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DOI: 10.1055/s-0036-1587032
Shear-wave Elastography of spleen identify clinically significant portal hypertension: a prospective multi-center study
Background: Clinically significant portal hypertension (CSPH) is associated with severe complications and decompensation of liver cirrhosis. Liver stiffness measured either by transient elastography (TE) or Shear-wave elastography (SWE) and spleen stiffness by TE might be helpful in the diagnosis of CSPH. We recently showed the algorithm to rule-out CSPH by using sequential liver- (L-SWE) and spleen-Shear-wave elastography (S-SWE). This study investigated the diagnostic value of S-SWE for CSPH.
Methods: 158 cirrhotic patients with pressure gradient measurements were included into this prospective multicenter study. Liver stiffness by SWE (L-SWE) was obtained in 155 patients. Spleen stiffness by SWE (S-SWE) was measured in 112 patients, and 109 patients received L-SWE and S-SWE.
Results: L-SWE and S-SWE correlated with clinical events and decompensation (Child, MELD Score, ascites). SWE of liver and spleen revealed strong correlations with the pressure gradient and a strong ability to separate patients with and without CSPH (AUC> 0.84). The best cut-off values regarding sensitivity and specificity were 24.6 kPa for L-SWE and 26.3 kPa for S-SWE. L-SWE ≤16.0 kPa and S-SWE ≤21.7 kPa were able to rule-out CSPH. Cut-off values of L-SWE > 29.5 kPa and S-SWE > 35.6 kPa were able to rule-in CSPH (specificity> 92%).
Conclusions: Liver and spleen SWE correlates with portal pressure and can be used as a non-invasive method to suggest CSPH. L-SWE and S-SWE are equally in their prognostic value.