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CC BY 4.0 · Journal of Gastrointestinal and Abdominal Radiology
DOI: 10.1055/s-0044-1790233
Original Article

Splenic and Liver Elastography in Prediction of Esophageal Varices and Variceal Severity in Patients with Chronic Liver Disease: A Diagnostic Validation Study

Trilochan Panthee
1   Department of Radiology, Bhim Hospital, Siddharthanagar, Nepal
,
Khanak K. Nandolia 
2   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Pankaj Sharma
2   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Itish Patnaik
3   Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Udit Chauhan
2   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
› Author Affiliations Funding None.
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Abstract

Objective The aim of this study was to assess the value of shear wave elastography (SWE) to predict the presence of esophageal varices (EVs) and to predict high-grade EV in patients with chronic liver disease (CLD).

Methods A cross-sectional observational study was conducted. One hundred twenty-one CLD patients were recruited. Liver stiffness (LS) and splenic stiffness (SS) were measured using SWE.

Results Evaluation of LS is superior to SS in predicting the presence of EV. Evaluation of SS is more valuable than LS in grading EV.

Conclusion LS and SS have good diagnostic performance in predicting and grading varices. SWE is simple to incorporate into standard ultrasonography assessments in patients with CLD. SWE can be used as an adjunct to upper gastrointestinal endoscopy to screen and monitor CLD patient.

Keywords

liver stiffness - splenic stiffness - chronic liver disease - shear wave elastography - esophageal varices - upper gastrointestinal endoscopy - ultrasonography

Ethical Statements

This study was conducted after approval of the institute's ethics committee. No animal experiments were done. Informed written consent was obtained from all study participants.


Authors' Contribution

T.P. contributed to data collection, manuscript preparation, and data analysis. K.K.N. contributed to manuscript preparation and editing, and data processing. P.S. and I.P. contributed to data collection. U.C. contributed to the study design and conceptualization, and manuscript editing.




Publication History

Article published online:
02 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol 2020; 18 (12) 2650-2666
    CrossrefPubMedSearch in Google Scholar
  • 2 Ma X, Wang L, Wu H. et al. Spleen stiffness is superior to liver stiffness for predicting esophageal varices in chronic liver disease: a meta-analysis. PLoS One 2016; 1: e0165786
    Search in Google Scholar
  • 3 Dietrich CF, Bamber J, Berzigotti A. et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med 2017; 38 (04) e16-e47
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Fateen W, Ragunath K, White J. et al. Validation of the AASLD recommendations for classification of oesophageal varices in clinical practice. Liver Int 2020; 40 (04) 905-912
    CrossrefPubMedSearch in Google Scholar
  • 5 Kim HY, Jin EH, Kim W. et al. The role of spleen stiffness in determining the severity and bleeding risk of esophageal varices in cirrhotic patients. Medicine (Baltimore) 2015; 94 (24) e1031
    CrossrefPubMedSearch in Google Scholar
  • 6 Ye XP, Ran H-T, Cheng J. et al. Liver and spleen stiffness measured by acoustic radiation force impulse elastography for noninvasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B. J Ultrasound Med 2012; 31 (08) 1245-1253
    CrossrefPubMedSearch in Google Scholar
  • 7 Merkel C, Gatta A, Arnaboldi L, Zuin R. Splenic haemodynamics and portal hypertension in patients with liver cirrhosis and spleen enlargement. Clin Physiol 1985; 5 (06) 531-539
    CrossrefPubMedSearch in Google Scholar
  • 8 Procopet B, Berzigotti A, Abraldes JG. et al. Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension. J Hepatol 2015; 62 (05) 1068-1075
    CrossrefPubMedSearch in Google Scholar
  • 9 de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII Faculty. Baveno VII: renewing consensus in portal hypertension. J Hepatol 2022; 76 (04) 959-974
    CrossrefPubMedSearch in Google Scholar
  • 10 Elkrief L, Rautou PE, Ronot M. et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology 2015; 275 (02) 589-598
    CrossrefPubMedSearch in Google Scholar
  • 11 Morisaka H, Motosugi U, Ichikawa S, Sano K, Ichikawa T, Enomoto N. Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease. J Magn Reson Imaging 2015; 41 (01) 117-124
    CrossrefPubMedSearch in Google Scholar
  • 12 Rifai K, Cornberg J, Bahr M. et al. ARFI elastography of the spleen is inferior to liver elastography for the detection of portal hypertension. Ultraschall Med 2011; 32 (Suppl. 02) E24-E30
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Bastard C, Miette V, Calès P, Stefanescu H, Festi D, Sandrin L. A novel fibroscan examination dedicated to spleen stiffness measurement. Ultrasound Med Biol 2018; 44 (08) 1616-1626
    CrossrefPubMedSearch in Google Scholar
  • 14 Ma X, Wang L, Wu H. et al. Spleen stiffness is superior to liver stiffness for predicting esophageal varices in chronic liver disease: a meta-analysis. PLoS One 2016; 11 (11) e0165786
    CrossrefPubMedSearch in Google Scholar
  • 15 Tang A, Cloutier G, Szeverenyi NM, Sirlin CB. Ultrasound elastography and MR elastography for assessing liver fibrosis: part 2, diagnostic performance, confounders, and future directions. AJR Am J Roentgenol 2015; 205 (01) 33-40
    CrossrefPubMedSearch in Google Scholar
  • 16 Castéra L, García-Tsao G. When the spleen gets tough, the varices get going. Gastroenterology 2013; 144 (01) 19-22
    CrossrefPubMedSearch in Google Scholar
  • 17 Mahmoud Hashim AE, Shakweer MM, Attia FF. et al. Measurement of liver and spleen stiffness by shear wave elastography as a noninvasive evaluation of esophageal varices in hepatitis C virus-related cirrhosis. Al-Azhar Assiut Med J 2017; 15: 111-116
    CrossrefSearch in Google Scholar
  • 18 Filiz M, Artuk C, Dur M. et al. Comparison of non-invasive methods and liver biopsy for detecting liver fibrosis associated with chronic hepatitis B. Viral Hepatitis Journal. 2023; 29: 114-118
    CrossrefSearch in Google Scholar
  • 19 Jiang W, Huang S, Teng H. et al. Diagnostic accuracy of point shear wave elastography and transient elastography for staging hepatic fibrosis in patients with non-alcoholic fatty liver disease: a meta-analysis. BMJ Open 2018; 8 (08) e021787
    CrossrefPubMedSearch in Google Scholar
  • 20 Medyńska-Przęczek A, Stochel-Gaudyn A, Wędrychowicz A. Liver fibrosis assessment in pediatric population - can ultrasound elastography be an alternative method to liver biopsy? A systematic review. Adv Med Sci 2024; 69 (01) 8-20
    CrossrefPubMedSearch in Google Scholar