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Evaluation of liver and splenic stiffness by acoustic radiation force impulse for assessment of esophageal varices

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

In routine clinical practice, assessment of portal hypertension (PHT) among patients with liver cirrhosis is done by a upper gastrointestinal endoscopy (UGIE); however, its invasive nature limits its use. Recent advances in ultrasound imaging make it possible to evaluate the tissue stiffness of the liver and spleen reflecting the severity of underlying fibrosis. Liver stiffness and spleen stiffness can be used to predict the presence of esophageal varices/PHT among cirrhotic patients.

Aim

To predict the presence or absence of esophageal varices by measuring the stiffness of the liver and spleen by ultrasonography (USG)-based acoustic radiation force impulse (ARFI).

Methods

This cross-sectional study included 90 subjects with liver cirrhosis. Liver and splenic stiffness were measured along with the USG abdomen, UGIE and aspartate aminotransferase to platelet ratio index (APRI).

Results

Liver and spleen stiffness were significantly higher in cirrhotic patients compared to chronic hepatitis B. The best cut-off value of liver stiffness (LS) obtained by the receiver operating characteristic (ROC) curve was 2.16 m/s for predicting esophageal varices (AUROC 0.78, p 0.0002). The best cut-off value of splenic stiffness (SS) obtained by the ROC curve was 3.04 m/s for predicting esophageal varices (AUROC 0.698, p 0.0274). When both LS and SS were taken together, the accuracy in predicting esophageal varices increased to 92.22%. An equation to predict “esophageal varices = (0.225 LS + 0.377SS) − 0.555” was derived.

Conclusion

LS and SS values of ≥ 2.16 m/s and 3.04 m/s, respectively, predict esophageal varices independently; however, combined assessment is better with 92% accuracy.

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Authors and Affiliations

  1. Department of Gastroenterology, Choithram Hospital and Research Centre, Indore, 452 014, India

    Ajay K. Jain, Amit K. Bundiwal & Shohini Sircar

  2. Department of Radiodiagnosis and Imaging, Choithram Hospital and Research Centre, Indore, 452 014, India

    Suchita Jain & Praveen Agrawal

  3. Department of Biostatistics, Choithram Hospital and Research Centre, Indore, 452 014, India

    Deepika Jain

Authors
  1. Ajay K. Jain
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  2. Amit K. Bundiwal
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  3. Suchita Jain
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  5. Deepika Jain
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  6. Shohini Sircar
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Contributions

Conceptualization: Ajay K. Jain, Amit K Bundiwal; methodology: Amit K Bundiwal, Ajay K Jain; formal analysis and investigation: Amit K Bundiwal, Deepika Jain, Suchita Jain, Praveen Agrawal; original draft preparation: Amit K Bundiwal, Ajay K. Jain; writing — review and editing: Ajay K Jain, Amit K Bundiwal, Suchita Jain, Praveen Agrawal, Deepika Jain, Shohini Sircar; final draft manuscript: approved by all authors.

Corresponding author

Correspondence to Ajay K. Jain.

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Competing interests

AKJ, AKB, SJ, PA, DJ and SS declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Ethical approval and consent to participate

The present study was conducted after getting ethical approval from the Institutional Ethical Committee (ECR/204/INST/MP/2013).

Human ethics

The authors declare that the study was performed to conform with the Helsinki Declaration of 1975, revised in 2000 and 2008, concerning human and animal rights.

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Written informed consent was taken from every subject before recruitment in the study.

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Jain, A.K., Bundiwal, A.K., Jain, S. et al. Evaluation of liver and splenic stiffness by acoustic radiation force impulse for assessment of esophageal varices. Indian J Gastroenterol (2023). https://doi.org/10.1007/s12664-023-01456-3

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