Abstract
In our study, we evaluated the feasibility of a new sampling method for splenic stiffness (SS) measurement by Quantitative Acoustic Radiation Force Impulse Elastography (Virtual Touch Tissue Quantification (VTTQ)).We measured SS in 54 patients with HCV-related cirrhosis of whom 28 with esophageal varices (EV), 27 with Chronic Hepatitis C (CHC) F1–F3, and 63 healthy controls. VTTQ-SS was significantly higher among cirrhotic patients with EV (3.37 m/s) in comparison with controls (2.19 m/s, P < 0.001), CHC patients (2.37 m/s, P < 0.001), and cirrhotic patients without EV (2.7 m/s, P < 0.001). Moreover, VTTQ-SS was significantly higher among cirrhotic patients without EV in comparison with both controls (P < 0.001) and CHC patients (P < 0.01). The optimal VTTQ-SS cut-off value for predicting EV was 3.1 m/s (AUROC = 0.96, sensitivity 96.4%, specificity 88.5%, positive predictive value 90%, negative predictive value 96%, positive likelihood ratio 8.36, and negative likelihood ratio 0.04). In conclusion, VTTQ-SS is a promising noninvasive and reliable diagnostic tool to screen cirrhotic patients for EV and reduce the need for upper gastrointestinal endoscopy. By using our cut-off value of 3.1 m/s, we would avoid endoscopy in around 45% of cirrhotic subjects, with significant time and cost savings.
Highlights
Chronic hepatitis C virus (HCV) infection represents a worldwide health concern, with 170 million chronically infected subjects, whose risk of developing cirrhosis within 20 years is estimated to be around 10% to 20% [1, 2].Portal hypertension (PH) is associated with the most severe complications of cirrhosis, such as ascites, hepatic encephalopathy, and bleeding from esophageal varices (EV)
We evaluated the feasibility of a new sampling method for splenic stiffness (SS) measurement by Quantitative Acoustic Radiation Force Impulse Elastography (Virtual Touch Tissue Quantification (VTTQ)).We measured SS in 54 patients with HCVrelated cirrhosis of whom 28 with esophageal varices (EV), 27 with Chronic Hepatitis C (CHC) F1–F3, and 63 healthy controls
PH is a common consequence of chronic liver diseases, leading to the formation of esophageal and gastric varices and other severe complications, such as portosystemic encephalopathy and sepsis [3, 4]
Summary
Chronic hepatitis C virus (HCV) infection represents a worldwide health concern, with 170 million chronically infected subjects, whose risk of developing cirrhosis within 20 years is estimated to be around 10% to 20% [1, 2]. Portal hypertension (PH) is associated with the most severe complications of cirrhosis, such as ascites, hepatic encephalopathy, and bleeding from esophageal varices (EV). Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis [3,4,5]. The most accurate method to evaluate PH is the measurement of the hepatic vein. It has been demonstrated that a HVPG value higher than 10 mmHg predicts the presence of EV, while a value higher than 12 mmHg is predictive for variceal bleeding [6]. The evaluation of HVPG is an invasive procedure, which is limited to highly specialized centers and experienced operators
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