Clinical applications of spleen ultrasound elastography – a review

Abstract

In the last few years, notable technical progress has taken place in ultrasound elastography. Qualitative methods have been replaced by quantitative ones, such as: transient elastography, acoustic radiation force impulse and shear wave elastography. Owing to the fact that the spleen is superficially located, it is possible to obtain reliable measuring accuracy of its hardness using sonoelastography. Lately, many researchers have been investigating how spleen elasticity changes in patients infected with hepatitis B virus or hepatitis C virus and in patients suffering from liver fibrosis, portal hypertension, esophageal varices or myelofibrosis. In this article, we review the role and current status of accessible qualitative ultrasound elastography methods, including recent advances in the evaluation of spleen stiffness and its clinical utility. As study results demonstrate, spleen stiffness correlates with liver fibrosis and is helpful in determining the level of fibrosis in the METAVIR scoring system. In patients infected with hepatitis B virus or hepatitis C virus, spleen stiffness increases even when liver elasticity remains unaltered. Furthermore, it is useful in diagnosing portal hypertension or predicting existence of esophageal varices. Moreover, in patients suffering from biliary atresia after Kasai portoenterostomy, spleen sonoelastography may be helpful in selecting patients for liver transplantation as well as for choosing the best strategy for portal vein reconstruction before liver transplantation. In myelofibrosis, spleen stiffness correlates with bone marrow fibrosis and may be used to assess the response to treatment. Spleen sonoelastography is also useful in the monitoring of transjugular intrahepatic portosystemic shunt function.

General advice in ultrasound based elastography of pediatric patients

“…It is advisable that the patients hold their breath. This might not be possible in small children; however studies have shown that valid results can be obtained also with free breathing [58]. Convex or linear US probes can be used; the convex probes show higher variability [58,59].…”

“…The normal values for children using pSWE (VTQ) are around 2.25 m/s [60]. Also, the size of the spleen has an influence on the stiffness values [58,61]. Obesity may reduce the quality of the B-mode US image, but this has not yet been investigated in studies.…”

“…In order to have comparable values, it is unavoidable to have a standardized setup. There are different kinds of settings, where measurements can be done transdermally or in a trans-rectal endoscopic setting [53,58,90]. EUS elastography offers a high resolution of the digestive tract, close view of organs and lymph nodes [91,92].…”

Low Risk of Variceal Bleeding in Patients With Cirrhosis After Variceal Screening Stratified by Liver/Spleen Stiffness

“…Spleen stiffness measurement (SSM) with the same machine is accurate at predicting portal hypertension and esophageal varices . An SSM cutoff value of <41.3 kPa is highly sensitive (98%) at ruling out varices.…”

Ultrasonic research of splen is in norm and pathology

“…а с другой -осведомленность врачей, как общей практики -семейной медицины, так и узких специальностей о его возможностях и критериях, продолжает оставаться довольно низкой [1,2,4,[6][7][16][17][18] . В свою очередь, среди органов, которые исследуются при ультразву-ке, весьма незначительную роль уделяют селезенке, диагностика заболеваний которой вообще является часто весьма отсроченной, что обусловлено, в первую очередь, низкой осведомленностью докторов о патологии данного органа вообще [3,5,[8][9][10][11][12][13][14][15] . Принимая это во внимание, целью данной работы является комплексный анализ возможностей ультразвукового исследования селезенки в норме и патологии .…”