The Usefulness of Liver and Spleen Stiffness Evaluated by Means of Acoustic Radiation Force Impulse Elastography for the Prediction of Esophageal Varices in Cirrhotic Patients

Abstract

To assess the value of ARFI elastography for the prediction of significant esophageal varices (EV; grades II and III) in cirrhotic patients. We studied 163 cirrhotic patients with recent gastroscopies (6 with liver biopsy, the others with clinical, ultrasonographic, endoscopic signs of cirrhosis), mean age 58.5 ± 10.6 years. We performed ten ARFI measurements in each patient (both in the liver and spleen), in the lateral position, and a median value was calculated, expressed in meters/second (m/s). ARFI was indeterminable in the spleen in three patients (1.8%) and in the liver in one patient (0.6%); 45 subjects (27.6%) did not have EV, 23 (14.1%) had grade I EV, 70 (42.9%) grade II EV, and 25 (15.3%) grade III EV. We did not find statistically significant differences between the mean ARFI values (m/s) in the liver in patients with or without significant EV (2.93 ± 0.69 vs. 2.78 ± 0.80, p = 0.20), but in the spleen they were statistically higher in patients with significant EV (3.31 ± 0.50 vs. 3.09 ± 0.56, p = 0.01). For a cutoff value >3.47 m/s , ARFI in spleen had 43.6% sensitivity, 80.3% specificity, 75.9% positive predictive value, 50% negative predictive value and 58.7% accuracy (AUROC = 0.60) for the prediction of significant EV. Our data suggest that ARFI measurements in the spleen could predict the presence of significant EV.