Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna A-1090, Austria.
World J Gastroenterol. 2019 Jan 21;25(3):308-329. doi: 10.3748/wjg.v25.i3.308.
Elastography-based liver stiffness measurement (LSM) is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease (ACLD). The presence of varices and especially of varices needing treatment (VNT) indicates distinct prognostic stages in patients with compensated ACLD (cACLD). The Baveno VI guidelines suggested a simple algorithm based on LSM < 20 kPa (by transient elastography, TE) and platelet count > 150 G/L for ruling-out VNT in patients with cACLD. These (and other) TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies. Novel point shear-wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) methodologies for LSM have also been evaluated for their ability to screen for "any" varices and for VNT. Finally, the measurement of spleen stiffness (SSM) by elastography (mainly by pSWE and 2D-SWE) may represent another valuable screening tool for varices. Here, we summarize the current literature on elastography-based prediction of "any" varices and VNT. Finally, we have summarized the published LSM and SSM cut-offs in clinically useful scale cards.
基于弹性成像的肝硬度测量（LSM）是一种非侵入性工具，可用于估计肝纤维化，但也可用于估计晚期慢性肝病（ACLD）患者门静脉高压的严重程度。静脉曲张的存在，尤其是需要治疗的静脉曲张（VNT），表明代偿性 ACLD（cACLD）患者存在不同的预后阶段。Baveno VI 指南提出了一种基于 LSM < 20 kPa（通过瞬时弹性成像，TE）和血小板计数 > 150 G/L 的简单算法，用于排除 cACLD 患者的 VNT。这些（和其他）基于 TE 的 LSM 截止值已在不同的肝病病因中评估了用于 VNT 筛查的效果。新型点剪切波弹性成像（pSWE）和二维剪切波弹性成像（2D-SWE）LSM 方法也已评估其筛查“任何”静脉曲张和 VNT 的能力。最后，弹性成像（主要是通过 pSWE 和 2D-SWE）测量脾脏硬度（SSM）可能是另一种有价值的静脉曲张筛查工具。在这里，我们总结了目前关于基于弹性成像的“任何”静脉曲张和 VNT 预测的文献。最后，我们总结了在临床有用的刻度卡中发布的 LSM 和 SSM 截止值。
