Spleen Assessment by Acoustic Radiation Force Impulse Elastography (ARFI) for Prediction of Liver Cirrhosis and Portal Hypertension

Aim: To establish the values of spleen stiffness (SS) assessed by Acoustic Radiation Force Impulse (ARFI) in healthy subjects and in cirrhotic patients, and to evaluate its predictive value for the presence of cirrhosis and for the presence and severity of esophageal varices (EV).

Patients And Methods: Our study included 82 subjects (15 healthy volunteers, 57 cirrhotic patients, 10 with various grade of liver fibrosis), 38 women and 44 men. Of these, 42 cirrhotic patients had varices, 30 had significant EV and 11 had a history of variceal bleeding. We performed 10 measurements in each patient expressed in meters/second (m/s) and a median value was obtained.

Results: The mean SS values (m/s) were: 2.04+/-0.28 in healthy subjects and 3.10+/-0.55 in cirrhotic patients (p<0.001). For a cut-off value of >2.51 m/s of SS, ARFI had 85.2% Se, 91.7% Sp, 95.8% PPV, 73.3% NPV, 87.1% accuracy (AUROC=0.91) for predincting liver cirrhosis. No significant differences regarding SS were observed between patients with and without EV, also between those with and without a history of variceal bleeding.

Conclusion: SS evaluated by means of ARFI had a very good predictive value for the presence of cirrhosis (AUROC=0.91, accuracy=87.1%), but could not predict the presence or severity of EV, also the risk of variceal bleeding.