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Liver and spleen elastography using supersonic shear imaging for the non-invasive diagnosis of cirrhosis severity and oesophageal varices

      Abstract

      Background

      Elastography is a promising non-invasive approach for assessing liver fibrosis. We assessed diagnostic performances of liver and spleen stiffness using supersonic shear imaging for diagnosing cirrhosis severity and oesophageal varices.

      Methods

      401 consecutive cirrhotic patients were prospectively enrolled from November 2012 to March 2014. All patients underwent liver and spleen stiffness measurement with supersonic shear imaging and Fibroscan.

      Results

      Failures of measurement were 6.2% and 29.2% for liver and spleen stiffness (supersonic shear imaging), and 18.4% for liver stiffness (Fibroscan). Liver and spleen stiffness were correlated with severity of cirrhosis, with values increasing according to Child–Pugh subclasses and presence of complications. With a negative predictive value ≥90%, liver stiffness cut-offs for high-risk oesophageal varices, history of ascites, Child–Pugh B/C, variceal bleeding and clinical decompensation were 12.8, 19, 21.4, 30.5, and 39.4 kPa, respectively. Areas under the curve of spleen and liver stiffness (supersonic shear imaging), and liver stiffness (Fibroscan) were 0.80, 0.77 and 0.73 respectively for detection of oesophageal varices.

      Conclusion

      Liver stiffness using supersonic shear imaging is a relevant diagnostic tool for assessing cirrhosis severity and its complications. Spleen stiffness shows promising results for the detection of oesophageal varices but is not yet sufficiently robust for clinical practice owing to high failure rates.

