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High accuracy of spleen stiffness measurement in diagnosing clinically significant portal hypertension in metabolic-associated fatty liver disease

Liver Int. 2023 Mar 13. doi: 10.1111/liv.15561. Online ahead of print.


BACKGROUND & AIMS: Spleen stiffness measurement (SSM) by transient elastography (VCTE) has been tested in a limited number of studies versus hepatic venous pressure gradient (HVPG), especially with the 100 Hz spleen specific module. The current study aims to evaluate the diagnostic performance of this novel module for detecting clinically significant portal hypertension (CSPH) in a cohort of compensated patients with metabolic-associated fatty liver disease (MAFLD) as the main etiology and to improve the performance of the Baveno VII criteria for CSPH diagnosis by including SSM.

METHODS: This is a retrospective single center study including patients with available measurements of HVPG, liver stiffness (LSM) and SSM by VCTE with the 100 Hz module. AUROC analysis was conducted to identify dual cut-offs (rule-out and in) associated with the absence/presence of CSPH. The diagnostic algorithms were adequate if negative (NPV) and positive predictive values (PPV) were >90%.

RESULTS: A total of 85 patients were included, 60 MAFLD and 25 non-MAFLD. SSM showed a good correlation with HVPG (MAFLD: r=0.74; p<0.0001; non-MAFLD: r=0.62; p< 0.0011). In MAFLD patients, SSM had a high accuracy in discarding/diagnosing CSPH (cutoffs values of <40.9 and >49.9 kPa, AUC 0.95). The addition of these cutoffs in a sequential or combined approach to the Baveno VII criteria significantly reduced the grey zone (60% vs 15-20%), while maintaining adequate NPV and PPV.

CONCLUSIONS: our findings support the utility of SSM for diagnosing CSPH in MAFLD patients and demonstrates that the addition of SSM to the Baveno VII criteria increases accuracy.

PMID:36912787 | DOI:10.1111/liv.15561

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