Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension: A prospective multicentre study

Background & Aims: Clinically significant portal hypertension (CSPH) is associated with severe complications and decompensation of cirrhosis. Liver stiffness measured either by transient elastography (TE) or Shear-wave elastography (SWE) and spleen stiffness by TE might be helpful in the diagnosis of CSPH. We recently showed the algorithm to rule-out CSPH using sequential liver-(L-SWE) and spleen-Shear-wave elastography (S-SWE). This study investigated the diagnostic value of S-SWE for diagnosis of CSPH. Methods: One hundred and fifty-eight cirrhotic patients with pressure gradient measurements were included into this prospective multicentre study. L-SWE was measured in 155 patients, S-SWE in 112 patients, and both in 109 patients. Results: Liver-shear-wave elastography and S-SWE correlated with clinical events and decompensation. SWE of liver and spleen revealed strong correlations with the pressure gradient and to differentiate between patients with and without CSPH. The best cut-off values were 24.6kPa:L-SWE and 26.3kPa:S-SWE. L-SWE 16.0kPa and S-SWE 21.7kPa were able to rule-out CSPH. Cut-off values of L-SWE >29.5kPa and S-SWE >35.6kPa were able to rule-in CSPH (specificity >92%). Patients with a L-SWE >38.0kPa had likely CSPH. In patients with L-SWE 38.0kPa, a S-SWE >27.9kPa ruled in CSPH. This algorithm has a sensitivity of 89.2% and a specificity of 91.4% to rule-in CSPH. Patients not fulfilling these criteria may undergo HVPG measurement. Conclusions: Liver and spleen SWE correlate with portal pressure and can both be used as a non-invasive method to investigate CSPH. Even though external validation is still missing, these algorithms to rule-out and rule-in CSPH using sequential SWE of liver and spleen might change the clinical practice.