engleski

DIAGNOSTIC PERFORMANCE OF SPLEEN STIFFNESS MEASUREMENTS WITH TWO-DIMENSIONAL SHEAR-WAVE ELASTOGRAPHY BY SUPERSONIC IMAGINE FOR ESOPHAGEAL VARICES IN PATIENTS WITH COMPENSATED ADVANCED CHRONIC LIVER DISEASE

Objectives Spleen stiffness measurements (SSM) as the non- invasive diagnostic modality for esophageal varices (EV) has been investigated, with most of the data obtained by using Transient elastography (TE). Here we aimed to evaluate diagnostic performance of SSM for the presence of EV in patients with compensated advanced chronic liver disease (cACLD) by using Two-Dimensional Shear- Wave Elastography incorporated in the Supersonic Imagine Aixplorer platform (2DSWE.SSI). Materials Retrospective analysis of the data collected from patients with cACLD who underwent SSM by 2DSWE.SSI. Eligible patients were those with available results of esophagogastroduodenoscopy (EGD) performed within 3 months from SSM, and no history of liver decompensation. cACLD was considered in patients with liver stiffness measurement (LSM) ≥10 kPa by TE or the presence of bridging fibrosis or cirrhosis in liver histology. Results There were 106 patients analyzed: 88 (83%) males, median age 62 years, IQR (56.25 - 66), 44 (41.5%) had alcoholic liver disease, 23 (21.7%) non- alcoholic fatty liver disease, 22 (20.8%) chronic viral hepatitis, and 17 (16%) other etiologies. Median SSM was 32.2 kPa, IQR (25.53 - 39.23) whereas median LSM was 18.3 kPa, IQR (12.23 - 27.33). EV (any grade) were present in 46/106 (43.4%) and large EV (grade II or III) were present in 21/106 (19.8%) patients. Higher SSM was significantly associated with higher LSM, higher HVPG, larger EV, presence of red signs, lower platelets, and higher Child-Pugh score (P<0.05 for all analyses). SSM at the cut-off value of 29 kPa could predict the presence of any grade of EV with 93% sensitivity, 70% specificity, 70.5% positive predictive value (PPV) and 93.3% negative predictive value (NPV), AUC 0.846, P<0.001. SSM at the cut-off value of 33.8 kPa could predict the presence of grade II or III EV with 90.5% sensitivity, 69.4% specificity, 42.2% PPV and 96.7% NPV, AUC 0.828, P<0.001. Conclusions SSM by 2DSWE.SSI may be reliably used to rule-out the presence of EV in patients with cACLD.

ElastographySpleen stiffness measuremetsEsophageal varicesChronic liver diseaseCirrhosis

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