Document Detail

Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices.
MedLine Citation:
PMID:  23022955     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: We evaluated whether spleen stiffness (SS), measured by acoustic radiation force impulse imaging, can identify patients who have esophageal varices (EVs); those without EVs would not require endoscopic examination.
METHODS: In a prospective study, we measured SS 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 noninvasive 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 with other noninvasive parameters, independent of the etiology of cirrhosis. An SS cutoff value of 3.18 m/s identified patients with EVs with a 98.4% negative predictive value, 98.5% sensitivity, 75.0% accuracy, and 0.025 negative likelihood ratio. An SS cutoff value of 3.30 m/s identified patients with high-risk EVs with a 99.4% negative predictive value, 98.9% sensitivity, 72.1% accuracy, and 0.018 negative likelihood ratio. SS values less than 3.3 m/s 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%).
CONCLUSIONS: 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 noninvasive screening test; UMIN Clinical Trials Registry number, UMIN000004363.
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:
Type:  Controlled Clinical Trial; Journal Article     Date:  2012-09-27
Journal Detail:
Title:  Gastroenterology     Volume:  144     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-24     Completed Date:  2013-03-04     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  92-101.e2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan.
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MeSH Terms
Aged, 80 and over
Area Under Curve
Elasticity Imaging Techniques*
Esophageal and Gastric Varices / blood,  diagnosis*,  etiology
Liver / pathology,  ultrasonography
Liver Cirrhosis / blood,  complications,  ultrasonography*
Middle Aged
Observer Variation
Organ Size
Platelet Count
Predictive Value of Tests
ROC Curve
Severity of Illness Index
Spleen / pathology*,  ultrasonography*
Statistics, Nonparametric
Young Adult
Comment In:
Gastroenterology. 2013 May;144(5):1150-1   [PMID:  23523836 ]
Gastroenterology. 2013 May;144(5):1151-2   [PMID:  23523835 ]
Gastroenterology. 2013 May;144(5):1154-5   [PMID:  23528664 ]
Gastroenterology. 2013 May;144(5):1152-3   [PMID:  23523840 ]
Gastroenterology. 2013 Jan;144(1):19-22   [PMID:  23164570 ]

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