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Measurement of liver and spleen stiffness by acoustic radiation force impulse elastography for noninvasive detection of esophageal varices in Egyptian cirrhotic patients

The Egyptian Journal of Internal Medicine volume 31, pages 78–85 (2019)Cite this article

Abstract

Introduction and aim

Screening for esophageal varices (EVs) is recommended in patients with cirrhosis. Recent studies have focused on noninvasive prediction of EVs. The aim of the study was to evaluate the accuracy of liver stiffness (LS) and spleen stiffness (SS) measured by acoustic radiation force impulse (ARFI) elastography for noninvasive detection of EVs in Egyptian cirrhotic patients.

Patients and methods

In this prospective study, we performed ARFI elastography to measure LS and SS on 30 patients with cirrhosis undergoing endoscopic screening for EVs and on 15 healthy volunteers (controls). The diagnostic utility of LS and SS for identifying the presence of EVs was compared.

Results

Patients with EVs showed higher LS and SS values than patients without varices. The diagnostic performance of LS for the detection of varices at a cutoff value of more than 2.47 showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 73.3, 66.7, 68.7, 71.4, and 71.3%, respectively. Regarding SS, at a cutoff value of more than 3.02, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 93.3, 73.3, 77.8, 91.7, and 87.6%, respectively.

Conclusion

SS measured using ARFI imaging is superior to LS with excellent diagnostic performance for predicting EVs and may be used as a noninvasive screening tool for the detection of EVs.

References

  1. Dib N, Konate A, Oberti F, Calès P. Non-invasive diagnosis of portal hypertension in cirrhosis. Application to the primary prevention of varices. Gastroenterol Clin Biol 2005; 29:975–987.

    Article  Google Scholar 

  2. Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 2007; 66:27–34.

    Article  Google Scholar 

  3. Thabut D, Moreau R, Lebrec D. Noninvasive assessment of portal hypertension in patients with cirrhosis. Hepatology 2011; 53:683–694.

    Article  Google Scholar 

  4. Rizzo L, Calvaruso V, Cacopardo B, Alessi N, Attanasio M, Petta S, et al. Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic hepatitis C. Am J Gastroenterol 2011; 106:2112–2120.

    Article  CAS  Google Scholar 

  5. Colecchia A, Montrone L, Scaioli E, Bacchi-Reggiani ML, Colli A, Casazza G, 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.

    Article  Google Scholar 

  6. Bota S, Sporea I, Sirli R, Popescu A, Dănilă M, Sendroiu M, Focşa M. Spleen assessment by acoustic radiation force impulse elastography (AFRI) for prediction of liver cirrhosis and portal hypertension. Med Ultrason 2010; 12:213–217.

    PubMed  Google Scholar 

  7. Potthoff A, Attia D, Pischke S, Kirschner J, Mederacke I, Wedemeyer H, et al. Influence of different frequencies and insertion depths on the diagnostic accuracy of liver elastography by acoustic radiation force impulse imaging (ARFI). Eur J Radiol 2013; 82:1207–1212.

    Article  Google Scholar 

  8. Giunta M, Conte D, Fraquelli M. Role of spleen elastography in patients with chronic liver diseases. World J Gastroenterol 2016; 22:7857–7867.

    Article  Google Scholar 

  9. Castera L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology 2010; 51:828–835.

    PubMed  Google Scholar 

  10. Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, et al. Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat 2012; 19:e212–e219.

    Article  CAS  Google Scholar 

  11. Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Toshikuni N, et al. Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices. Gastroenterology 2013; 144:92–101.

    Article  Google Scholar 

  12. Vermehren J, Polta A, Zimmermann O, Herrmann E, Poynard T, Hofmann WP, et al. Comparison of acoustic radiation force impulse imaging with transient elastography for the detection of complications in patients with cirrhosis. Liver Int 2012; 32:852–858.

    Article  Google Scholar 

  13. Rifai K, Cornberg J, Bahr M, Mederacke I, Potthoff A, Wedemeyer H, et al. ARFI elastography of the spleen is inferior to liver elastography for the detection of portal hypertension. Ultraschall Med 2011; 32 (Suppl 2): E24–E30.

    Article  Google Scholar 

  14. Gallotti A, D’Onofrio M, Pozzi Mucelli R. Acoustic radiation force impulse (ARFI) technique in ultrasound with virtual touch tissue quantification of the upper abdomen. Radiol Med 2010; 115:889–897.

    Article  CAS  Google Scholar 

  15. Ma X, Wang L, Wu H, Feng Y, Han X, Bu H, Zhu Q. Spleen stiffness is superior to liver stiffness for predicting esophageal varices in chronic liver disease: a meta-analysis. PLoS ONE 2016; 11:e0165786.

    Article  Google Scholar 

  16. Lim JK, Groszmann RJ. Transient elastography for diagnosis of portal hypertension in liver cirrhosis: is there still a role for hepatic venous pressure gradient measurement? Hepatology 2007; 45:1087–1090.

    Article  Google Scholar 

  17. Kim BK, Han KH, Park JY, Ahn SH, Kim JK, Paik YH, et al. A liver stiffness measurement based, non-invasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol 2010; 105:1382–1390.

    Article  Google Scholar 

  18. Mori K, Arai H, Abe T, Takayama H, Toyoda M, Ueno T, Sato K. Spleen stiffness correlates with the presence of ascites but not esophageal varices in chronic hepatitis C patients. Biomed Res Int 2013; 2013:857–862.

    Article  Google Scholar 

  19. Ye XP, Ran HT, Cheng J, Zhu YF, Zhang DZ, Zhang P, Zheng YY. Liver and spleen stiffness measured by acoustic radiation force impulse elastography for noninvasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B. J Ultrasound Med 2012; 31:1245–1253.

    Article  Google Scholar 

  20. Bolognesi M, Merkel C, Sacerdoti D, Nava V, Gatta A. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis 2002; 34:144–150.

    Article  CAS  Google Scholar 

  21. Liangpunsakul S, Ulmer BJ, Chalasani N. Predictors and implications of severe hypersplenism in patients with cirrhosis. Am J Med Sci 2003; 326:111–116.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Ain Shams University, Cairo, Egypt

    Ossama A. Ahmed & Ramy S. A. Hamid

  2. Department of Tropical Medicine, Ain Shams University, Abbassia, Cairo, 11566, Egypt

    Mohamed O. Khalifa MD

  3. Department of Internal Medicine, National Research Centre, Cairo, Egypt

    Yasser A. Elhossary

Authors
  1. Ossama A. Ahmed
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  2. Yasser A. Elhossary
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  3. Ramy S. A. Hamid
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  4. Mohamed O. Khalifa MD
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Correspondence to Mohamed O. Khalifa MD.

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Ahmed, O.A., Elhossary, Y.A., Hamid, R.S.A. et al. Measurement of liver and spleen stiffness by acoustic radiation force impulse elastography for noninvasive detection of esophageal varices in Egyptian cirrhotic patients. Egypt J Intern Med 31, 78–85 (2019). https://doi.org/10.4103/ejim.ejim_62_18

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  • DOI: https://doi.org/10.4103/ejim.ejim_62_18

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