Can ARFI elastography predict the presence of significant esophageal varices in newly diagnosed cirrhotic patients?
OBJECTIVE
To establish an algorithm which includes the liver stiffness (LS) and/or spleen stiffness (SS) assessed by ARFI for the prediction of significant esophageal varices-EV (at least grade 2).


METHODS
Our study included 145 newly diagnosed cirrhotic patients admitted in our Department between September 2009-August 2011. 62 patients (42.7%) had significant EV. We performed 10 ARFI measurements in each patient, both in the liver and in the spleen; median values were calculated, expressed in meters/second. In 24 consecutive newly diagnosed cirrhotic patients admitted between September 2011-December 2011, we prospectively analyzed the value of the new score for predicting significant EV.


RESULTS
The LS and SS assessed by ARFI elastography, and the percentage of patients with ascites were stastically significant higher in patients with significant EV as compared with those without EV or grade 1 EV. By multiple regression analysis we obtained the following formula for predicting significant EV: prediction of significant EV (Pred EV(2-3)) score: -0.572 + 0.041 x LS (m/s) + 0.122 x SS (m/s) + 0.325 x ascites (1-absent, 2-present). The best Pred EV(2-3) cut-off value for predicting significant EV was > 0.395 (AUROC = 0.721, accuracy = 69.6%). The accuracy in the group of patients in which the value of this score was prospectively analyzed was similar with that obtained in the first cohort of patients (70.8 vs. 69.6%). In conclusion, the proposed Pred EV(2-3) score had a enough good value for predicting significant EV.
Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timisoara, Romania. bota_simona1982@yahoo.com
Simona
S
Bota
Ioan
I
Sporea
Roxana
R
Sirli
Mircea
M
Focsa
Alina
A
Popescu
Mirela
M
Danila
Mihnea
M
Strain
D000368:Aged; D000465:Algorithms; D001201:Ascites / Q000209:etiology; D016009:Chi-Square Distribution; D054459:Elasticity Imaging Techniques; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012383:Romania; D012720:Severity of Illness Index; D013154:Spleen / Q000000981:diagnostic imaging*