Feasibility of measuring spleen stiffness with MR elastography and splenic volume to predict hepatic fibrosis stage.

Yao-Li Chen,Han-Chieh Lin,Yi-Wen Cheng,Chen-Te Chou,Ran-Chou Chen,Ya-Chien Chang

doi:10.1371/journal.pone.0217876

Abstract

AimThe aim of this study was to investigate the relationship between spleen stiffness value, splenic volume and the liver fibrosis stages.Materials and methodsThis retrospective study was approved by the institutional review board of our institute. We enrolled 109 patients that had undergone abdominal MR imaging and histopathological examination. The preoperative MR imaging, MR elastography and laboratory data were reviewed. Liver stiffness and spleen stiffness were determined with MR elastography, and splenic volume was calculated. Liver fibrosis stage was determined using surgical pathology.ResultsThe correlation coefficient between the liver stiffness and the fibrosis stage was r = 0.72 and r = 0.62 when the passive driver was on right chest wall and the left chest wall, respectively. The correlation coefficient between the spleen stiffness and the fibrosis stage was r = 0.63 and r = 0.18 when the passive driver was on the left chest wall and the right chest wall, respectively. The correlation coefficient between the splenic volume and the fibrosis stage was r = 0.31. The diagnostic performance of spleen stiffness was similar to liver stiffness in prediction of advanced liver fibrosis. The combination of spleen stiffness and liver stiffness provided greater sensitivity in prediction of advanced fibrosis than spleen or liver stiffness alone, but no significant difference was found.ConclusionAccording to our study, the spleen stiffness value was useful in staging liver fibrosis. The combination of spleen stiffness and liver stiffness could provide higher diagnostic sensitivity than liver stiffness alone in prediction of advanced fibrosis.

Highlights

Chronic liver disease is a major health concern and can lead to liver fibrosis
The correlation coefficient between the liver stiffness and the fibrosis stage was r = 0.72 and r = 0.62 when the passive driver was on right chest wall and the left chest wall, respectively
The diagnostic performance of spleen stiffness was similar to liver stiffness in prediction of advanced liver fibrosis

Summary

Introduction

Chronic liver disease is a major health concern and can lead to liver fibrosis. Liver fibrosis can be reversible with specific treatment; treatment is associated with an increased risk of morbidity and mortality [1,2]. Liver biopsy has been used as the gold standard to detect hepatic fibrosis. It has several limitations such as a lower patient acceptance, sampling error and inter-observer interpretation variation [3]. There is a clinical demand for a noninvasive and sensitive method to assess liver fibrosis. MR elastography (MRE), using an MRI-based quantitative shear wave elastography method, has been shown to be an accurate method for staging liver fibrosis with advantages of large organ coverage, excellent inter-scan reproducibility and inter-reader agreement [4,5,6,7]. Using MRE in determination of hepatic stiffness and splenic stiffness might provide a comprehensive assessment of liver fibrosis and portal hypertension [10,11,12]. It has been reported that splenic stiffness measurement with MRE is useful for predicting clinical complications in cirrhosis patients [13,14,15]

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