Spleen Stiffness on Magnetic Resonance Elastography for the Detection of Portal Hypertension: A Systematic Review and Meta-Analysis
Background: Chronic liver disease, complicated by portal hypertension (PH), may alter the extra-hepatic hemodynamic condition and spleen stiffness (SS). We aimed to evaluate the diagnostic accuracy of MRI-based elastographic methods (MRE) for detecting PH.
Methods: Seven studies were included with reference to SS with regard to the prediction of PH patients. Major outcomes considered for data extraction were diagnostic parameters for MRI for concluding mild PH, clinically significant PH and severe PH. PubMed, Scopus, Google Scholar, Cochrane and Science Direct databases were used to extract the published literature through to May, 2021Using the Rayyan Zotero and R softwares
Results: Out of 587 studies extracted, 7 were selected based on inclusion and exclusion criteria. A QUADAS-2 assessment showed that all studies were clear in terms of patient selection and reference standard. A funnel plot showed that all the selected studies were outliers, indicating a low level of accuracy for the studies included. Subgroup analysis, with reference to SS as a predictor of PH, revealed raw mean difference (RMD) of 7.78% (95% CI 5.23-10.34, P<0.01). The corresponding RMD observed for <60 years and >60 yr were 34.26% (95% CI 9.33- 59.20, I2=100%,
2. Paik JM, Golabi P, Younossi Y, Mishra A, Younossi ZM (2020). Changes in the Global Burden of Chronic Liver Diseas-es from 2012 to 2017: The Growing Im-pact of NAFLD. Hepatology, 72:1605–16.
3. Global Burden of Liver Disease: A True Burden on Health Sciences and Econo-mies!! | World Gastroenterology Organi-sation [Internet]. [cited 2021 Jun 26].
4. Gibiino G, Garcovich M, Ainora ME, Zocco MA (2019). Spleen ultrasound elastography: state of the art and future directions – a systematic review. Eur Rev Med Pharmacol Sci, 23:4368-81.
5. Garcia-Tsao G, Bosch J (2015). Varices and variceal hemorrhage in cirrhosis: a new view of an old problem. Clin Gastroenterol Hepatol, 13(12): 2109-17.
6. Giunta M, Conte D, Fraquelli M (2016). Role of spleen elastography in patients with chronic liver diseases. World J Gastroenterol, 22:7857–67.
7. Marcon J, Trottmann M, Rübenthaler J, et al (2016). Three-dimensional vs. two-dimensional shear-wave elastography of the testes - preliminary study on a healthy collective. Clin Hemorheol Microcirc, 64:447-56.
8. Pawluś A, Inglot MS, Szymańska K, et al (2016). Shear wave elastography of the spleen: evaluation of spleen stiffness in healthy volunteers. Abdom Radiol, 41:2169–2174.
9. Cheng YW, Chang YC, Chen YL, Chen RC, Chou CT (2019). Feasibility of meas-uring spleen stiffness with MR elas-tography and splenic volume to predict hepatic fibrosis stage. PLoS One, 14:e0217876.
10. Hsu C, Caussy C, Imajo K, et al (2019). Magnetic resonance vs. transient elas-tography analysis of patients with nonal-coholic fatty liver disease: A systematic review and pooled analysis of individual participants. Clin Gastroenterol Hepatol, 17:630–37.
11. Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting systemat-ic reviews. BMJ, 372:71.
12. Tsoris A, Marlar CA. Use of the Child-Pugh Score in liver disease. StatPearls [Internet]. 2021 Jan.
13. Ronot M, Lambert S, Elkrief L, et al (2014). Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifre-quency MR elastography in liver cirrhosis. Eur Radiol, 24:1394–02.
14. Yoon H, Shin HJ, Kim M-J, et al (2019). Predicting gastroesophageal varices through spleen magnetic resonance elas-tography in pediatric liver fibrosis. World J Gastroenterol, 25:367–77.
15. Shin SU, Lee JM, Yu MH, et al (2014). Pre-diction of esophageal varices in patients with cirrhosis: usefulness of three-dimensional MR elastography with echo-planar imaging technique. Radiology, 272(1):143–53.
16. Guo J, Büning C, Schott E, et al (2015). In vivo abdominal magnetic resonance elas-tography for the assessment of portal hypertension before and after transjugu-lar intrahepatic portosystemic shunt im-plantation. Invest Radiol, 50:347–51.
17. Dillman JR, Serai SD, Trout AT, et al (2019). Diagnostic performance of quantitative magnetic resonance imaging biomarkers for predicting portal hypertension in children and young adults with autoim-mune liver disease. Pediatr Radiol; 49:332–341.
18. Morisaka H, Motosugi U, Ichikawa S, Sano K, Ichikawa T, Enomoto N (2015). As-sociation of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease. J Magn Reson Imaging; 41:117–124.
19. Jhang ZE, Wu KL, Chen CB, Chen YL, Lin PY, Chou CT (2021). Diagnostic value of spleen stiffness by magnetic resonance elastography for prediction of esophageal varices in cirrhotic patients. Abdom Radiol, 46:526–33.
20. Hu X, Huang X, Hou J, Ding L, Su C, Meng F (2021) . Diagnostic accuracy of spleen stiffness to evaluate portal hyper-tension and esophageal varices in chronic liver disease: a systematic review and me-ta-analysis. Eur Radiol, 31:2392–404.
21. Ma X, Wang L, Wu H, et al (2016). Spleen stiffness is superior to liver stiffness for predicting esophageal varices in chronic liver disease: A Meta-Analysis. PLoS One, 11:e0165786.
22. Tang A, Cloutier G, Szeverenyi NM, Sirlin CB (2015). Ultrasound Elastography and MR Elastography for Assessing Liver Fi-brosis: Part 1, Principles and Techniques. AJR Am J Roentgenol; 205:22–32.
23. Mannelli L, Godfrey E, Joubert I, et al (2010). MR elastography: Spleen stiffness measurements in healthy volunteers--preliminary experience. AJR Am J Roent-genol, 195:387–92.
24. Venkatesh SK, Ehman RL (2015). Magnetic Resonance Elastography of Abdomen. Abdom Imaging, 40:745–59.
25. Singh R, Wilson MP, Katlariwala P, Murad MH, McInnes MD, Low G (2021). Accu-racy of liver and spleen stiffness on magnetic resonance elastography for de-tecting portal hypertension: a systematic review and meta-analysis. Eur J Gastroen-terol Hepatol, 32(2):237-45.
|Issue||Vol 51 No 9 (2022)|
|Spleen stiffness Portal hypertension Elastography Chronic liver disease|
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