Spleen or liver? – Prospective study to evaluate the role of Splenic and Hepatic Shear Wave elastography for evaluation of portal hyperdynamic circulation.

PURPOSE:

In advanced fibrosis, liver stiffness measurements were shown to have no predictive potential for the severity of portal hypertension. We propose to test if an additional evaluation of splenic stiffness could improve the non-invasive prediction of portal hyperdynamic circulation. To compare the role of the liver (LSM) and splenic stiffness measurements (SSM) measured by shear wave elastography (SWE) in predicting the presence of esophagogastric varices (EGV) in patients with portal hypertension and to determine the correlation between the SSM and endoscopic grade of EGV.

METHODS AND MATERIALS:

• This study included 40 patients with chronic liver disease being evaluated for portal hypertension and planned for esophagogastroduodenoscopy.
• To measure liver stiffness, the region of interest is positioned in an area inthe right lobe free of vessels and bile ducts, at least 1.5 cm below the liver capsule. For spleen stiffness, the ROI is placed in the parenchyma of the lower pole at least 1 cm below the spleen capsule.
• The shear wave liver stiffness (in kPa) was recorded at ten locations and the median values calculated. Endoscopic findings were interpreted with reference to the presence of varices and grade of the varices. Correlation between SSM, LSM, and grade of varices was analyzed with the Pearson correlation coefficient. Multiclass Receiver operating characteristic (ROC) curves were constructed, and the area under the ROC curves (AUC) was calculated to determine the discriminating power between the grades of the varices.

RESULTS:

LSM and variceal grade showed weak positive linear correlation (R = 0.36076, P <. 0001) whereas the SSM and variceal grade showed even weaker positive linear correlation (R = 0.20, P <. 0001). The AUC for the detection of varices was 0.77 for LSM and 0.63 for SSM respectively.

CONCLUSION:

Our results are against the conventional knowledge of the significant positive correlation between LSM, SSM and variceal grading.

The poster can be viewed here: http://dx.doi.org/10.26044/ecr2020/C-14820