“…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].…”