title: Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis.
abstract: OBJECTIVE
  Primary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; "event") in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV).
  
  
  METHODS
  Predictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV.
  
  
  RESULTS
  In the follow-up cohort (n=44) 18 patients (40.9%) experienced an "event" over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P=0.026) higher risk of event. Association between SS and outcomes was weaker (P=0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n=43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P<0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; Plt;0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients.
  
  
  CONCLUSIONS
  This is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients.
authors.affiliation: Ivica Grgurevic, Division of Liver Diseases, Department of Gastroenterology, University Hospital Dubrava, Avenija Gojka Suska 6, Zagreb 10 000, Croatia-EU, ivica.grgurevic@zg.htnet.hr.
authors.forename: Ivica
authors.initials: I
authors.lastname: Grgurević
authors.forename: Tomislav
authors.initials: T
authors.lastname: Bokun
authors.forename: Sanda
authors.initials: S
authors.lastname: Mustapić
authors.forename: Vladimir
authors.initials: V
authors.lastname: Trkulja
authors.forename: Renata
authors.initials: R
authors.lastname: Heinzl
authors.forename: Marko
authors.initials: M
authors.lastname: Banić
authors.forename: Željko
authors.initials: Ž
authors.lastname: Puljiz
authors.forename: Boris
authors.initials: B
authors.lastname: Lukšić
authors.forename: Milan
authors.initials: M
authors.lastname: Kujundžić
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003199:Computer Systems; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging* / Q000473:pathology