-TW4 (treatment week 4) (0.060 [À0.050 to 0.225] meter/second/month [m/s/mo]) and TW4-EOT (0.010 [À0.030 to 0.075] m/s/mo). All SS values (1704 visits) were negatively correlated with time only at PW24 (P < .001) and positively correlated with baseline SS values (P < .001). The slopes of the SS values differed significantly (P < .001) only between EOT-PW12 (À0.010 [À0.110 to 0.083] m/s/ mo) and PW12-PW24 (0.043 [À0.063 to 0.160] m/s/mo).Conclusions-The biphasic fast-to-slow decline in LS occurred early in the ontreatment phase, which is consistent with the resolution of hepatic necroinflammation. The slow-to-fast decline in SS occurred off treatment. Future studies should investigate the association with regressions in liver fibrosis and portal hypertension.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Liver and Spleen Stiffness Surveillance Through Elastography During and After Direct‐Acting Antiviral Therapy in Patients With Chronic Hepatitis C

Chen

Lai

et al. 2021

J of Ultrasound Medicine

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“…The optimal cut-off values of SSM by 2D-SWE and p-SWE were 13.2 kPa (AUROC=0.84) and 2.91 m/s (AUROC=0.90), respectively. 61 While the postulation of Baveno VI criteria (LSM <20 kPa and platelet count >150×10 9 /L) have been validated in clinical practice, there still were many attempts made to improve the rate of saving EGDs. A new combination of SSM (cut-off ≤46 kPa, assessed by TE) with Baveno VI is a reliable option.…”

Section: Open Accessmentioning

confidence: 99%

Spleen stiffness measurement as a non-invasive assessment in patients with portal hypertension

Xu,

Liu,

Zhu

et al. 2024

egastro

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For patients with advanced chronic liver disease who are in a compensated state, the development of portal hypertension (PHT) can lead to a heightened risk of hepatic decompensation and mortality. This underscores the importance of timely and appropriate treatment to manage the condition and prevent further complications. The current gold standard procedure for determining PHT is the hepatic venous pressure gradient, but its invasiveness limits its usage in clinical practice and larger trials of novel agents. The current clinical demand for accurate, validated and non-invasive methods to assess the severity of PHT remains unmet. One potential non-invasive option is tissue elastography, which examines the elastic behaviour of tissue after a force has been applied. This method involves quantifying alterations in the biomechanical properties of the liver or spleen in patients with cirrhosis. Available methods are various, including transient elastography, shear wave elastography, acoustic radiation force impulse and magnetic resonance elastography. Importantly, the measurement of spleen stiffness appears to outperform liver stiffness as a direct and dynamic indicator of portal pressure, offering the potential to monitor PHT and evaluate improvements in PHT as a marker for clinical outcomes.

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“…VNT was defined as the presence of any of the following three conditions: (1) grade 1 esophageal varices with red color sign, or (2) medium to large esophageal varices (grade 2 or 3) 33,34 . Regarding VNT prediction, our study compared the following previously published scoring systems: LSM evaluated by the FibroScan® Expert 630 model, LSPS (platelet count to longitudinal spleen diameter ratio) 35 , PSR (platelet count/spleen diameter ratio) 36 , and VRS (varices risk score) 37 .…”

Section: Prediction Models For Vntmentioning

confidence: 99%

Enhancing liver cirrhosis varices and CSPH risk prediction with spleen stiffness measurement using 100-Hz probe

Yoo,

Maeng,

Chang

et al. 2024

Sci Rep

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Managing complications of liver cirrhosis such as varices needing treatment (VNT) and clinically significant portal hypertension (CSPH) demands precise and non-invasive diagnostic methods. This study assesses the efficacy of spleen stiffness measurement (SSM) using a 100-Hz probe for predicting VNT and CSPH, aiming to refine diagnostic thresholds. A retrospective analysis was conducted on 257 cirrhotic patients, comparing the diagnostic performance of SSM against traditional criteria, including Baveno VII, for predicting VNT and CSPH. The DeLong test was used for statistical comparisons among predictive models. The success rate of SSM@100 Hz was 94.60%, and factors related to SSM failure were high body mass index and small spleen volume or length. In our cohort, the identified SSM cut-off of 38.9 kPa, which achieved a sensitivity of 92% and a negative predictive value (NPV) of 98% for detecting VNT, is clinically nearly identical to the established Baveno threshold of 40 kPa. The predictive capability of the SSM-based model for VNT was superior to the LSM ± PLT model (p = 0.017). For CSPH prediction, the SSM model notably outperformed existing non-invasive tests (NITs), with an AUC improvement and significant correlations with HVPG measurements (obtained from 49 patients), highlighting a correlation coefficient of 0.486 (p < 0.001) between SSM and HVPG. Therefore, incorporating SSM into clinical practice significantly enhances the prediction accuracy for both VNT and CSPH in cirrhosis patients, mainly due to the high correlation between SSM and HVPG. SSM@100 Hz can offer valuable clinical assistance in avoiding unnecessary endoscopy in these patients.

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Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE)

Cited by 11 publications

References 43 publications

Liver and Spleen Stiffness Surveillance Through Elastography During and After Direct‐Acting Antiviral Therapy in Patients With Chronic Hepatitis C

Liver and Spleen Stiffness Surveillance Through Elastography During and After Direct‐Acting Antiviral Therapy in Patients With Chronic Hepatitis C

Spleen stiffness measurement as a non-invasive assessment in patients with portal hypertension

Enhancing liver cirrhosis varices and CSPH risk prediction with spleen stiffness measurement using 100-Hz probe

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