      Keywords

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      References

        • Vergniol J.
        • Foucher J.
        • Terrebonne E.
        • et al.
        Non-invasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C.
        Gastroenterology. 2011; 140: 1970-1979
        • de Lédinghen V.
        • Vergniol J.
        • Barthe C.
        • et al.
        Non-invasive tests for fibrosis and liver stiffness predict 5-year survival of patients chronically infected with hepatitis B virus.
        Alimentary Pharmacology and Therapeutics. 2013; 37: 979-988
        • Vergniol J.
        • Boursier J.
        • Coutzac C.
        • et al.
        The evolution of non-invasive tests of liver fibrosis is associated with prognosis in patients with chronic hepatitis C.
        Hepatology. 2014; 60: 65-76
        • Foucher J.
        • Chanteloup E.
        • Vergniol J.
        • et al.
        Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study.
        Gut. 2006; 55: 403-408
        • Berzigotti A.
        • Seijo S.
        • Arena U.
        • et al.
        Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis.
        Gastroenterology. 2013; 144: 102-111
        • Bureau C.
        • Metivier S.
        • Peron J.M.
        • et al.
        Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease.
        Alimentary Pharmacology and Therapeutics. 2008; 27: 1261-1268
        • Vizzutti F.
        • Arena U.
        • Romanelli R.G.
        • et al.
        Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis.
        Hepatology. 2007; 45: 1290-1297
        • Castéra L.
        • Pinzani M.
        • Bosch J.
        Noninvasive evaluation of portal hypertension using transient elastography.
        Journal of Hepatology. 2012; 56: 696-703
        • Garcia-Tsao G.
        • Friedman S.
        • Iredale J.
        • et al.
        Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis.
        Hepatology. 2010; 51: 1445-1449
        • Castera L.
        • Garcia-Tsao G.
        When the spleen gets tough, the varices get going.
        Gastroenterology. 2013; 144: 19-22
        • Collecchia A.
        • Montrone L.
        • Scaioli E.
        • et al.
        Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis.
        Gastroenterology. 2012; 143: 646-654
        • Takuma Y.
        • Nouso K.
        • Morimoto Y.
        • et al.
        Measurement of spleen stiffness by acoustic radiation force impulse identifies cirrhotic patients with esophageal varices.
        Gastroenterology. 2013; 144: 92-101
        • Ye X.P.
        • Ran H.T.
        • Cheng J.
        • et al.
        Liver and spleen stiffness measured by acoustic radiation force impulse elastography for non-invasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B.
        Journal of Ultrasound in Medicine. 2012; 31: 1245-1253
        • Bercoff J.
        • Tanter M.
        • Fink M.
        Supersonic shear imaging: a new technique for soft tissue elasticity mapping.
        IEEE Ultrasonics, Ferroelectrics and Frequency Control. 2004; 51: 396-409
        • Muller M.
        • Gennisson J.L.
        • Deffieux T.
        • et al.
        Quantitative viscoelasticity mapping of human liver using supersonic shear imaging: preliminary in vivo feasability study.
        Ultrasound in Medicine and Biology. 2009; 35: 219-229
        • Ferraioli G.
        • Tinelli C.
        • Dal Bello B.
        • et al.
        Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study.
        Hepatology. 2012; 56: 2125-2133
        • Leung V.Y.
        • Shen J.
        • Wong V.W.
        • et al.
        Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shear-wave elastography and transient elastography with liver biopsy correlation.
        Radiology. 2013; 269: 910-918
        • Cassinotto C.
        • Lapuyade B.
        • Mouries A.
        • et al.
        Non-invasive assessment of liver fibrosis with impulse elastography: comparison of supersonic shear imaging with ARFI and Fibroscan.
        Journal of Hepatology. 2014; 61: 550-557
        • Boursier J.
        • Zarski J.P.
        • de Lédinghen V.
        • et al.
        Determination of reliability criteria for liver stiffness evaluation by transient elastography.
        Hepatology. 2013; 57: 1182-1191
        • Sterling R.K.
        • Lissen E.
        • Clumeck N.
        • et al.
        Development of a simple non-invasive index to predict significant fibrosis in patients with HIV/HCV coinfection.
        Hepatology. 2006; 43: 1317-1325
        • Williams A.L.B.
        • Hoofnagle J.H.
        Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis.
        Gastroenterology. 1988; 95: 734-739
        • Wai C.T.
        • Greenson J.K.
        • Fontana R.J.
        • et al.
        A simple non-invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C.
        Hepatology. 2003; 38: 518-526
        • Giannini E.
        • Botta F.
        • Borro P.
        • et al.
        Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis.
        Gut. 2003; 52: 1200-1205
        • Kim B.K.
        • Han K.H.
        • Park J.Y.
        • et al.
        A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis.
        American Journal of Gastroenterology. 2010; 105: 1382-1390
        • Child C.G.
        • Turcotte J.G.
        Surgery and portal hypertension.
        Major Problems in Clinical Surgery. 1964; 1: 1-85
        • Kamath P.S.
        • Wiesner R.H.
        • Malinchoc M.
        • et al.
        A model to predict survival in patients with end-stage liver disease.
        Hepatology. 2001; 33: 464-470
        • De Franchis R.
        • Faculty Baveno V.
        Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension.
        Journal of Hepatology. 2010; 53: 762-768
        • Zhou X.
        • Obuchowski N.
        • McClish D.
        Statistical methods in diagnostic medicine.
        1st ed. John Wiley & Sons, New York2002
        • Calvaruso V.
        • Bronte F.
        • Conte E.
        • et al.
        Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis.
        Journal of Viral Hepatitis. 2013; 20: 867-874
        • Collecchia A.
        • Colli A.
        • Casazza G.
        • et al.
        Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: a prospective study.
        Journal of Hepatology. 2014; 60: 1158-1164
        • Singh S.
        • Eaton J.E.
        • Murad M.H.
        • et al.
        Accuracy of spleen stiffness measurement in detection of esophageal varices in patients with chronic liver disease: systematic review and meta-analysis.
        Clinical Gastroenterology and Hepatology. 2014; 12: 935-945
        • Cassinotto C.
        • Lapuyade B.
        • Aït-Ali A.
        • et al.
        Liver fibrosis: noninvasive assessment with acoustic radiation force impulse elastography – comparison with Fibroscan M and XL probes and FibroTest in patients with chronic liver disease.
        Radiology. 2013; 269: 283-292