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The role of liver and spleen elastography in advanced chronic liver disease
Elton Dajti1, Giovanni Marasco1, Federico Ravaioli1
1Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Insights
Non-invasive elastography, including liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), helps identify advanced chronic liver disease (ACLD) complications. Combining Baveno VI criteria with SSM can reduce unnecessary endoscopies for esophageal varices screening.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Diagnostics
Background:
- Portal hypertension is a primary driver of complications in advanced chronic liver disease (ACLD).
- Non-invasive elastography techniques, such as liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), have emerged as valuable tools for assessing portal hypertension severity.
- These methods aid in identifying patients with clinically significant portal hypertension (CSPH) and predicting outcomes like hepatic decompensation and hepatocellular carcinoma (HCC).
Purpose of the Study:
- To evaluate the role of LSM and SSM in identifying CSPH and its complications in ACLD patients.
- To assess the utility of elastography in stratifying risk for HCC development and recurrence.
- To explore the potential of SSM in monitoring treatment responses and its accuracy in screening for esophageal varices.
Main Methods:
- Review and synthesis of recent studies on liver and spleen elastography in ACLD.
- Application of Baveno VI consensus criteria for varices requiring treatment (VNT) screening.
- Analysis of a combined model using Baveno VI criteria and SSM (≤46 kPa) for VNT risk stratification.
Main Results:
- Elastography accurately identifies CSPH, stratifies HCC risk, and monitors treatment response in ACLD.
- LSM <20 kPa with platelets >150,000/mm³ identifies low-risk patients for VNT, potentially avoiding endoscopy.
- A combined Baveno VI and SSM model significantly increases spared endoscopies (>40-50%) while maintaining a low missed VNT rate (<5%).
Conclusions:
- Spleen stiffness measurement (SSM) is a direct and accurate surrogate for portal hypertension severity and predicting VNT.
- Combining Baveno VI criteria with SSM enhances the non-invasive screening of esophageal varices, reducing the need for invasive procedures.
- Elastography offers a powerful, non-invasive approach for managing ACLD patients, improving risk stratification and potentially optimizing treatment strategies.
Abstract:
Portal hypertension is the main driver of complications in patients with advanced chronic liver disease (ACLD). In the last decade, many non-invasive tests, such us liver and spleen elastography, have been proposed and validated for the identification of patients with clinically significant portal hypertension (CSPH) and its complications, mainly hepatic decompensation and liver-related morbidity and mortality. Moreover, elastography accurately stratifies for the risk of HCC development, HCC recurrence and decompensation after liver surgery. Recent studies suggest a role of SSM in monitoring response to treatments and interventions in ACLD, such as viral eradication, non-selective beta-blockers and transjugular intrahepatic portosystemic shunt placement. However, one of the most indications to perform elastography in ACLD still remains the screening for esophageal varices. In fact, according to the Baveno VI consensus, liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm3 can safely identify patients at low risk of varices requiring treatment (VNT) and could therefore avoid invasive upper invasive endoscopy; LSM>20-25 kPa can accurately rule-in CSPH in patients with viral etiology. Spleen stiffness measurement (SSM) is a direct surrogate of portal hypertension and has been demonstrated more accurate in predicting portal hypertension severity and VNT. A combined model including Baveno VI Criteria and SSM (≤46 kPa) can significantly increase the number of spared endoscopies (>40-50%), maintaining a low (<5%) of missed VNT.
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