Spleen Stiffness Performance in the Noninvasive Assessment of Gastroesophageal Varices after Transjugular Intrahepatic Portosystemic Shunts

Abstract

Objectives. To investigate the performance of spleen stiffness (SS) by using two-dimensional shear-wave elastography (2D-SWE) for assessing the severity of gastroesophageal varices (GEVs) after transjugular intrahepatic portosystemic shunt (TIPS). Methods. 102 eligible patients were categorized as in the post-TIPS short-term ( $n=69$ ) and long-term ( $n=38$ ) follow-up groups. The performance of SS by using 2D-SWE for evaluating the severity of GEVs was compared with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), liver stiffness spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension (PH) risk score, platelet count-to-spleen diameter ratio (PSR), and varices risk score by using receiver operating characteristic (ROC) curve and DeLong test. Results. In the post-TIPS short-term follow-up group, area under the receiver operating characteristic curves (AUCs) of SS were 0.585 for mild ( $\text{cutoff}\text{value}=30.3$  kPa), 0.655 for moderate ( $\text{cutoff}\text{value}=30.6$  kPa), and 0.739 for severe ( $\text{cutoff}\text{value}=31.9$  kPa) GEVs, which were higher than other parameters for severe GEVs. AUCs of SS were lower than other parameters for mild and moderate GEVs, but no difference was found ( $p>0.05$ ). In the post-TIPS long-term follow-up group, AUCs of SS were 0.778 for mild ( $\text{cutoff}\text{value}=28.9$  kPa), 0.82 for moderate ( $\text{cutoff}\text{value}=29.9$  kPa), and 0.824 for severe ( $\text{cutoff}\text{value}=37.7$  kPa) GEVs, which were higher than other parameters except for severe GEVs. AUC of SS was lower than other parameters for severe GEVs, but no significant difference was found ( $p>0.05$ ). Conclusion. SS is an effective noninvasive tool to predict GEV severity during the post-TIPS follow-up.