Mackintosh Cecilia, Kaplan Julio Sebastian, Prati Alejandra Yanet, Ruvinsky Silvina Denise, Roel Macarena, Bottero Adriana, Dardanelli Esteban Pablo
Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881, 1245, Buenos Aires, Argentina.
Department of Research and Development, Hospital de Pediatría Dr. Juan P. Garrahan, Buenos Aires, Argentina.
Pediatr Radiol. 2025 Jul 30. doi: 10.1007/s00247-025-06351-x.
Portal hypertension in children can result from a wide range of liver diseases, both cirrhotic and non-cirrhotic. Non-invasive diagnosis of esophageal varices, a potentially life-threatening complication, is of utmost importance in these patients.
To assess the agreement between spleen stiffness by bidimensional shear wave elastography (2D SWE) and endoscopic findings (presence and grading of esophageal varices) in pediatric patients with portal hypertension.
Single-center retrospective observational study between February 2021 and August 2024. Data from pediatric patients (< 18 years old) who underwent esophagogastroduodenoscopy within a month of a grayscale ultrasound including spleen elastography were collected. Patients were divided into three groups: varices-free, low-risk varices, and high-risk varices (enlarged tortuous varices with red color sign, or large size varices). The area under the receiver operating characteristic curve (AUROC), positive predictive value (PPV), and negative predictive value (NPV) were estimated.
We included 163 patients (86 males, 77 females; median age: 9 years (interquartile range (IQR) 6-13 years)). The sample included 80 varices-free (49%), 38 low-risk varices (23%), and 45 high-risk varices (28%) cases. The median spleen elastography was 20 kPa (2.58 m/s), 34 kPa (3.36 m/s), and 40 kPa (3.65 m/s) in the varices-free, low-risk, and high-risk varices groups, respectively. When a cut-off value of 28.5 kPa (3.08 m/s) was used to detect varices of any grade, the sensitivity was 93% (95% confidence interval: 85-97), the specificity was 94% (86-98), PPV 94% (86-98), and NPV 93% (85-97). An AUROC of 0.93 (0.90-0.98) was obtained. When comparing the high versus low-risk varices groups, using a cut-off point of 35.35 kPa (3.43 m/s), we obtained an AUROC of 0.66, with a sensitivity of 71%, specificity of 61%, PPV 68%, and NPV of 64%.
Spleen stiffness by bidimensional shear wave elastography showed excellent diagnostic performance for detecting esophageal varices in children with portal hypertension and a moderate performance for distinguishing patients with low-risk varices from those with high-risk varices.
儿童门静脉高压可由多种肝脏疾病引起，包括肝硬化和非肝硬化疾病。食管静脉曲张是一种潜在的危及生命的并发症，对这些患者进行非侵入性诊断至关重要。
评估二维剪切波弹性成像（2D SWE）测量的脾脏硬度与门静脉高压患儿内镜检查结果（食管静脉曲张的存在及分级）之间的一致性。
2021年2月至2024年8月的单中心回顾性观察研究。收集在进行包括脾脏弹性成像的灰阶超声检查后一个月内接受食管胃十二指肠镜检查的18岁以下儿科患者的数据。患者分为三组：无静脉曲张组、低风险静脉曲张组和高风险静脉曲张组（曲张静脉扩大迂曲且有红色征，或为大尺寸静脉曲张）。估计受试者操作特征曲线下面积（AUROC）、阳性预测值（PPV）和阴性预测值（NPV）。
我们纳入了163例患者（86例男性，77例女性；中位年龄：9岁（四分位间距（IQR）6 - 13岁））。样本包括80例无静脉曲张（49%）、38例低风险静脉曲张（23%）和45例高风险静脉曲张（28%）病例。无静脉曲张组、低风险静脉曲张组和高风险静脉曲张组的脾脏弹性成像中位值分别为20 kPa（2.58 m/s）、34 kPa（3.36 m/s）和40 kPa（3.65 m/s）。当使用28.5 kPa（3.08 m/s）的截断值检测任何级别的静脉曲张时，敏感性为93%（95%置信区间：85 - 97），特异性为94%（86 - 98），PPV为94%（86 - 98），NPV为93%（85 - 97）。获得的AUROC为0.93（0.90 - 0.98）。在比较高风险与低风险静脉曲张组时，使用35.35 kPa（3.43 m/s）的截断点，我们获得的AUROC为0.66，敏感性为71%，特异性为61%，PPV为68%，NPV为64%。
二维剪切波弹性成像测量的脾脏硬度在检测门静脉高压患儿食管静脉曲张方面显示出优异的诊断性能，在区分低风险和高风险静脉曲张患者方面表现中等。
