Clinical Significance of Liver and Spleen Stiffness: Evaluation with Shear Wave Ultrasound Elastography

Abstract

Objectives: To investigate clinical significance of liver and spleen stiffness in patients with chronic parenchymal liver disease. Materials and Methods: Fifty patients with chronic parenchymal liver disease who underwent 2D ultrasound (US) shear wave elastography (SWE) in the Ultrasonography Unit of Ankara University Medical Faculty Hospital between November 2018-June 2021 were enrolled in our prospective study. Liver size, contour, echogenicity, presence of portosystemic collateralls, and ascites were investigated on B-mode examination. Portal vein diameter was measured. Splenic volume was calculated. Liver and spleen stiffness values were measured by 2D SWE. Serum platelet count was noted. Child- Pugh score was calculated for all patients. Results: Thirty-four patients were grouped as Child-Pugh A, 15 patients were grouped as Child-Pugh B, 1 patient was grouped as Child-Pugh C. Platelet count was between 51-360x109/L. The most common conventional US finding was parenchymal heterogeneity. All patients had splenomegaly, the mean portal vein diameter was 12.58 mm, 34 patients had hepatopedal flow. Portosystemic collateralls were detected in 15 patients. Liver and spleen stiffness values were between 4.12 kPa-16.29 kPa, and 9.20 kPa-29.19 kPa, respectively. There was a positive correlation between liver and spleen stiffness (p=0.002). The relationship between splenic volume and spleen/liver stiffness was statistically significant (p=0.0004, p=0.008, respectively). Both liver and spleen stiffness was correlated with Child-Pugh score (p=0.02, p=0.00003, respectively). There was no statistically significant correlation between portal vein diameter and liver/spleen stiffness, and between platelet count and liver stiffness (p>0.05). The correlation between platelet count and spleen stiffness was statistically significant (p=0.002). Conclusion: SWE can provide information about the clinical status of the patients. Measuring spleen stiffness is as important as measuring liver stiffness.

Keywords

• Cirrhosis
• portal hypertension
• elastography
• ultrasound

Karaciğer ve Dalak Sertliğinin Klinik Önemi: Shear Wave Ultrason Elastografi ile Değerlendirme

Abstract

Amaç: Kronik karaciğer parankim hastalığı olanlarda karaciğer ve dalak sertliğinin klinik önemini araştırmaktır. Gereç ve Yöntem: Prospektif çalışmamıza, Kasım 2018-Haziran 2021 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Hastanesi Ultrasonografi Ünitesi’nde ultrason (US) shear wave elastografi (SWE) ve abdomen US incelemesi yapılan kronik karaciğer parankim hastalığı olan elli hasta dahil edildi. B-mod incelemede karaciğer boyutu, konturu, ekojenitesi, portosistemik kollaterallerin varlığı ve asit araştırıldı. Portal ven çapı ölçüldü. Dalak hacmi hesaplandı. Karaciğer ve dalak sertlik değerleri SWE ile ölçüldü. Serum trombosit sayısı not edildi. Tüm hastalar için Child-Pugh skoru hesaplandı. Bulgular: Otuz dört hasta Child-Pugh A, 15 hasta Child-Pugh B, 1 hasta Child-Pugh C grubundaydı. Trombosit sayısı 51-360 x109/L arasındaydı. En yaygın konvansiyonel US bulgusu parankimal heterojeniteydi. Tüm hastalarda splenomegali vardı, ortalama portal ven çapı 12,58 mm idi, 34 hastada hepatopedal akım vardı. On beş hastada portosistemik kollateraller saptandı. Karaciğer ve dalak sertlik değerleri sırasıyla 4.12 kPa-16.29 kPa ve 9.20kPa-29.19 kPa arasındaydı. Karaciğer ve dalak sertliği arasında pozitif korelasyon vardı (p=0,002). Dalak hacmi ile dalak/karaciğer sertliği arasındaki ilişki istatistiksel olarak anlamlıydı (sırasıyla p=0,0004, p=0,008). Hem karaciğer hem de dalak sertliği Child-Pugh skoru ile koreleydi (sırasıyla p=0,02, p=0,00003). Portal ven çapı ile karaciğer/dalak sertliği arasında ve trombosit sayısı ile karaciğer sertliği arasında istatistiksel olarak anlamlı bir ilişki yoktu (p>0,05). Trombosit sayısı ile dalak sertliği arasındaki korelasyon istatistiksel olarak anlamlıydı (p=0,002). Sonuç: SWE, hastaların klinik durumu hakkında bilgi sağlayabilir. Dalak sertliğini ölçmek, karaciğer sertliğini ölçmek kadar önemlidir.

