Τίτλος:
Role of Spleen Stiffness Measurement by 2D-Shear Wave Elastography in Ruling Out the Presence of High-Risk Varices in Cirrhotic Patients
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background and Aim: To evaluate if spleen stiffness measurement (SSM) can rule out the presence of high-risk varices in patients with cirrhosis, avoiding an upper gastrointestinal endoscopy (UGE). Methods: We enrolled 71 cirrhotic patients irrespective of liver disease’s etiology. 2D shear wave elastography (SWE) of spleen and UGE was performed. High-risk varices (HRV) were defined as esophageal varices ≥ 5 mm and/or red spots and any gastric varices. Results: Esophageal varices were documented in 37 (52.1%) and HRV in 25 (35.2%) patients. SSM was not technically feasible in 7/71 patients (9.8%). From the remaining 64 patients, when those with cholestatic liver disease were excluded (n = 17), SSM < 35.8 kPa was found to exclude well the existence of HRV offering an AUROC of 0.854 (p < 0.001), sensitivity 88.9%, negative predictive value (NPV) 91.3%, specificity 72.4%, and positive predictive value (PPV) 66.7%. Only 2/47 patients (4.3%) were misclassified, and 23 (48.9%) could avoid endoscopy. In the total cohort of 64 patients, SSM < 33.7 kPa was found to exclude well the presence of HRV offering AUROC 0.792 (p < 0.001), sensitivity 91.7%, specificity 60%, NPV 92.3%, and PPV 57.9%. The misclassification rate was 3.1% (2/64), while 26/64 (40.6%) could avoid endoscopy. Conclusions: 2D-SWE of spleen is a reliable method for ruling out the presence of HRV in cirrhotic patients. If larger studies confirm our results, a large number of endoscopies could be avoided. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Συγγραφείς:
Karagiannakis, D.S.
Voulgaris, T.
Koureta, E.
Chloupi, E.
Papatheodoridis, G.V.
Vlachogiannakos, J.
Περιοδικό:
Digestive Diseases and Sciences
Εκδότης:
Springer New York LLC
Λέξεις-κλειδιά:
alanine aminotransferase; aspartate aminotransferase, acoustic radiation force impulse imaging; adult; aged; alcoholism; Article; ascites; aspartate aminotransferase blood level; Child Pugh score; chronic hepatitis; clinical evaluation; diagnostic test accuracy study; digestive tract parameters; esophagus varices; female; gastrointestinal endoscopy; hepatic encephalopathy; hepatic portal vein; high risk patient; human; international normalized ratio; liver cirrhosis; liver stiffness; major clinical study; male; Model For End Stage Liver Disease Score; non invasive procedure; nonalcoholic fatty liver; outpatient; portal hypertension; prediction; predictive value; priority journal; sensitivity and specificity; shear wave elastography; spleen stiffness measurement; splenectomy; splenomegaly; thrombocyte; transient elastography; transjugular intrahepatic portosystemic shunt; virus hepatitis; area under the curve; complication; diagnostic imaging; elasticity; elastography; esophagus varices; liver cirrhosis; middle aged; pathophysiology; procedures; receiver operating characteristic; risk factor; spleen, Aged; Area Under Curve; Elasticity; Elasticity Imaging Techniques; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Predictive Value of Tests; Risk Factors; ROC Curve; Spleen
DOI:
10.1007/s10620-019-05616-4
