| Measurement of Spleen Stiffness by Acoustic Radiation Force Impulse Imaging Identifies Cirrhotic Patients with Esophageal Varices. | |
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MedLine Citation:
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PMID: 23022955 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND & AIMS: We evaluated whether spleen stiffness (SS), measured by acoustic radiation force impulse (ARFI) imaging, can identify patients who have esophageal varices (EVs); those without EVs and would not require endoscopic examination. METHODS: In a prospective study, we measured spleen and liver stiffness (LS) in 340 patients with cirrhosis undergoing endoscopic screening for EVs and 16 healthy volunteers (controls) at the Kurashiki Central Hospital in Okayama, Japan. The diagnostic accuracy of SS for the presence of EVs was compared with that of other non-invasive parameters (LS, spleen diameter, and platelet count). Optimal cutoff values of SS were chosen to confidently rule out the presence of varices. RESULTS: Patients with cirrhosis had significantly higher SS and LS values than controls (P<.0001 and P<.0001, respectively). Levels of SS were higher among patients with EVs (n=132) than controls, and values were highest among patients with high-risk EVs (n=87). SS had the greatest diagnostic accuracy for the identification of patients with EVs or high-risk EVs, compared to other non-invasive parameters, independent of the etiology of cirrhosis. An SS cutoff value of 3.18 m/sec identified patients with EVs with a 98.4% negative predictive value (NPV), 98.5% sensitivity, 75.0% accuracy, and 0.025 negative likelihood ratio (negLR). An SS cutoff value of 3.30 m/sec identified patients with high-risk EVs with a 99.4% NPV, 98.9% sensitivity, 72.1% accuracy, and 0.018 negLR. SS values below 3.3 m/sec ruled out the presence of high-risk varices in patients with compensated or decompensated cirrhosis. SS could not be measured in 16 patients (4.5%). CONCLUSION: Measurements of SS can be used to identify patients with cirrhosis with EVs or high-risk EVs. A cutoff SS was identified that could rule out the presence of varices and could be used as an initial non-invasive screening test. |
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Authors:
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Yoshitaka Takuma; Kazuhiro Nouso; Youichi Morimoto; Junko Tomokuni; Akiko Sahara; Nobuyuki Toshikuni; Hiroyuki Takabatake; Hiroyuki Shimomura; Akira Doi; Ichiro Sakakibara; Kazuhiro Matsueda; Hiroshi Yamamoto |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-9-27 |
Journal Detail:
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Title: Gastroenterology Volume: - ISSN: 1528-0012 ISO Abbreviation: Gastroenterology Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-10-1 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0374630 Medline TA: Gastroenterology Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan. Electronic address: takuma@enjoy.ne.jp. |
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