Results of liver and spleen endoscopic ultrasonographic elastography predict portal hypertension secondary to chronic liver disease

Abstract

Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

The role of endoscopic ultrasound for portal hypertension in liver cirrhosis

“…Similar findings were also shown with EUS-elastography of the spleen through strain ratio, which demonstrated slightly higher accuracy (sensitivity 87.5%, specificity 69%, PPV 75.7%, NPV 83.3%) compared to spleen strain histogram (sensitivity 56.3%, specificity 89.7%, PPV 85.7%, NPV 65%). In addition, this study showed that in alcohol-related cirrhotic patients, the combination of an azygos vein diameter higher than 7.6 mm, mean velocity higher than 5.8 cm/s, or blood-flow volume index (BFVI) higher than 2.75 mm 3 /s yielded 100% sensitivity and 100% NPV in predicting PHT, suggesting that a combination of EUS-elastography and azygos vein evaluation can enhance the diagnostic accuracy of each modality [41]. Overall, EUS has been demonstrated to improve diagnostic accuracy in elastography examinations of liver tissues, especially in differentiating between benign and malignant tissues [42].…”

Advances in Endohepatology

“…Currently, the usefulness of not only semiquantitative EUS–strain elastography but also quantitative EUS–shear wave elastography (EUS-SWE) is being explored. Robles-Medranda (23) measured liver and spleen stiffness by the strain ratio and strain histogram. For identification of patients with cirrhosis and PHT, the liver strain ratio had a sensitivity, specificity, positive predictive value, and NPV of 84.3%, 82.8%, 84.4%, and 82.8%, respectively.…”