Elastography in the diagnosis of portal hypertension in patients with liver cirrhosis

Aim. To establish the diagnostic accuracy of liver and spleen density (LD and SD) measurements in patients with compensated alcoholic liver cirrhosis (LC) in the diagnosis of portal hypertension. Subjects and methods. The investigation enrolled 83 patients with compensated alcoholic and viral (hepatitis C virus) LC. All the patients underwent LD and SD determinations, abdominal ultrasonography, and endoscopy to detect esophageal varices (EV), as well as examination of blood indices. Results. In viral LC, there were substantial LD differences in patients with and without EV. The patients with EV were ascertained to have higher LD [27.9 (21—45) kPa] than those without EV [19.5 (16—26.2) kPa]. SD was also significantly higher than that in the EV group than in the non-EV group (p<0.001). There were no statistically significant differences in SD and LD or in spleen size in patients with alcoholic LC in relation to the presence of EV. Comparison of patients with EV of different etiology revealed differences in platelet count and spleen size. Thrombocytopenia was more pronounced in HCV-related LC patients (p=0.04). The spleen size in patients with viral LC was higher than that in those with alcoholic LC. Conclusion. Elastography of the spleen and liver may be used to identify portal hypertension in patients with viral (HCV) LC (83% sensitivity, 75% specificity) with the following threshold values: LD=26 kPa and SD=50 kPa. The threshold LD and SD values obtained for viral LC do not make possible to diagnose clinically significant portal hypertension (EV) in patients with alcoholic LC. There is a need for further investigations to determine the optimal threshold values of LD and SD for the diagnosis of EV.

portal hypertension, elastography, liver cirrhosis, noninvasive diagnosis