title: Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension: A prospective multicentre study.
abstract: Clinically significant portal hypertension (CSPH) is associated with severe complications and decompensation of cirrhosis. Liver stiffness measured either by transient elastography (TE) or Shear-wave elastography (SWE) and spleen stiffness by TE might be helpful in the diagnosis of CSPH. We recently showed the algorithm to rule-out CSPH using sequential liver- (L-SWE) and spleen-Shear-wave elastography (S-SWE). This study investigated the diagnostic value of S-SWE for diagnosis of CSPH.
  
  
  
  One hundred and fifty-eight cirrhotic patients with pressure gradient measurements were included into this prospective multicentre study. L-SWE was measured in 155 patients, S-SWE in 112 patients, and both in 109 patients.
  
  
  
  Liver-shear-wave elastography and S-SWE correlated with clinical events and decompensation. SWE of liver and spleen revealed strong correlations with the pressure gradient and to differentiate between patients with and without CSPH. The best cut-off values were 24.6 kPa:L-SWE and 26.3 kPa:S-SWE. L-SWE ≤16.0 kPa and S-SWE ≤21.7 kPa were able to rule-out CSPH. Cut-off values of L-SWE >29.5 kPa and S-SWE >35.6 kPa were able to rule-in CSPH (specificity >92%). Patients with a L-SWE >38.0 kPa had likely CSPH. In patients with L-SWE ≤38.0 kPa, a S-SWE >27.9 kPa ruled in CSPH. This algorithm has a sensitivity of 89.2% and a specificity of 91.4% to rule-in CSPH. Patients not fulfilling these criteria may undergo HVPG measurement.
  
  
  
  Liver and spleen SWE correlate with portal pressure and can both be used as a non-invasive method to investigate CSPH. Even though external validation is still missing, these algorithms to rule-out and rule-in CSPH using sequential SWE of liver and spleen might change the clinical practice.
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Christian
authors: C
authors: Jansen
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Christopher
authors: C
authors: Bogs
authors: Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
authors: Wim
authors: W
authors: Verlinden
authors: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
authors: Maja
authors: M
authors: Thiele
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Philipp
authors: P
authors: Möller
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Jan
authors: J
authors: Görtzen
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Jennifer
authors: J
authors: Lehmann
authors: Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
authors: Thomas
authors: T
authors: Vanwolleghem
authors: Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
authors: Luisa
authors: L
authors: Vonghia
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Michael
authors: M
authors: Praktiknjo
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Johannes
authors: J
authors: Chang
authors: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
authors: Aleksander
authors: A
authors: Krag
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors: Christian P
authors: CP
authors: Strassburg
authors: Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
authors: Sven
authors: S
authors: Francque
authors: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
authors: Jonel
authors: J
authors: Trebicka
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001530:Belgium; D003718:Denmark; D054459:Elasticity Imaging Techniques; D005260:Female; D005858:Germany; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017082:Portal Pressure; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: liver; portal hypertension; shear-wave elastography; spleen