Hepatic Shear Wave Elastography: Correlation Between Liver Stiffness and Esophagogastric Varices

(RSNA 2018, Mon Nov 26 2018 11:40AM - 11:50AM ROOM Z10) PURPOSE To evaluate the role of liver stiffness measurement (LSM) measured by shear wave elastography (SWE) in predicting the presence of esophagogastric varices (EGV) in patients with portal hypertension and to determine the correlation between the LSM and endoscopic grade of EGV. METHOD AND MATERIALS This study included 331 patients with chronic liver disease being evaluated for portal hypertension and planned for esophagogastroduodenoscopy. SWE was performed in the right lobe of the liver by using a convex broadband probe on GE LOGIQ E9 ultrasound machine. The shear wave liver stiffness (in kPa) was recorded at ten locations and the median values calculated. Endoscopic findings were interpreted with reference to the presence of varices and grade of the varices. Correlation between LSM and grade of varices was analyzed with the Pearson correlation coefficient. Multiclass Receiver operating characteristic (ROC) curves were constructed, and the area under the ROC curves (AUC) was calculated to determine the discriminating power between the grades of the varices. RESULTS LSM and variceal grade showed no significant correlation (R = 0.351286, P <0001). The AUC for detection of the presence of varices was 0.7259. The AUC for differentiating between various grades of the varices was 0.6470, 0.5802, 0.6259 and 0.7692. