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Objective:To measure liver and spleen stiffness in patients with BCR-ABL-negative myeloproliferative neoplasms and analyze their clinical significance.Methods:Fifteen healthy volunteers and 27 patients with BCR-ABL-negative myeloproliferative neoplasms underwent liver and spleen thickness measurements using FibroScan 502 Touch medical device between June 2018 and June 2020 in Hebei Petro China Central Hospital and they were included in this study. Liver and spleen stiffness was correlated with clinical laboraty indicators.Results:Liver stiffness, spleen stiffness, and the difference between spleen stiffness and liver stiffness in patients with BCR-ABL-negative myeloproliferative neoplasms were significantly greater than those in healthy controls [(6.34 ± 2.22) kPa vs. (5.07 ± 1.27) kPa; (26.00 ± 10.66) kPa vs. (13.61 ± 5.64) kPa; (19.65 ± 10.37) kPa vs. (8.54 ± 5.33) kPa, t = -2.01, -4.30, -4.06, all P < 0.05]. Platelet count was negatively correlated with liver and spleen stiffness ( r = -0.39, -0.42). White blood cell count was negatively correlated with the difference between spleen stiffness and liver stiffness ( r = -0.40, P < 0.05). The uric acid level was negatively correlated with liver stiffness ( r = -0.54, P < 0.05), but it was positively correlated with spleen thickness ( r = 0.41, P < 0.05). The percentage of B lymphocytes among lymphocytes was negatively correlated with spleen stiffness and the difference between spleen stiffness and liver stiffness ( r= -0.56, -0.56, both P < 0.05). The percentage of diseased megakaryocytes was positively correlated with spleen stiffness ( r = 0.40, P < 0.05). The percentage of sideroblasts was negatively correlated with liver stiffness ( r = -0.44, P < 0.05). Conclusion:Spleen stiffness and liver stiffness are closely related to clinical indicators in patients with BCR-ABL-negative myeloproliferative neoplasms, including white blood cell count, platelet count, uric acid level, percentage of B lymphocytes, diseased megakaryocytes and sideroblasts. Dynamic monitoring of liver and spleen stiffnesses or in combination with bone marrow examination in future can help evaluate the condition of patients with BCR-ABL-negative myeloproliferative neoplasms.
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Liver stiffness measurement (LSM) has been widely used in predicting portal hypertension in clinical practice, and in recent years, spleen stiffness measurement (SSM) has also become a diagnostic tool. Studies have shown that SSM can predict portal hypertension and its complications such as esophagogastric variceal bleeding in patients with chronic liver diseases and assist in the risk stratification management of portal hypertension and esophagogastric variceal bleeding. It can accurately predict clinically significant portal hypertension, high-risk esophageal and gastric varices, decompensation rate, and mortality rate in patients with chronic liver diseases. At present, SSM data in most studies are obtained by detection using the liver equipment FibroScan Ⓡ (SSM@50 Hz). FibroScan Ⓡ 630 is a new scanner dedicated for SSM with a special mode for SSM (SSM@100 Hz). This article elaborates on the significance of SSM in predicting portal hypertension and briefly introduces the advantages and disadvantages of the new equipment for SSM.
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Objective:To explore the value of liver stiffness and spleen stiffness measured by two-dimensional shear wave elastography (2D-SWE) in predicting high-risk varices (HRV) with compensated cirrhosis patients.Methods:Seventy patients with compensated cirrhosis who attended the First Hospital of Lanzhou University from November 2019 to April 2022 were recruited. All patients underwent examinations of liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) by 2D-SWE. Binary logistic regression was used to analyze the risk factors affecting the occurrence of HRV. The diagnostic performances of LSM, liver stiffness (by 2D-SWE)-spleen length-to-platelet (LSPS) score, and SSM in predicting HRV were compared.Results:SSM was not technically feasible in 6/70 (8.6%) patients due to small volume of spleen.Among 64 patients with compensated cirrhosis, 30/64 (46.9%) were HRV. Binary multivariate Logistic regression analysis showed that SSM and platelet counts were independent influencing factors for predicting HRV, with OR values of 1.126 ( P=0.006) and 0.971 ( P=0.039), respectively. The area under the receiver operating characteristic curve (AUC) of LSM, LSPS score, and SSM were 0.660, 0.828 and 0.858, respectively. The AUCs of SSM and LSPS score were significantly higher than that of LSM ( P<0.05), but there was no statistical difference between SSM and LSPS score ( P=0.608). Conclusions:LSM and SSM measured by 2D-SWE have high success rate. SSM and LSPS score have high value in predicting HRV in patients with compensated cirrhosis, and the diagnostic performances of the above two methods are significantly higher than that of LSM.
