Liver and spleen stiffness measurement

Abstract

Esophageal varices (EV) are often complicated in cirrhotic patients, and bleeding from EV induces high mortality rate. Endoscopic screening for EV and hepatic venous pressure gradient (HVPG) is recommended for all cirrhotic patients; however, these are invasive procedures. Liver stiffness (LS) measurement (LSM) is a noninvasive technique using elastographic method by ultrasonography or magnetic resonance imaging and is a very useful examination method to assess significant fibrosis and to rule out liver cirrhosis (LC). LS values are thought to increase gradually alongside the increment of HVPG in line with the progresses of LC state. However, regarding the presence of EV, spleen stiffness (SS) is a more accurate predictor with high area under receiver operating characteristic curve than LS. The measurement of SS values can reveal cirrhotic patients with high-risk EV. Moreover, measuring the spleen/liver stiffness ratio by elastography made it possible to noninvasively, specifically, and accurately diagnose idiopathic portal hypertension or extrahepatic portal vein obstruction.