Point Shear Wave Elastography of the Spleen: Its Role in Patients with Portal Hypertension

Lucchina, Natalie; Recaldini, Chiara; Macchi, Monica; Molinelli, Valeria; Montanari, M; Segato, Sergio; Novario, Raffaele; Fugazzola, Carlo

doi:10.1016/j.ultrasmedbio.2017.11.019

Cited by 16 publications

(15 citation statements)

References 28 publications

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“…Similar results were found in a Japanese cohort of patients with mixed etiologies with an AUC 0.833 for the prediction of CSPH, an AUC of 0.789 for any varices and AUC an 0.788 for VNT respectively[37]. Most recently LSM via pSWE was found to predict presence of EV with an AUC of 0.913, as compared to pSWE-based SSM with an AUC of 0.675[38], however, only 21 patients with “low-grade EVs” and none with VNT have been included.…”

Section: Elastography Methodssupporting

confidence: 67%

Elastography-based screening for esophageal varices in patients with advanced chronic liver disease

Paternostro

Reiberger

Bucsics

2019

WJG

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Elastography-based liver stiffness measurement (LSM) is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease (ACLD). The presence of varices and especially of varices needing treatment (VNT) indicates distinct prognostic stages in patients with compensated ACLD (cACLD). The Baveno VI guidelines suggested a simple algorithm based on LSM < 20 kPa (by transient elastography, TE) and platelet count > 150 G/L for ruling-out VNT in patients with cACLD. These (and other) TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies. Novel point shear-wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) methodologies for LSM have also been evaluated for their ability to screen for “any” varices and for VNT. Finally, the measurement of spleen stiffness (SSM) by elastography (mainly by pSWE and 2D-SWE) may represent another valuable screening tool for varices. Here, we summarize the current literature on elastography-based prediction of “any” varices and VNT. Finally, we have summarized the published LSM and SSM cut-offs in clinically useful scale cards.

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Section: Elastography Methodssupporting

confidence: 67%

Elastography-based screening for esophageal varices in patients with advanced chronic liver disease

Paternostro

Reiberger

Bucsics

2019

WJG

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“…The SS had the highest classification ability (AUROC = 0.768) and the best possible diagnostic cutoff value of 1.9 m/s = 13.23 KPa, which was comparable to work by Kim et al 16 (AUROC = 0.785 with higher cutoff of 3.16 m/s). However, Lucchina et al 17 reported that LS had the highest AUROC curve (0.913 with similar cutoff of 12.27 KPa) and higher sensitivity (100%) compared to the current study, with similar specificity. The reason for their reported results may be due to a difference in inclusion criteria.…”

Section: Discussioncontrasting

confidence: 47%

“…The reason for their reported results may be due to a difference in inclusion criteria. Lucchina et al 17 excluded patients with large varices, while the present study included both small and large varices patients. Structural changes in the liver can influence the formation of varices in early stages, whereas extrahepatic factors can affect them in later stages.…”

Section: Discussionmentioning

confidence: 92%

Point Shear Wave Elastography of the Spleen in Predicting the Presence of Esophageal Varices in Cirrhosis: Liver Stiffness vs. Spleen Stiffness

Sindhu

Koteshwar

Shetty

2019

Journal of Diagnostic Medical Sonography

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Objective: To determine the diagnostic ability of the spleen and liver stiffness in predicting the presence of esophageal varices (EVs). Methods: A sample of cirrhotic patients, diagnosed with sonography, was recruited. The cohorts’ liver stiffness (LS) and spleen stiffness (SS) were measured with the Philips’ Elast PQ technique. Platelet count and spleen size were also documented. The endoscopic report was used as the diagnostic gold standard. Singular and combined parameters were assessed to determine the presence of EV using an independent variable t test, area under the receiver operating characteristic curve, and multilogistic regression analysis statistical tests. Results: In predicting the presence of EV, there was a statistically significant difference in means of SS (2.13 ± 0.69 m/s vs. 3.23 ± 1.32 m/s) and LS (2.33 ± 1.20 m/s vs. 3.05 ± 1.4 m/s), as well as discriminating between groups of patients, with and without EV. The ability to diagnostically classify EV with SS and LS was fair while the remaining parameters were deemed poor, using a SS cutoff value of 1.99 m/s. Conclusion: Despite the difference in means, none of the assessed parameters demonstrated a better classification ability than endoscopy. LS and SS were equal in the prediction of EV in these patients. The LS estimate of fibrosis would have grossly predicted the presence of varices. However, the addition of SS, for the estimation of varices, provided no significant benefit.

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“…The examinations were performed by a physician with 10 years of US experience who had performed more than 400 SWE examinations. The patient was positioned in a supine position with the right arm in maximum abduction to increase the intercostal acoustic window . A routine two‐dimensional US examination was performed before SWE examination to exclude morphologic abnormalities of the liver, spleen, gallbladder, and biliary system.…”

Section: Methodsmentioning

confidence: 99%

“…The patient was positioned in a supine position with the right arm in maximum abduction to increase the intercostal acoustic window. 12 A routine two-dimensional US examination was performed before SWE examination to exclude morphologic abnormalities of the liver, spleen, gallbladder, and biliary system. The probe was then placed along an intercostal space and perpendicular to the liver capsule.…”

Section: Shear Wave Elastographymentioning

confidence: 99%

Shear‐wave elastography of the liver in a healthy pediatric population

Yang

Sun

Tang

et al. 2019

J of Clinical Ultrasound

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Purpose The aim of this study was to determine the elastic modulus values of normal liver tissue in school‐age children by shear wave elastography (SWE) and to study the factors that influence these stiffness measurements. Methods Six hundred and four school‐age children (295 girls and 309 boys) who were recruited at a hospital and had normal results of specific laboratory tests and imaging studies underwent SWE examinations. The elastic modulus values were obtained in segment V and VI for each subject and comparisons were made between age groups. Results The mean elastic modulus values for school‐age children were 6.3 ± 1.1 kPa for segment V and 6.2 ± 1.1 kPa for segment VI. A positive linear trend in liver stiffness was found for the 6 to 9‐year‐old age group in segments V and VI (R2 = 0.076 vs R2 = 0.085, respectively, P < .05). No statistically significant difference in liver stiffness was found between genders and between segment groups (P > .05). Conclusion SWE is a feasible method to measure liver stiffness in the school‐age population. We established a normal range of liver elastic modulus values in school‐age children, which will provide a basis for evaluating the changes in liver stiffness caused by various diseases.

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Point Shear Wave Elastography of the Spleen: Its Role in Patients with Portal Hypertension

Cited by 16 publications

References 28 publications

Elastography-based screening for esophageal varices in patients with advanced chronic liver disease

Elastography-based screening for esophageal varices in patients with advanced chronic liver disease

Point Shear Wave Elastography of the Spleen in Predicting the Presence of Esophageal Varices in Cirrhosis: Liver Stiffness vs. Spleen Stiffness

Shear‐wave elastography of the liver in a healthy pediatric population

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