Significance of spleen elastography in diagnosis of portal hypertension

Abstract

Objective: to evaluate the significance of spleen ultrasound elastography in the diagnosis of portal hypertension.

Material and methods: thirty-three patients (18 men and 15 women, mean age 48.47±1.97 years) with liver cirrhosis were examined. In 23 cases, the cause of cirrhosis was hepatitis B virus, while 10 patients had hepatitis C virus as the cause. Liver and spleen elastography were performed using FibroScan. Child-Pugh class A was diagnosed in 15 patients (45.4%), class B in seven patients (21.2%), and class C in 11 patients (33.3%); the mean Child-Pugh score was 8.24 ± 1.6. Esophageal varices were grade I in 12 patients, grade II in five, grade III in six, and grade IV in seven; varices were absent on endoscopy in three patients. Large varices were present in 18 patients (55%). Spleen stiffness values ranged from 8 to 24 kPa in healthy individuals and from 18 to 75 kPa in patients with cirrhosis. Spleen stiffness was significantly higher in patients with large varices than in those with small varices or no varices (61.91 ± 2.94 kPa vs. 43.72 ± 3.35 kPa; p < 0.05), which supports the use of elastography in the detection of large esophageal varices. Multivariable analysis indicated that splenomegaly, dilatation of the portal and splenic veins, decreased peripheral platelet count and spleen elastography may predict bleeding from esophageal varices.

Results: spleen stiffness measurement is an effective method for identifying large varices at risk of bleeding and complements other noninvasive methods used in screening for esophageal varices in patients with liver cirrhosis.