title: Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis.
abstract: OBJECTIVE
  To investigate the performance of real-time 2D shear wave elastography (RT 2D-SWE) for non-invasive staging of liver disease in patients with chronic viral hepatitis (CVH).
  
  
  METHODS
  Naive CVH patients underwent liver (LS) and spleen stiffness (SS) measurements by an intercostal approach. Patients with ALT >3× upper limit of normal, cholestasis as revealed by dilated intrahepatic biliary tree, and liver congestion were excluded. Results were expressed in kPa and compared to histological stage (Ishak) of liver fibrosis (LF). Patients with decompensated liver cirrhosis (LC) were diagnosed using standard clinical, ultrasound, and endoscopic criteria.
  
  
  RESULTS
  Of 123 patients, LS was successfully measured in 79.7% and SS in 53.7%. LS accurately differentiated between liver disease stages, with cut-off values of 8.1 (AUC 0.991) for F ≥ 3, 10.8 kPa (AUC 0.954) for F ≥ 5, and 27 kPa (AUC 0.961) for decompensated LC. SS was significantly different between non-cirrhotic stages (F0-4) and LC (cut-off 24 kPa; AUC 0.821). While both LS and SS increased with liver disease progression, the difference between them decreased, as reflected by the stiffness ratio index.
  
  
  CONCLUSIONS
  RT 2D-SWE can accurately differentiate between the stages of LF, and can distinguish LF from LC and compensated from decompensated LC.
  
  
  CONCLUSIONS
  • RT 2D-SWE is an accurate method for assessment of liver fibrosis. • RT 2D-SWE is applicable in 80% of patients with chronic viral hepatitis. • RT 2D-SWE accurately differentiates compensated from decompensated liver cirrhosis. • Both liver and spleen stiffness increase with progression of liver fibrosis. • In cirrhosis, the difference between liver and spleen stiffness decreases.
authors.affiliation: Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
authors.forename: Ivica
authors.initials: I
authors.lastname: Grgurevic
authors.affiliation: Department of Gastroenterology, University Hospital Center Split, University of Split School of Medicine, Split, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Puljiz
authors.affiliation: Department of Gastroenterology, University Hospital Center Split, University of Split School of Medicine, Split, Croatia.
authors.forename: Darko
authors.initials: D
authors.lastname: Brnic
authors.affiliation: Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Bokun
authors.affiliation: Department of Pathology, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Renata
authors.initials: R
authors.lastname: Heinzl
authors.affiliation: Intensive Care Unit, Varazdin General Hospital, Varazdin, Croatia.
authors.forename: Anita
authors.initials: A
authors.lastname: Lukic
authors.affiliation: Department of Infectious diseases, University Hospital Center Split, University of Split School of Medicine, Split, Croatia.
authors.forename: Boris
authors.initials: B
authors.lastname: Luksic
authors.affiliation: Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
authors.forename: Milan
authors.initials: M
authors.lastname: Kujundzic
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, University of Zagreb School of Medicine, Avenija Gojka Suska 6, Zagreb, 10 000, Croatia. boris@brkljacic.com.
authors.forename: Boris
authors.initials: B
authors.lastname: Brkljacic
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging / Q000473:pathology*; D019698:Hepatitis C, Chronic / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013154:Spleen / Q000473:pathology* / Q000648:ultrastructure
keywords: Cirrhosis; Elastography; Portal hypertension; Ultrasound; Viral hepatitis