Spleen Stiffness Measurement by Transient Elastography to Diagnose Portal Hypertension in Children

Goldschmidt, Imeke; Brauch, Catharina; Poynard, Thierry; Baumann, Ulrich

doi:10.1097/mpg.0000000000000400

Cited by 48 publications

(51 citation statements)

References 28 publications

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“…Some studies have suggested that spleen stiffness may be a marker of portal hypertension [80, 81]. Additionally, spleen stiffness may help predict the presence of esophageal varices and the risk of bleeding [82].…”

Section: Future Directionsmentioning

confidence: 99%

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

Tang

Cloutier

Szeverenyi

et al. 2015

American Journal of Roentgenology

176

112

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OBJECTIVE-The purpose of the article is to review the diagnostic performance of ultrasound and MR elastography techniques for detection and staging of liver fibrosis, the main current clinical applications of elastography in the abdomen.CONCLUSION-Technical and instrument-related factors and biologic and patient-related factors may constitute potential confounders of stiffness measurements for assessment of liver fibrosis. Future developments may expand the scope of elastography for monitoring liver fibrosis and predict complications of chronic liver disease. Keywords elasticity; elastography; liver fibrosis; MR elastography (MRE); MRI; ultrasound; viscosity In abdominal imaging, liver stiffness estimated by elastography techniques may be used as a quantitative imaging biomarker for detection, staging, and monitoring of liver fibrosis [1][2][3]. Liver stiffness is used to evaluate the severity of the underlying chronic liver disease, guide treatment decision, assess disease outcome, and evaluate response to therapy [4].In this second article of a two-part series [5], we will discuss the clinical applications in the liver. We will focus on diagnostic performance of ultrasound elastography and MR Address correspondence to C. B. Sirlin (csirlin@ucsd.edu).. Technologies developed by the team of G. Cloutier were licensed to Rheolution, Inc., and Acist Medical Systems. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript elastography techniques for detection, staging, and monitoring of liver fibrosis, the main current clinical applications of elastography in the abdomen. We will discuss potential confounders of stiffness measurements for assessment of liver fibrosis, which include technical and instrument-related factors (location and depth of measurements, wave frequencies, and device dependencies) and biologic and patient-related factors (concomitant hepatic steatosis, inflammation, cholestasis; breathing; right heart failure and hepatic venous congestion; and fasting vs postprandial state). Finally, we will briefly discuss future directions and technical innovations in this field of research.As will be shown in this article, elastography techniques integrated to clinical ultrasound and MR systems now provide the capability to examine by imaging what once could be examined only by direct palpation, which is likely to open new opportunities to noninvasively diagnose disease, guide management, and improve outcomes. Key Learning PointsFirst, the main current clinical indications for abdominal elastography techniques are detection and staging of liver fibrosis. In general, elastography techniques provide good-toexcellent diagnostic accuracy for the detection of advanced fibrosis but have more modest performance for detection of early or mild fibrosis. Most studies to date have been in adults; performance characteristics in children are less well known. Research is needed to better understand the performance of elastography for monitoring longitudinal changes in fibrosis. Emerg...

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Section: Future Directionsmentioning

confidence: 99%

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

Tang

Cloutier

Szeverenyi

et al. 2015

American Journal of Roentgenology

176

112

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show abstract

“…Liver transient elastography (L‐TE) and liver ARFI (L‐ARFI) estimate liver stiffness, which correlates with fibrosis . Some studies have investigated spleen stiffness, and most of them have focused on the correlation with oesophageal varices and portal hypertension . Elevated spleen stiffness obtained by ARFI (S‐ARFI) was significantly associated with increased hepatic vein pressure gradient diagnosing portal hypertension in a recent study …”

Section: Introductionmentioning

confidence: 99%

Regression of fibrosis and portal hypertension in HCV‐associated cirrhosis and sustained virologic response after interferon‐free antiviral therapy

Knop

Hoppe

Welzel

et al. 2016

Journal of Viral Hepatitis

159

116

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It is still controversial, whether and to what amount cirrhosis and portal hypertension are reversible in patients with hepatitis C virus (HCV)-associated cirrhosis and sustained virologic response (SVR) after interferon-free antiviral therapy. In this study, we prospectively evaluated dynamics of liver and spleen stiffness in HCV-infected patients with advanced liver disease and SVR after interferon-free treatment. A total of 54 patients with HCV-associated cirrhosis and SVR were included. Liver and spleen stiffness was measured at therapy baseline (BL), end of treatment (EOT) and 24 weeks after EOT (FU24) by transient liver elastography (L-TE) as well as by acoustic radiation force impulse of the liver (L-ARFI) and spleen (S-ARFI), as well as biochemical, virologic and clinical data. Improvement of liver and spleen stiffness was found in 44 of 50 (88%), 31 of 54 (57%) and 25 of 54 (46%) of patients assessed by L-TE, L-ARFI and S-ARFI between baseline and FU24. Liver stiffness assessed by L-TE improved between BL [median (range), 32.5 (9.1-75) kPa] and EOT [median (range), 21.3 (6.7-73.5) kPa; (P<.0001)], and between BL and FU24 [median (range), 21.2 (5.4-70) kPa; (P<.0001)]. Liver stiffness assessed by L-ARFI improved between BL [median (range), 2.7 (1.2-4.1) m/s] and FU24 [median (range), 2.4 (1.2-3.9) m/s; P=.002), while spleen stiffness remained unchanged. Our data suggest that improvement of liver stiffness may be rather due to reduced necroinflammation and may be due to a less extent to regression of cirrhosis, as dynamics of liver stiffness improvement was more pronounced between BL and EOT than BL and FU24.

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“…Sonoelastography of the liver and spleen has been studied as an alternative modality for predicting portal hypertension and esophageal varices . Previous studies using transient elastography have suggested that spleen stiffness has high diagnostic accuracy in predicting portal hypertension and esophageal varices because spleen stiffness reflects splanchnic flow better than liver stiffness …”

mentioning

confidence: 99%

Spleen Stiffness Measurement Using 2‐Dimensional Shear Wave Elastography: The Predictors of Measurability and the Normal Spleen Stiffness Value

Cho

Lim

Kim

et al. 2018

J of Ultrasound Medicine

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Spleen Stiffness Measurement by Transient Elastography to Diagnose Portal Hypertension in Children

Abstract: SSM by TE is feasible in children and the results reflect the degree and occurrence of complications. A prospective follow-up study with larger patient numbers and performance of screening endoscopies appears justified and desirable.

Cited by 48 publications

References 28 publications

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

Regression of fibrosis and portal hypertension in HCV‐associated cirrhosis and sustained virologic response after interferon‐free antiviral therapy

Spleen Stiffness Measurement Using 2‐Dimensional Shear Wave Elastography: The Predictors of Measurability and the Normal Spleen Stiffness Value

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