2D-Shear Wave Elastography in Predicting Esophageal Varices in Patients with Compensated Liver Cirrhosis

Abstract

Background: Current guidelines require endoscopic screening for esophageal varices. It is a costly and invasive procedure. So, there has always been a search for non-invasive measures that can predict the varices obviating the use of endoscopy. We tried to see whether 2D-Shear wave elastography (2D-SWE) measurements could predict the presence of esophageal varices and high-risk esophageal varices in patients with compensated cirrhosis. Aim: To investigate the diagnostic performance of 2D-SWE in predicting the presence of esophageal varices and high-risk varices in patients with compensated cirrhosis and to compare the diagnostic capabilities of 2D-SWE with those of transient elastography(TE), and other non-invasive parameters. Methods: 108 patients with compensated cirrhosis undergoing B-mode, 2D-SWE, TE, and endoscopy were enrolled. Comparisons of the accuracy of prediction between groups were made by AUROCs. Regression analysis was performed for the multiple variables. Results: There were 64 males and 44 females, with a mean age of 51.73 ± 11.35 years. NASH(40%) and Alcohol(27%) were the main etiologies. Esophageal varices were found in 63 patients. 36 had high-risk varices. The AUROC value of 2D- SWE(0.967) was comparable to that of TE(0.961) but significantly higher than other non-invasive parameters(platelet count, spleen diameter, platelet count/spleen diameter ratio, FIB-4, APRI). 2D-SWE had 92.1% sensitivity, 88.7% specificity, 90.6% PPV, and 88.6% NPV for predicting the presence of varices at an optimal cut-off value > 21.1kPa, and 91.7% sensitivity, 88.6% specificity, 80.2 % PPV, and 95.1% NPV for predicting high-risk varices at an optimal cut-off value > 24.6 kPa. No patient with 2dSWE value <20.3 kPa had varices. Conclusion: In patients with compensated cirrhosis, liver stiffness measured by 2D- SWE is an effective non-invasive diagnostic tool for predicting the presence of esophageal varices and high-risk varices. The diagnostic performance of 2D-SWE is similar to that of TE, but better than other non-invasive parameters.