Keywords

• Siroz
• portal hipertansiyon
• elastografi
• ultrason

References

1. 1. 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.
2. 2. Bloom S, Kemp W, Lubel J. Portal hypertension: pathophysiology, diagnosis and management. Intern Med J. 2015;45:16-26.
3. 3. Takuma Y, Nouso K, Morimoto Y, et al. Portal Hypertension in Patients with Liver Cirrhosis: Diagnostic Accuracy of Spleen Stiffness. Radiology. 2016;279:609-619.
4. 4. Augustin S, Millán L, González A, et al. Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: a prospective study. J Hepatol. 2014;60:561-569.
5. 5. Elkrief L, Ronot M, Andrade F, et al. Non-invasive evaluation of portal hypertension using shear-wave elastography: analysis of two algorithms combining liver and spleen stiffness in 191 patients with cirrhosis. Aliment Pharmacol Ther. 2018;47:621-630.
6. 6. You MW, Kim KW, Pyo J, et al. A Meta-analysis for the Diagnostic Performance of Transient Elastography for Clinically Significant Portal Hypertension. Ultrasound Med Biol. 2017;43:59-68.
7. 7. Grgurevic I, Bokun T, Bozin T, et al. Non-invasive diagnosis of portal hypertension in cirrhosis using ultrasound based elastography. Med Ultrason. 2017;19:310-317.
8. 8. Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76:959-974.

9. 9. Jansen C, Bogs C, Verlinden W, et al. Algorithm to rule out clinically significant portal hypertension combining Shear-wave elastography of liver and spleen: a prospective multicentre study. Gut. 2016;65:1057-1058.
10. 10. Giunta M, Conte D, Fraquelli M. Role of spleen elastography in patients with chronic liver diseases. World J Gastroenterol. 2016;22:7857-7867.
11. 11. Srinivasa Babu A, Wells ML, Teytelboym OM, et al. Elastography in Chronic Liver Disease: Modalities, Techniques, Limitations, and Future Directions. Radiographics. 2016;36:1987-2006.
12. 12. Wang J, Wang Q, Yu G, et al. Correlation Between Liver Stiffness Measured by Shear Wave Elastography and Child-Pugh Classification. J Ultrasound Med. 2018;37:2191-2199. 13. Liu F, Li TH, Han T, et al. Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography. Zhonghua Gan Zang Bing Za Zhi. 2013;21:840-844.
13. 14. Hu X, Xu X, Zhang Q, et al. Indirect prediction of liver fibrosis by quantitative measurement of spleen stiffness using the FibroScan system. J Ultrasound Med. 2014;33:73-81. 15. Ahmad AK, Atzori S, Taylor-Robinson SD, et al. Spleen stiffness measurements using point shear wave elastography detects noncirrhotic portal hypertension in human immunodeficiency virus. Medicine. 2019;98:e17961.
14. 16. Kamaya A, Machtaler S, Safari Sanjani S, et al. New technologies in clinical ultrasound. Semin Roentgenol. 2013;48:214-223.
15. 17. Suh CH, Kim KW, Park SH, et al. Shear Wave Elastography as a Quantitative Biomarker of Clinically Significant Portal Hypertension: A Systematic Review and Meta-Analysis. Am J Roentgenol. 2018;210:185-195.
16. 18. Song J, Huang J, Huang H, et al. Performance of spleen stiffness measurement in prediction of clinical significant portal hypertension: A meta-analysis. Clin Res Hepatol Gastroenterol. 2018;42:216-226.
17. 19. Guo YL, Lu XL, Cheng Y, et al. Combination measurement of liver and spleen stiffness with portal vein width to evaluate risk of bleeding in esophageal and gastric varices patients. Zhonghua Gan Zang Bing Za Zhi. 2016;24:56- 61.
18. 20. Takuma Y, Morimoto Y, Takabatake H, et al. Measurement of Spleen Stiffness With Acoustic Radiation Force Impulse Imaging Predicts Mortality and Hepatic Decompensation in Patients With Liver Cirrhosis. Clin Gastroenterol Hepatol. 2017;15:1782-1790.
19. 21. Kim HY, Jin EH, Kim W, et al. The Role of Spleen Stiffness in Determining the Severity and Bleeding Risk of Esophageal Varices in Cirrhotic Patients. Medicine. 2015;94:e1031.
20. 22. Colecchia A, Colli A, Casazza G, et al. Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: a prospective study. J Hepatol. 2014;60:1158-1164.