The role of spleen stiffness using ARFI in predicting esophageal varices in patients with Hepatitis B and C virus-related cirrhosis

Abstract

Introduction. Current guidelines recommend that all patients with cirrhosis undergo upper gastrointestinal endoscopy (UGE) screening for esophageal varices (EV). Unfortunately, UGE has a lot of disadvantages, consequently various non-invasive methods of diagnosing EV have been proposed. We evaluated if spleen stiffness (SS) measured by Acoustic Radiation Force Impulse (ARFI) is a viable technique in diagnosing EV. Methods. We recruited 178 patients with cirrhosis caused by Hepatitis B and C who underwent biochemical tests, abdominal ultrasound, UGE, LS and SS measurements using ARFI elastography. Based on the endoscopic results the patients were divided in 3 groups: without EV, with small EV (<5 mm) and with large EV (>5 mm). Results. ARFI SS was the only non-invasive parameter associated with the presence of EV (2.7±0.30 vs. 3.4±0.52, p<0.001) and large EV (2.91±0.36 vs. 3.86±0.37, p=0.001) after multivariate logistic regression (p<0.001). ARFI SS for predicting EV showed an AUROC of 0.872 (CI 95%: 0.799–0.944), for a cut-off value of 2.89 m/s: Sensitivity (Se) 91.4% (CI 95%: 81–97%), Specificity (Sp) 67.7% (CI 95%: 51–85%). ARFI SS for diagnosing large EV (>5mm) had better results with an AUROC 0.969 (CI 95%:0.935–0.99), and for a cut-off of 3.30 m/s: Se 96.4% (CI 95%: 82–99.9%), Sp 88.5% (CI 95%: 78–95%). Conclusions. SS measured using ARFI is a good method of detecting EV and is an excellent method of diagnosing large EV in patients with virus-related cirrhosis.

Our experience with liver and spleen elastography in the prediction of oesophageal varices

“…This is consistent with the findings of several previous studies. 33,34,35,36,37,38 37 Although the absolute values are lower than in this study, the general trend is similar between the two studies. The ROC curves of splenic SWV for the prediction of EVs in patients with CLD have been depicted in Figure 5 and Figure 6.…”

“…This is consistent with the findings of several previous studies. 33 , 34 , 35 , 36 , 37 , 38 Park Y et al, in their study found the mean SWVs to be 2.39 m/s ± 0.67 m/s, 2.19 m/s ± 0.73 m/s and 1.64 m/s ± 0.57 m/s, respectively, in patients with high risk, low risk and no EVs. 37 Although the absolute values are lower than in this study, the general trend is similar between the two studies.…”

Spleen stiffness measurement by shear wave elastography using acoustic radiation force impulse in predicting the etiology of splenomegaly

“…The degree of fibrosis increases as the degree of spleen stiffness increases [18]. In a recent study by Peagu et al [29], the cut-off value for spleen stiffness measured by ARFI elastography was determined to be 2.89 m/s (sensitivity 91.4%, specificity 67.7%) in predicting esophageal varices and 3.30 m/s (sensitivity 96.4%, specificity 88.5%) for the diagnosis of large varices (> 5 mm) in the patients with hepatitis-related cirrhosis. Spleen stiffness measured by ARFI elastography is also useful in predicting outcomes (such as hepatic decompensation and death) of cirrhosis patients [30].…”

Small varices in chronic liver diseases

“…Their prediction algorithm for GEVs has an AUROC of 0.94 in one chronic hepatitis B validation cohort and 0.90 in the validation cohort with other CLDs [51]. SS is also a tested method for detecting EVs with an AUROC of 0.872 in Peagu R et al 's study [52]. Fierbinteanu- Braticevici C et al showed the AUROC for the detection of EVs using SS was 0.776 [53].…”