1. In a prospective study of 60 patients with liver cirrhosis, measurement of spleen stiffness (SS) by shear-wave elastography demonstrated a linear correlation to the hepatic venous pressure gradient (HVPG).
2. SS was a more accurate predictor of clinically important portal hypertension as compared to liver stiffness (LS) elastography, and was predictive of the presence of relevant sequelae of hepatic cirrhosis such as esophageal varices.
Evidence Rating Level: 2 (Good)
Study Rundown: Accurate assessment of portal venous pressures in patients with hepatic cirrhosis is important in the management and prevention of sequelae such as esophageal variceal bleeds, ascites, and hepatic encephalopathy. Currently, measurement of the hepatic venous pressure gradient (HVPG) is the gold standard for portal pressure assessment, however direct measurements require invasive catheter placement. Previous studies have demonstrated the use of ultrasound-based elastography of the liver and spleen as a non-invasive, surrogate marker of portal venous pressures based on the concept that increased portal pressures may increase splenic sequestration and tension, while hepatic fibrosis may increase liver stiffness. However, there has been a paucity of evidence comparing these two non-invasive markers. The purpose of this trial was to compare the utility of liver (LS) and spleen stiffness (SS) in measuring clinically significant portal venous pressures, predictive of sequelae such as esophageal varices.
The study prospectively measured the LS and SS of 60 patients with known liver cirrhosis and compared this to invasive measurements of the HVPG. At the conclusion of the study, increased SS was superior to LS in correlation to the measured HVPG. Furthermore, SS demonstrated significantly higher accuracy in detecting clinically important portal hypertension predictive of the presence of esophageal varices as compared to LS. The results of this trial support the use of SS as a non-invasive surrogate marker of portal venous pressures in patients with liver cirrhosis. However, the study was limited by a relatively small sample size at a single academic center. Larger, multi-center prospective trials are needed to externally validate SS as an accurate measurement of portal venous pressures.
In-Depth [prospective cohort]: This study prospectively evaluated the utility of LS and SS for the detection of portal venous pressures. Overall, the study enrolled 60 patients with histologically confirmed liver cirrhosis from a single center in Japan. All patients underwent shear wave elastography of the liver and spleen, followed by invasive measurement of the HVPG by a hepatologist blinded to the results ultrasound data. The ultrasound results were analyzed against the HVPG using a Spearman rank-order correlation coefficient and receiver operating characteristic (ROC) curve analysis. At the conclusion of the study, SS demonstrated a significantly stronger correlation to HVPG as compared to LS (r2: 0.876 vs. 0.609; p < 0.0001). Additionally, SS demonstrated significantly higher area under the ROC curve for detecting clinically significant portal hypertension (AUC: 0.94 vs. 0.83; p < 0.05) or esophageal varices (AUC: 0.96 vs. 0.85; p < 0.05) as compared to LS. The negative likelihood ratio of a low SS for portal hypertension or esophageal varices was 0.051 and 0.054, respectively.
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