Measurement of Spleen Stiffness by Acoustic Radiation Force Impulse Imaging Identifies Cirrhotic Patients With Esophageal Varices

Takuma, Yoshitaka; Nouso, Kazuhiro; Morimoto, Youichi; Tomokuni, Junko; Sahara, Akiko; Toshikuni, Nobuyuki; Tanaka, Hiroyuki; Shimomura, Hideki; Doi, Akira; Sakakibara, Ichiro; Matsueda, Kazuhiro; Yamamoto, Hiroshi

doi:10.1053/j.gastro.2012.09.049

Cited by 218 publications

(174 citation statements)

References 35 publications

Supporting

Mentioning

152

Contrasting

Unclassified

Order By: Relevance

“…19 New transient elastography probes (XL probe), as well as new sonoelastography methods, might overcome this limitation of transient elastography, 34 with the added advantage of improving the applicability of measurement of spleen stiffness, which is emerging as a novel noninvasive parameter closely correlating with HVPG and presence of EVs. 35,36 Second, the prevalence of EVs in our population of compensated patients was relatively low, which might represent a bias for the generalizability of our results 37 ; however, the prevalence of varices in the validation cohort was exactly as anticipated. It should also be noted that patients included in the training set and in the validation set differed in a number of characteristics; however, the similar results obtained by applying our models in the validation set further confirms the robustness of our findings.…”

Section: Clinical Livermentioning

confidence: 78%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

View full text Add to dashboard Cite

BACKGROUND & AIMS:Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS ϫ spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824 -0.943; P Ͻ .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872Ϫ0.965; P Ͻ .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P Ͻ .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841Ϫ0.954 and 0.882; 95% CI, 0.810 -0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV.

show abstract

Section: Clinical Livermentioning

confidence: 78%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

View full text Add to dashboard Cite

show abstract

“…An unsuccessful measurement was excluded from further analysis. 22,23 The main portal vein velocity (PVV) and splenic vein velocity (SVV) were measured at the hepatic hilus ( Figure 2) and splenic hilus (Figure 3), respectively. Doppler settings, including Doppler angle correction (the sound beam should be as parallel to the flow direction as possible, at least <60°), sample gate (3 mm), pulse repetition frequency, scale, and Doppler gain, were adjusted according to the depth of the portal and splenic veins and venous flow status.…”

Section: Elastography and Splenoportal Vein Doppler Sonographymentioning

confidence: 99%

Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function

Gao¹,

Xiao

Zheng

et al. 2016

J of Ultrasound Medicine

View full text Add to dashboard Cite

A Pilot Studyhe transjugular intrahepatic portosystemic shunt (TIPS) is used for management of refractory acute variceal hemorrhage and intractable ascites in late-stage liver diseases with portal hypertension. 1 In addition to monitoring the clinical status, it is important to monitor TIPS hemodynamic function objectively. 2,3 Although the portosystemic pressure gradient (PPG) and hepatic venous pressure gradient are still considered the reference standards for diagnosis and monitoring of portal hypertension, they Jing Gao, MD, Xiao Zheng, MS, Yuan-Yi Zheng, MD, Guo-Qing Zuo, MD, Hai-Tao Ran, MD, Yong Ho Auh, MD, Levi Waldron, PhD, Tiffany Chan, MS, Zhi-Gang Wang, MD Received July 6, 2015, Objectives-To assess the feasibility of splenic shear wave elastography in monitoring transjugular intrahepatic portosystemic shunt (TIPS) function.Methods-We measured splenic shear wave velocity (SWV), main portal vein velocity (PVV), and splenic vein velocity (SVV) in 33 patients 1 day before and 3 days to 12 months after TIPS placement. We also measured PVV, SVV, and SWV in 10 of 33 patients with TIPS dysfunction 1 day before and 3 to 6 days after TIPS revision. Analyses included differences in portosystemic pressure gradient (PPG), PVV, SVV, and mean SWV before and after TIPS procedures; comparison of median SWV before and after TIPS procedures; differences in PVV, SVV, and SWV before and at different times up to 12 months after TIPS placement; accuracy of PVV, SVV, and SWV in determining TIPS dysfunction; and correlation between PPG and SWV.Results-During 12 months of follow-up, 23 of 33 patients had functioning TIPS, and 10 had TIPS dysfunction. The median SWV was significantly different before and after primary TIPS placement (3.60 versus 3.05 m/s; P = .005), as well as before and after revision (3.73 versus 3.06 m/s; P = .003). The PPG, PVV, and SVV were also significantly different before and after TIPS placement and revision (P < .001). The PPG and SWV decreased, whereas PVV and SVV increased, after successful TIPS procedures. A positive correlation was observed between PPG and SWV (r = 0.70; P < .001), and a negative correlation was observed between PPG and PVV and SVV (r = -0.65; P < .001). The areas under the receiver operating characteristic curve for PVV, SVV, and SWV in determining TIPS dysfunction were 0.82, 0.84, and 0.81, respectively.Conclusions-Splenic SWV is compatible with splenoportal venous velocity in quantitatively monitoring TIPS function and determining TIPS dysfunction.

show abstract

“…Future studies using the combination of Doppler-US and elastographic methods [24][25][26] for non-invasive assessment of changes in intrahepatic haemodynamics (a new target for the treatment of portal hypertension [27]) should take into account the limitations of Doppler-US.…”

Section: Resultsmentioning

confidence: 99%

Reliability of the estimation of total hepatic blood flow by Doppler ultrasound in patients with cirrhotic portal hypertension

Berzigotti

Reverter

García-Criado

et al. 2013

Journal of Hepatology

View full text Add to dashboard Cite

Measurement of Spleen Stiffness by Acoustic Radiation Force Impulse Imaging Identifies Cirrhotic Patients With Esophageal Varices

Cited by 218 publications

References 35 publications

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function

Reliability of the estimation of total hepatic blood flow by Doppler ultrasound in patients with cirrhotic portal hypertension

Contact Info

Product

Resources

About