Role of 2-D Shear Wave Splenic Elastography in Predicting Esophageal Varices in Patients with Chronic Liver Disease: A Validation Study from North India

Abstract

Background: The term Chronic Liver Disease (CLD) refers to continuous worsening of liver function over a period of 6 months. Major complication of CLD is portal hypertension (PH), often leading to esophageal varices (EV), which pose a risk of life-threatening gastrointestinal (GI) bleeding. Current guidelines of regular endoscopic screening are resource intensive and inconvenient for these patients.
Objectives: The objectives of this study were to determine the splenic stiffness values in patients of CLD with documented EV using 2D-shear wave elastography (2D-SWE) and to predict the severity of EV in patients of CLD.
Methods: This cross-sectional study was conducted in a tertiary care hospital in North India. All Patients with CLD and esophageal varices (EV), referred for splenic stiffness measurement, over a period of one year were included in the study. Splenic stiffness was measured using 2D-SWE and its correlation with the severity of EV was analyzed.
Results: Mean splenic stiffness measurement (SSM) on (2D-SWE) were 22.67, 31.5 and 40.08 kPa in grade I, II and III EV respectively. The mean difference between the splenic stiffness in high grade (Grade II & II) and low-grade (Grade I) EV was 13.1 kPa which was statistically significant (p<0.05). On ROC curve analysis, a cut off value of 32 kPa was established for distinguishing high-grade from low-grade EV, with area under the ROC curve (AUROC) of 0.93, sensitivity of 75%, and specificity of 100%.
Conclusion: 2-D SWE of spleen is a reliable non-invasive tool to predict high-grade EV in patients with CLD.