Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: a prospective cohort study

Abstract

BackgroundTo assess correlation between liver or spleen stiffness measurement by transient elastography (TE) and hepatic venous pressure gradient (HVPG) in patients with chronic liver disease as well find optimal and rule in/rule out cut-offs for prognosis of clinically significant (CSPH) and severe (SPH) portal hypertension.MethodsIn this prospective study patients with different chronic liver diseases were included. TE was performed at the same day prior to HVPG measurement. HVPG was measured using catheter tip occlusion technique. Based on HVPG, patients were categorized into groups of CSPH and SPH. Cut-off values were established by applying ROC curve analysis.ResultsThe study included 107 consecutive patients referred for HVPG measurement or transjugular liver biopsy. Successful spleen TE was performed in 99 of the patients. Liver and spleen TE strongly correlated with HVPG, r = 0.75 and r = 0.62, respectively. Accuracy to detect CSPH was 88.7 % for liver stiffness of 17.4 kPa and 77.7 % for spleen stiffness of 47.6 kPa. Accuracy to detect SPH was 83.1 % for liver stiffness of 20.6 kPa and 77.7 % for spleen stiffness of 50.7 kPa. Liver stiffness <11.4 kPa could rule out CSPH with 55.2 % specificity and >21.9 kPa rule in CSPH with 74.4 % sensitivity. Liver stiffness <12.1 kPa could rule out SPH with 50.0 % specificity and >35 kPa rule in SPH with 58.2 % sensitivity.ConclusionsLiver and spleen stiffness correlate with HVPG and could be used to predict CSPH or SPH. Spleen elastography was not superior to liver elastography in predicting portal hypertension.

Shear‐wave elastography of the liver and spleen identifies clinically significant portal hypertension: A prospective multicentre study

“…Our study hence showed that S‐SWE is a possible tool to assess CSPH, similar to TE . On the basis of these significant results, we set for the first time the cut‐off values for S‐SWE to predict accurately portosystemic pressure gradients of 5, 10 and 12 mm Hg.…”

“…Transient elastography (TE) has already been considered not only a good tool for the evaluation of liver fibrosis, but also for the diagnosis of portal hypertension. [21][22][23][24][25] Therefore, TE measurements have found their way into the guidelines for diagnosing, stratifying and classifying liver diseases. 25 Also in the last Baveno meeting, TE of the liver has been recommended to stratify patients at risk for varices.…”

Modification of splenic stiffness on acoustic radiation force impulse parallels the variation of portal pressure induced by transjugular intrahepatic portosystemic shunt

“…Spleen stiffness (SS) measured by tissue elastometry has been showed to be significantly correlated to the hepatic venous pressure gradient . Moreover, the capacity of SS was measured either by tissue elastometry or by ARFI in identifying patients with portal hypertension (i.e., hepatic venous pressure gradient [HVPG] > 10 mmHg); clinically significant portal hypertension (HVPG > 12 mmHg) or varices at endoscopy has been shown to be superior to liver stiffness (LS) although not in all studies . Thus, SS can be considered a promising method for the non‐invasive diagnosis of portal hypertension .…”

“…10 Moreover, the capacity of SS was measured either by tissue elastometry [10][11][12] or by ARFI 13 in identifying patients with portal hypertension (i.e., hepatic venous pressure gradient [HVPG] > 10 mmHg); clinically significant portal hypertension (HVPG > 12 mmHg) or varices at endoscopy has been shown to be superior to liver stiffness (LS) although not in all studies. [14][15][16] Thus, SS can be considered a promising method for the non-invasive diagnosis of portal hypertension. [17][18][19] However, little is known on the relationship between the modification of the portal pressure and the modification of splenic stiffness.…”

Spleen Stiffness Is Superior to Liver Stiffness for Predicting Esophageal Varices in Chronic Liver Disease: A Meta-Analysis

“…Research has shown that SS assessed by elastography was a more effective parameter with high diagnostic accuracy for identifying and grading EV than LS [14,15]. Conversely, other studies have concluded that spleen elastography is not superior to liver elastography in predicting EV for its inconstant accuracy, poor repeatability and highly unreliable measurement [16–18]. In 2014, a meta-analysis summarized the accuracy of SS measurement in predicting EV.…”