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ObjectiveTo investigate the value of two-dimensional shear wave elastography (2D-SWE) in the noninvasive evaluation of the presence or absence of esophageal varices (EV) in patients with hepatitis B cirrhosis by liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). MethodsA total of 172 patients who were diagnosed with hepatitis B cirrhosis in Beijing Ditan Hospital, Capital Medical University, from April 2019 to February 2020 were enrolled in a prospective study, and according to the results of gastroscopy, they were divided into non-EV group and EV group. The two groups were compared in terms of spleen thickness (ST), spleen diameter (SD), LSM, and SSM. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data. The receiver operating characteristic (ROC) curve was used to investigate the value of LSM and SSM in the diagnosis of EV, and the Z test was used to compare the diagnostic accuracy of LSM and SSM. ResultsThere were 121 patients in the EV group and 51 patients in the non-EV group. There were significant differences between the two groups in ST (t=8143, P＜0.001), SD (t=7.363, P＜0.001), LSM (Z=3.024, P=0.002), SSM (t=15.142, P＜0.001), and presence or absence of ascites (χ2=22.101, P＜0.001). LSM had an area under the ROC curve (AUC) of 0.646 (95% confidence interval ［CI］: 0570-0.718) in the diagnosis of EV, with a sensitivity (Se) of 83.47%, a specificity (Sp) of 47.06%, a positive predictive value (PPV) of 78.9%, and a negative predictive value (NPV) of 54.5% at the optimal cut-off value of 13.16. SSM had an AUC of 0.951 (95% CI: 0.907-0.978) in the diagnosis of EV, with an Se of 80.99%, an Sp of 96.08%, a PPV of 98.0%, and an NPV of 68.1% at the optimal cut-off value of 38.08. SSM had a better diagnostic accuracy than LSM (Z=6.096, P＜0.001). ConclusionLSM and SSM can be used to predict the presence or absence of EV in patients with hepatitis B cirrhosis. SSM has a higher accuracy than LSM and can provide accurate diagnostic information for clinical practice.
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Objective To assess the applicability of sound touch elastography ( ST E) and sound touch quantify ( ST Q ) in measuring liver and spleen stiffness . Methods One hundred and eighteen healthy volunteers were included and underwent ST E and ST Q . T he success rate ,variability and reproducibility of ST E and ST Q were analyzed . T he accurate sampling size and number of tests for liver ST Q were also analyzed . Results T he success rates ,variability ,reproducibility of ST E and ST Q in liver were 97 .5% and 99 .2% ,8 .7% and 12 .0% ,0 .917 and 0 .916 , respectively . While those with spleen were 76 .3% and 66 .9% ,12 .4% and 16 .4% ,0 .847 and 0 .706 ,respectively . The sampling size of 1 .5 cm×1 .0 cm yield the lowest variability ( 8 .5% ) ( F ＝6 .562 , P ＝0 .002) ,and there was no significant difference between results of detecting 5 times and 10 times( P ＝0 .571) . T he liver and spleen stiffness of ST E were 5 .75 kPa ( 95%CI :5 .60－5 .91 kPa) and 15 .58 kPa ( 95% CI :14 .99 －16 .16 kPa) . Conclusions The measurement of liver stiffness using both ST E and ST Q have a high success rate and low variability . However ,ST E is better than STQ in measuring spleen stiffness .
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Cirrhotic portal hypertension can lead to serious complications including esophageal variceal bleeding. Hepatic venous pressure gradient (HVPG) and upper gastrointestinal endoscopy can be used to evaluate the severity of portal hypertension and predict the risk of bleeding. However, both methods are invasive, which limits their clinical practice. Therefore, noninvasive techniques for the evaluation of portal hypertension will have certain advantages in clinical practice. This article introduces the noninvasive methods for the measurement of spleen stiffness, including transient elastography, acoustic radiation force impulse, real-time tissue elastography, and magnetic resonance elastography, as well as the value of these methods in evaluation of portal hypertension and influencing factors. It is pointed out that the difference in the diagnostic efficiency of spleen stiffness measured by these methods in portal hypertension needs to be verified by further studies.
