Date Published: May 31, 2019
Publisher: Public Library of Science
Author(s): Yi-Wen Cheng, Ya-Chien Chang, Yao-Li Chen, Ran-Chou Chen, Chen-Te Chou, Han-Chieh Lin.
The aim of this study was to investigate the relationship between spleen stiffness value, splenic volume and the liver fibrosis stages.
This retrospective study was approved by the institutional review board of our institute. We enrolled 109 patients that had undergone abdominal MR imaging and histopathological examination. The preoperative MR imaging, MR elastography and laboratory data were reviewed. Liver stiffness and spleen stiffness were determined with MR elastography, and splenic volume was calculated. Liver fibrosis stage was determined using surgical pathology.
The correlation coefficient between the liver stiffness and the fibrosis stage was r = 0.72 and r = 0.62 when the passive driver was on right chest wall and the left chest wall, respectively. The correlation coefficient between the spleen stiffness and the fibrosis stage was r = 0.63 and r = 0.18 when the passive driver was on the left chest wall and the right chest wall, respectively. The correlation coefficient between the splenic volume and the fibrosis stage was r = 0.31. The diagnostic performance of spleen stiffness was similar to liver stiffness in prediction of advanced liver fibrosis. The combination of spleen stiffness and liver stiffness provided greater sensitivity in prediction of advanced fibrosis than spleen or liver stiffness alone, but no significant difference was found.
According to our study, the spleen stiffness value was useful in staging liver fibrosis. The combination of spleen stiffness and liver stiffness could provide higher diagnostic sensitivity than liver stiffness alone in prediction of advanced fibrosis.
Chronic liver disease is a major health concern and can lead to liver fibrosis. Liver fibrosis can be reversible with specific treatment; however, treatment is associated with an increased risk of morbidity and mortality [1,2]. Thus, it is essential to detect hepatic fibrosis in advance. Currently, liver biopsy has been used as the gold standard to detect hepatic fibrosis. However, it has several limitations such as a lower patient acceptance, sampling error and inter-observer interpretation variation . There is a clinical demand for a noninvasive and sensitive method to assess liver fibrosis. MR elastography (MRE), using an MRI-based quantitative shear wave elastography method, has been shown to be an accurate method for staging liver fibrosis with advantages of large organ coverage, excellent inter-scan reproducibility and inter-reader agreement [4–7]. Because of the high accuracy of MRE in hepatic fibrosis staging, MRE could potentially replace invasive liver biopsy for fibrosis staging [8,9]. Using MRE in determination of hepatic stiffness and splenic stiffness might provide a comprehensive assessment of liver fibrosis and portal hypertension [10–12]. It has been reported that splenic stiffness measurement with MRE is also useful for predicting clinical complications in cirrhosis patients [13–15].
In our study, the combination of spleen stiffness and liver stiffness could provide higher AUC than spleen or liver stiffness alone, although no significant difference was found. There were two major components for the elevation of hepatic stiffness in patients with chronic liver disease: structural change or fibrosis and portal/venous pressure . Talwalkar et al. reported a strong linear relationship between liver stiffness and splenic stiffness (r2 = 0.75), and a splenic stiffness value ≥ 10.5 kPa was associated with a 100% rate of esophageal varices . The measurement of spleen stiffness might reflect the portal pressure status . Yin et al. also reported a strong correlation (r > 0.80) between splenic stiffness measured with MRE and hepatic vein-portal vein gradient . The combination of spleen stiffness and liver stiffness might provide a higher diagnostic performance in detecting advanced fibrosis. However, limited data of splenic stiffness values measured by MRE is available to date for discrimination of different fibrosis stages and further study with a large patient group is needed.
Our study verified the feasibility of staging liver fibrosis via splenic volume calculation and MR elastography of the spleen. Spleen stiffness could provide useful information in characterization of different liver fibrosis stages. A combination of spleen stiffness and liver stiffness could provide higher sensitivity in detection of advanced fibrosis stages than liver stiffness alone.