Measurement of Spleen Stiffness by Shear-Wave Elastography for Prediction of Splenomegaly Etiology

Abstract

Objective The aim of this study was to evaluate the reproducibility of measurement of spleen stiffness at the time of the initial detection of splenomegaly, whether it is found incidentally or not, in determining the etiology of splenomegaly. Methods The pathologies that brought about the diffuse splenomegaly were evaluated in 3 main groups as follows: hepatoportal, myeloproliferative, and infectious causes. In addition, 17 healthy control patients were recruited. All patients were examined with acoustic radiation force impulse imaging with VTQ. Results The difference between the splenic parenchymal elasticity values in the hepatoportal group (3.27 ± 0.36 m/s), in the myeloproliferative disease group (2.98 ± 0.33 m/s), in the infectious disease group (2.44 ± 0.21 m/s), and in the control group (2.08 ± 0.19 m/s) was found to be statistically significant (P = 0.001). The intraclass correlation coefficient for shear wave velocity measurement between hepatoportal causes and myeloproliferative causes was 71.2% (95% confidence interval [CI], 54.9%–87.4%), between hepatoportal causes and infective causes was 99.7% (95% CI, 98.6%–100.0%), and between myeloproliferative causes and infective causes was 83.3% (95% CI, 68.8%–97.9%). In the same patient groups, spleen volumes were measured as 64.08 ± 9.66, 78.18 ± 18.52, and 51.57 ± 7.44 cm2, respectively; in the control group, it was 26.75 ± 6.57 cm2. The difference between spleen volumes was found to be statistically significant (P = 0.001). Conclusions Distinguishing the causes of splenomegaly is important because the disorders require different management strategies. In diseases that cause splenomegaly, tissue content may change according to pathogenesis. Such changes in the spleen are mechanical properties that can be quantified by elastography.

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

“…Moreover, Webb et al [31] reported that the low number of study participants (9 myelofibrosis, 11 cirrhosis, 8 healthy controls) and absence of liver or spleen biopsy confirming the degree of fibrosis were the limitations of their study and emphasized the need for further studies. In a recent study, Batur et al [5] investigated the predictive value of spleen stiffness in the etiology of splenomegaly and found the mean SWV to be 3.27 ± 0.36 m/s in the hepatoportal group, 2.98 ± 0.33 m/s in the myeloproliferative group, 2.44 Fig. 3 ROC curve for distinguishing splenomegaly causes: a distinguishing hepatoportal causes from myeloproliferative causes, b distinguishing hepatoportal causes from infectious causes, c distinguishing myeloproliferative causes from infectious causes ▸ ± 0.21 m/s in the infective group, and 2.08 ± 0.19 m/s in the healthy controls.…”

“…Diseases causing splenomegaly may alter tissue stiffness values. Shear wave velocity values determined by SWE may be helpful in determining the etiology of the splenomegaly [5]. In the present study, splenomegaly patients were evaluated in three groups according to their etiologies; (1) hepatoportal, (2) myeloproliferative, and (3) infectious.…”

“…Patients who referred our radiology department with splenomegaly due to hepatoportal, myeloproliferative, and infectious reasons, who had not received any treatment, were enrolled into the study between 1 July 2019 and 14 February 2020 prospectively. Patients were assigned into three groups according to their etiologies as hepatoportal group, myeloproliferative group, and infectious group as previous investigators [5]. The diagnosis of splenomegaly secondary to portal hypertension was based on the clinical features and dilatation of splenic vein and associated varices.…”

“…For spleen stiffness, SWV was measured in three regions (upper pole, hilum, and lower pole) using ARFI elastography [5] (Fig. 1).…”

WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

“…US should be extended to examine the liver and portal venous system (e.g., flow direction, flow velocity, collaterals, thrombosis) and to search for abdominal and retroperitoneal lymphadenopathy (Trenker et al 2018). Shear-wave elastography has been found to be useful in predicting the etiology of splenomegaly (Batur et al 2019;Yalcin and Demir 2021). However, in a significant number of cases, the root cause cannot be identified, even after a complete diagnostic workup (Curovic Rotbain et al 2017).…”