Zhang Yuan, Huang Chunyang, Meng Fankun, Hu Xing, Huang Xiaojie, Chang Jing, Han Xue, Zhang Tieying, Han Jing, Ge Huiyu
Beijing Youan Hospital, Capital Medical University, No. 8, Xitoutiao, Youanmenwai, Fengtai District, 100069, Beijing, China.
Beijing Chaoyang Hospital, Beijing, China.
Eur Radiol. 2025 Apr;35(4):2330-2338. doi: 10.1007/s00330-024-11049-z. Epub 2024 Sep 11.
The Baveno VII consensus recommends endoscopic screening for varicose veins in cases of liver stiffness measurement (LSM) ≥ 20 kPa or platelet count ≤ 150 × 10/L. Whether this approach was appropriate for patients with primary biliary cholangitis (PBC) remains uncertain. This study expanded the observed risk factors by adding analysis of ultrasound images as a non-invasive tool to predict the risk of esophageal or fundic varices.
We enrolled 111 patients with PBC whose complete ultrasound images, measurement data, and LSM data were available. The value of the periportal hypoechoic band (PHB), splenic area, and LSM in determining the risk of varicose veins and variceal rupture was analyzed. A prospective cohort of 67 patients provided external validation.
The area under the receiver operating characteristic curve (AUC) for predicting varicose veins using LSM > 12.1 kPa or splenic areas > 41.2 cm was 0.806 (95% confidence interval (CI): 0.720-0.875) and 0.852 (95% CI: 0.772-0.912), respectively. This finding could assist in avoiding endoscopic screening by 76.6% and 83.8%, respectively, with diagnostic accuracy surpassing that suggested by Baveno VII guidelines. The AUCs for predicting variceal rupture using splenic areas > 56.8 cm was 0.717 (95% CI: 0.623-0.798). The diagnostic accuracy of PHB for variceal rupture was higher than LSM and splenic areas (75.7% vs. 50.5% vs. 68.5%).
We recommend LSM > 12.1 kPa as a cutoff value to predict the risk of varicosity presence in patients with PBC. Additionally, the splenic area demonstrated high accuracy and relevance for predicting varicose veins and variceal rupture, respectively. The method is simple and reproducible, allowing endoscopy to be safely avoided.
The measurement of the splenic area and identification of the periportal hypoechoic band (PHB) on ultrasound demonstrated high accuracy and relevance for predicting the risk of esophageal or fundic varices presence and variceal rupture, respectively.
Predicting varices in patients with primary biliary cholangitis (PBC) can reduce the morbidity and mortality of gastrointestinal hemorrhage. Transient elastography (TE) and ultrasound play an important role in predicting patients with PBC with varices. TE and ultrasound can predict varicose veins and variceal rupture. Liver stiffness measurement and splenic area measurements can allow endoscopy to be safely avoided.
《巴韦诺 VII 共识》建议，对于肝脏硬度测量（LSM）≥20 kPa 或血小板计数≤150×10⁹/L 的患者，进行静脉曲张的内镜筛查。这种方法对原发性胆汁性胆管炎（PBC）患者是否适用仍不确定。本研究通过增加对超声图像的分析作为一种非侵入性工具来预测食管或胃底静脉曲张的风险，扩展了观察到的风险因素。
我们纳入了 111 例有完整超声图像、测量数据和 LSM 数据的 PBC 患者。分析了门静脉周围低回声带（PHB）、脾面积和 LSM 在确定静脉曲张和曲张静脉破裂风险中的价值。67 例患者的前瞻性队列提供了外部验证。
使用 LSM＞12.1 kPa 或脾面积＞41.2 cm²预测静脉曲张的受试者操作特征曲线（AUC）下面积分别为 0.806（95%置信区间（CI）：0.720 - 0.875）和 0.852（95%CI：0.772 - 0.912）。这一发现分别有助于避免 76.6%和 83.8%的内镜筛查，诊断准确性超过了《巴韦诺 VII 指南》的建议。使用脾面积＞56.8 cm²预测曲张静脉破裂的 AUC 为 0.717（95%CI：0.623 - 0.798）。PHB 对曲张静脉破裂的诊断准确性高于 LSM 和脾面积（75.7%对 50.5%对 68.5%）。
我们建议将 LSM＞12.1 kPa 作为预测 PBC 患者静脉曲张风险的临界值。此外，脾面积分别对预测静脉曲张和曲张静脉破裂具有较高的准确性和相关性。该方法简单且可重复，可安全避免内镜检查。
超声测量脾面积和识别门静脉周围低回声带（PHB）分别对预测食管或胃底静脉曲张的风险和曲张静脉破裂具有较高的准确性和相关性。
预测原发性胆汁性胆管炎（PBC）患者的静脉曲张可降低胃肠道出血的发病率和死亡率。瞬时弹性成像（TE）和超声在预测 PBC 曲张患者中起重要作用。TE 和超声可预测静脉曲张和曲张静脉破裂。肝脏硬度测量和脾面积测量可安全避免内镜检查。
