title: Liver and spleen elastography using supersonic shear imaging for the non-invasive diagnosis of cirrhosis severity and oesophageal varices.
abstract: BACKGROUND
  Elastography is a promising non-invasive approach for assessing liver fibrosis. We assessed diagnostic performances of liver and spleen stiffness using supersonic shear imaging for diagnosing cirrhosis severity and oesophageal varices.
  
  
  METHODS
  401 consecutive cirrhotic patients were prospectively enrolled from November 2012 to March 2014. All patients underwent liver and spleen stiffness measurement with supersonic shear imaging and Fibroscan.
  
  
  RESULTS
  Failures of measurement were 6.2% and 29.2% for liver and spleen stiffness (supersonic shear imaging), and 18.4% for liver stiffness (Fibroscan). Liver and spleen stiffness were correlated with severity of cirrhosis, with values increasing according to Child-Pugh subclasses and presence of complications. With a negative predictive value ≥90%, liver stiffness cut-offs for high-risk oesophageal varices, history of ascites, Child-Pugh B/C, variceal bleeding and clinical decompensation were 12.8, 19, 21.4, 30.5, and 39.4 kPa, respectively. Areas under the curve of spleen and liver stiffness (supersonic shear imaging), and liver stiffness (Fibroscan) were 0.80, 0.77 and 0.73 respectively for detection of oesophageal varices.
  
  
  CONCLUSIONS
  Liver stiffness using supersonic shear imaging is a relevant diagnostic tool for assessing cirrhosis severity and its complications. Spleen stiffness shows promising results for the detection of oesophageal varices but is not yet sufficiently robust for clinical practice owing to high failure rates.
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; INSERM U1053, Université Bordeaux, Bordeaux, France. Electronic address: christophe.cassinotto@chu-bordeaux.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cassinotto
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Charrie
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Amaury
authors.initials: A
authors.lastname: Mouries
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lapuyade
authors.affiliation: Centre d'investigation de la fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Hiriart
authors.affiliation: Centre d'investigation de la fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Gaye
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Hocquelet
authors.affiliation: Centre d'investigation de la fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Maude
authors.initials: M
authors.lastname: Charbonnier
authors.affiliation: Centre d'investigation de la fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Foucher
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, CHU and University of Bordeaux, Pessac, France.
authors.forename: François
authors.initials: F
authors.lastname: Laurent
authors.affiliation: Centre d'investigation de la fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Faiza
authors.initials: F
authors.lastname: Chermak
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, CHU and University of Bordeaux, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Montaudon
authors.affiliation: INSERM U1053, Université Bordeaux, Bordeaux, France; Centre d'investigation de la fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Victor
authors.initials: V
authors.lastname: de Ledinghen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001201:Ascites / Q000175:diagnosis / Q000209:etiology; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013154:Spleen / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Cirrhosis; Elasticity imaging techniques; Esophageal varices; Non-invasive diagnosis; Supersonic shear imaging; Ultrasonography