title: Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension.
abstract: OBJECTIVE
  Hepatic vein pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension (CSPH). The aim of this study was to investigate-in comparison to HVPG-the ability to diagnose CSPH by liver and spleen stiffness measurements obtained by acoustic radiation force impulse (ARFI) imaging.
  
  
  METHODS
  A total of 78 patients (mean age: 53 ± 13 years, 62 % male) with chronic liver disease were enrolled in this study. Each patient received liver (LSM) and spleen (SSM) stiffness measurements by ARFI, an HVPG measurement and a transjugular liver biopsy on the same day. Patients were classified according to their HVPG into three different groups: HVPG < 10 mmHg, HVPG ≥ 10-< 12 mmHg and HVPG ≥ 12 mmHg.
  
  
  RESULTS
  LSM, SSM were significantly higher in patients with HVPG ≥ 10 - < 12 in comparison to HVPG < 10 mmHg (p < 0.001 and p < 0.001, respectively), and in patients with HVPG ≥ 12 mmHg in comparison to ≥ 10 - < 12 mmHg (p < 0.001 and p < 0.001, respectively). LSM and SSM were able to diagnose HVPG ≥ 10 mmHg and HVPG ≥ 12 mmHg with high diagnostic performance (AUC LSM: 0.93 and 0.87, respectively; AUC SSM: 0.97 and 0.95, respectively). The AUC of SSM in predicting esophageal varices (EVs) plus HVPG ≥ 10 mmHg and EVs plus HVPG ≥ 12 mmHg were higher compared to LSM in both groups of patients (SSM: 0.90 and 0.93 vs. LSM: 0.84 and 0.88, respectively). No significant difference between both AUCs was detected in the different HVPG groups. In the multivariate -analysis SSM remained a factor predicting HVPG (HVPG > 10 mmHg p = 0.007; HVPG ≥ 12 mmHg p = 0.003).
  
  
  CONCLUSIONS
  LSM and SSM by ARFI are noninvasive diagnostic tools that may help in diagnosing CSPH. LSM and SSM could be used as a guiding noninvasive screening tool in patients with esophageal varices requiring endoscopic evaluation.
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Attia
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schoenemeier
authors.affiliation: Hannover Medical School, Diagnostic and Interventional Radiology, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Rodt
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: A A
authors.initials: AA
authors.lastname: Negm
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lenzen
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: T O
authors.initials: TO
authors.lastname: Lankisch
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Manns
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gebel
authors.affiliation: Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Potthoff
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging*; D061705:Image-Guided Biopsy; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017082:Portal Pressure / Q000502:physiology; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging*