Department of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
Department of Ultrasound, Xi'an Central Hospital, Xi'an, 710003, Shaanxi, China.
BMC Med Imaging. 2023 Feb 9;23(1):30. doi: 10.1186/s12880-023-00977-9.
Noninvasive assessment of high-risk varices (HRV) in idiopathic portal hypertension (IPH) is rare. The purpose of this study was to investigate the performance of spleen stiffness (SS) for evaluating the presence of HRV in IPH patients as compared the measurements in patients with hepatitis B virus (HBV).
A retrospective single-center study was performed to evaluate the performance of SS for assessing HRV in IPH and HBV-infected patients, in comparison with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), LS spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension risk score (PH risk score) and varices risk score, by using upper gastrointestinal endoscopy (UGE) as the gold standard. Finally, 86 IPH and 102 HBV-infected patients were enrolled. UGE, two-dimensional shear wave elastography (2D-SWE) and laboratory data were collected, and noninvasive parameters were calculated. Analysis of receiver operating characteristic (ROC) curves was conducted to acquire the optimal area under the ROC curve (AUC) and cutoff value for predicting the presence of HRV.
In patients with HRV, the significantly different parameters between IPH (34.9%) and HBV-infected patients (46.1%) were as follows: spleen size (diameter 18.5 ± 3.9 cm vs. 20.8 ± 2.7 cm), SS (50.2 kPa vs. 42.9 kPa), LS (11.1 kPa vs. 18.3 kPa) and PT (prothrombin time 15.1 s vs. 16.7 s). No statistically significant differences were found in liver function, platelet counts, spleen thickness and flow volumes in the portal venous system (p > 0.05). The AUCs of SS were 0.98 and 0.96 for predicting the presence of HRV in IPH (44.0 kPa cutoff value; 0.93 sensitivity; 0.96 specificity) and HBV-infected patients (35.2 kPa cutoff value; 1.00 sensitivity; 0.82 specificity), respectively, which were significantly better than other parameters.
SS shows the optimal overall performance for predicting the presence of HRV in IPH and HBV-infected patients, in comparison with other noninvasive parameters.
特发性门静脉高压症（IPH）中高危静脉曲张（HRV）的无创评估较为少见。本研究旨在探讨脾脏硬度（SS）评估 IPH 患者 HRV 存在的价值，并与乙型肝炎病毒（HBV）感染患者进行比较。
回顾性单中心研究评估了 SS 评估 IPH 和 HBV 感染患者 HRV 的性能，与肝硬度（LS）、脾脏硬度与肝硬度比值（SS/LS）、LS 脾脏直径与血小板比值评分（LSPS）、门静脉高压风险评分（PH 风险评分）和静脉曲张风险评分进行比较，以上消化道内镜（UGE）为金标准。最终纳入 86 例 IPH 和 102 例 HBV 感染患者。收集 UGE、二维剪切波弹性成像（2D-SWE）和实验室数据，并计算无创参数。进行受试者工作特征（ROC）曲线分析，获得预测 HRV 存在的最佳 ROC 曲线下面积（AUC）和最佳截断值。
在 HRV 患者中，IPH（34.9%）和 HBV 感染患者（46.1%）之间有显著差异的参数如下：脾脏大小（直径 18.5±3.9cm 比 20.8±2.7cm）、SS（50.2kPa 比 42.9kPa）、LS（11.1kPa 比 18.3kPa）和 PT（凝血酶原时间 15.1s 比 16.7s）。肝功能、血小板计数、脾脏厚度和门静脉系统血流容积无统计学差异（p＞0.05）。SS 预测 IPH（44.0kPa 截断值；0.93 灵敏度；0.96 特异性）和 HBV 感染患者（35.2kPa 截断值；1.00 灵敏度；0.82 特异性）HRV 存在的 AUC 分别为 0.98 和 0.96，明显优于其他参数。
SS 对预测 IPH 和 HBV 感染患者 HRV 存在的价值明显优于其他无创参数。