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Objective To investigate the diagnosis value of spleen stiffness measurement by transient elastography (FibroScan, FS) for esophageal-gastric varices (EV) in patients with HBV-related liver cirrhosis receiving anti-viral treatment. Method Total of 41 patients from Jan 2014 to Dec 2014 diagnosed with HBV-related liver cirrhosis receiving anti-viral treatment were enrolled. All patients were evaluated for spleen and liver stiffness measurement by FS and checked by gastroscopy for diagnosis of EV. Using gastroscopy as the gold standard, the area under receiver operating characteristic curve (AUROC) were used to evaluate the value of the spleen stiffness and liver stiffness in diagnosis of EV and its degree. Results The spleen and liver FS values in patients were (40.64 ± 25.45) kPa and (20.76 ± 13.21) kPa respectively, and they showed a positive correlation (r = 0.402, P < 0.001). The spleen FS values in patients without EV were significantly lower than those in patients with mild EV and moderate-severe EV (all P < 0.05). Furthermore, they showed significantly lower in patients with mild EV than those in patients with moderate-severe EV too (P < 0.05). The AUROC of spleen FS in patients with EV was 0.863, with sensitivity of 79.4% and specificity of 83.2%. Moreover, the AUROC of spleen FS in patients with moderate-severe EV was 0.924, with sensitivity of 87.9% and specificity of 91.3%. Both of them were much higher than those of liver FS. Conclusion Spleen FS may act as a non-invasive marker to predict EV and its degree in patients with HBV-related liver cirrhosis receiving anti-viral treatment.
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Objective To retrospectively analyze the diagnostic value of a noninvasive score system based on transient elastography (TE),serological test and imaging examination on esophageal variceal bleeding (EVB) in patients with hepatitis B virus (HBV)-related cirrhosis.Methods Between April 2011 and December 2012,172 patients with HBV-related cirrhosis including 120 males and 52 females who visited clinic or hospitalized at the Department of Hepatology,Tianjin Third Central Hospital,were retrospectively enrolled.The mean age was (52.9 ± 10.6) years.Patients underwent upper gastrointestinal endoscopy to evaluate esophageal varices (EV) and were further categorized into three stages of mild,moderate and severe according to the morphology of EV and the risk of bleeding.Liver stiffness and spleen stiffness measurement were performed using Fibroscan.Portal vein width,splenic width and spleen thickness were measured using color Doppler ultrasound.All the patients were tested for white blood cell counts and platelet counts.With endoscopy as the gold standard,receiver operating characteristic (ROC) curves and the areas under curves (AUC) were used to assess the performance of the noninvasive score system in predicting EV by liver stiffness,spleen stiffness,portal vein width,spleen thickness and platelet counts.Student's t-test was performed to determine differences between continuous variables.Pearson's correlation was used to evaluate the association between EVB and these parameters.Results All these 172 patients underwent endoscopy.Among them,41 were EVB patients and 131 with no bleeding of EV.Among 172 EV patients,39 without EV,30 were mild EV,47 were moderate EV and 56 were severe EV.EVB was all positively correlated with liver and spleen stiffness,portal vein width,spleen thickness,splenic vein width (r=0.224,0.771,0.214,0.425 and 0.364,respectively; all P＜0.05).EVB was negatively correlated with platelet counts (r=-0.408,P=0.000).Liver stiffness,spleen stiffness,portal vein width,spleen thickness and splenic vein width in EVB patients were significantly higher than those in EV patients (P＜0.05).In contrast,platelet counts level was lower in EVB patients with difference of statistical significance (P＜0.05).AUC of non-invasive score system for EV and EVB were 0.953 and 0.882,respectively (P＜0.05).The optimal cut-off level of noninvasive score system for prediction of EV and EBV were 7 (sensitivity:96 ％,specificity:85 ％) in EV patients and 10 (sensitivity:78％,specificity:89 ％) in EVB patients.Conclusion Non-invasive score system based on liver stiffness,spleen stiffness,spleen thickness,width of splenic and portal vein and platelet counts is of clinical importance in assessing the presence of EV in patients with HBV-related cirrhosis,which is higher clinically valuable in the diagnosis for EV.