title: Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients.
abstract: OBJECTIVE
  Splenomegaly in a common finding in liver cirrhosis that should determine changes in the spleen's density because of portal and splenic congestion and/or because of tissue hyperplasia and fibrosis. These changes might be quantified by elastography, so the aim of the study was to investigate whether spleen stiffness measured by transient elastography varies as liver disease progresses and whether this would be a suitable method for the noninvasive evaluation of the presence of esophageal varices.
  
  
  METHODS
  One hundred and ninety-one patients (135 liver cirrhosis, 39 chronic hepatitis and 17 healthy controls) were evaluated by transient elastography for measurements of spleen and liver stiffness. Cirrhotic patients also underwent upper endoscopy for the diagnosis of esophageal varices.
  
  
  RESULTS
  Spleen stiffness showed higher values in liver cirrhosis patients as compared with chronic hepatitis and with controls: 60.96 vs 34.49 vs 22.01 KPa (P<0.0001). In the case of liver cirrhosis, spleen stiffness was significantly higher in patients with varices as compared with those without (63.69 vs 47.78 KPa, P<0.0001), 52.5 KPa being the best cut-off value, with an area under the receiver operating characteristic of 0.74. Using both liver and spleen stiffness measurement we correctly predicted the presence of esophageal varices with 89.95% diagnostic accuracy.
  
  
  CONCLUSIONS
  Spleen stiffness can be assessed using transient elastography, its value increasing as the liver disease progresses. In liver cirrhosis patients spleen stiffness can predict the presence, but not the grade of esophageal varices. Esophageal varices' presence can be better predicted if both spleen and liver stiffness measurements are used.
authors.affiliation: Department of Hepatology, 3rd Medical Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania. hstefanescu@umfcluj.ro
authors.forename: Horia
authors.initials: H
authors.lastname: Stefanescu
authors.forename: Mircea
authors.initials: M
authors.lastname: Grigorescu
authors.forename: Monica
authors.initials: M
authors.lastname: Lupsor
authors.forename: Bogdan
authors.initials: B
authors.lastname: Procopet
authors.forename: Anca
authors.initials: A
authors.lastname: Maniu
authors.forename: Radu
authors.initials: R
authors.lastname: Badea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012383:Romania; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging*; D013163:Splenomegaly / Q000000981:diagnostic imaging* / Q000209:etiology; D055815:Young Adult