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Noninvasive diagnostic method for idiopathic portal hypertension based on measurements of liver and spleen stiffness by ARFI elastography

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Acoustic radiation force impulse (ARFI) elastography is an ultrasound technique that is capable of measuring tissue stiffness noninvasively. It is difficult to differentiate idiopathic portal hypertension (IPH) from liver cirrhosis (LC) or chronic hepatitis (CH), and liver biopsy is essential. We investigated whether it would be possible to noninvasively diagnose IPH by measuring the stiffness of the liver and spleen by ARFI.

Methods

The subjects were 17 IPH patients, 25 LC patients, 20 CH patients, and 20 normal controls (NC). We measured liver stiffness, spleen stiffness, and the spleen/liver stiffness ratio, and plotted ROC curves.

Results

The median value of liver stiffness in the IPH group was lower than that in the LC group (p = 0.00077) and about the same as in the CH group (p = 0.79). The median value of spleen stiffness was highest in the IPH group (IPH vs. LC group, p = 0.003; IPH vs. CH group, p < 0.00001). The spleen/liver stiffness ratio was lower in the LC group and in the CH group, and higher in the IPH group (p < 0.001, respectively). When an ROC curve of spleen/liver stiffness ratios was plotted to differentiate between the IPH group and the combined group of patients with other liver diseases (LC + CH group), when a cutoff value of 1.71 was used, the AUROC was 0.933 sensitivity 0.941, specificity 0.800, and accuracy 0.839.

Conclusion

Measuring the spleen/liver stiffness ratio by ARFI made it possible to noninvasively, specifically, and accurately diagnose IPH.

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Abbreviations

ARFI:

Acoustic radiation force impulse

IPH:

Idiopathic portal hypertension

LC:

Liver cirrhosis

CH:

Chronic hepatitis

NC:

Normal controls

ROC:

Receiver operatorating characteristic curve

INCPH:

Idiopathic non-cirrhotic portal hypertension

EVs:

Esophageal varices

ROI:

Region of interest

VTTQ:

Virtual touch tissue quantification

Se:

Sensitivity

Sp:

Specificity

PPV:

Positive predictive value

NPV:

Negative predictive value

LR:

Likelihood ratio

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

NBNC:

Non B non C hepatitis

PT-INR:

Prothrombin time international normalized ratio

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

HCC:

Hepatocellular caricinoma

PALS:

Periarterial lymphoid sheath

LFs:

Lymph follicles

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Acknowledgments

We are indebted to Mr. Roderick J. Turner, Associate Professor Edward F. Barroga and Professor J. Patrick Barron, Chairman of the Department of International Medical Communications of Tokyo Medical University, for their editorial review of the English manuscript. This study was partially supported by a Health and Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan for Research on Intractable Diseases and Portal Hemodynamic Abnormalities.

Conflict of interest

None of the authors has any conflicts of interest.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023, Japan

    Yoshihiro Furuichi, Fuminori Moriyasu, Junichi Taira, Katsutoshi Sugimoto, Takatomo Sano, Shigeki Ichimura, Yuki Miyata & Yasuharu Imai

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  1. Yoshihiro Furuichi
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  2. Fuminori Moriyasu
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Correspondence to Yoshihiro Furuichi.

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Furuichi, Y., Moriyasu, F., Taira, J. et al. Noninvasive diagnostic method for idiopathic portal hypertension based on measurements of liver and spleen stiffness by ARFI elastography. J Gastroenterol 48, 1061–1068 (2013). https://doi.org/10.1007/s00535-012-0703-z

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  • DOI: https://doi.org/10.1007/s00535-012-0703-z

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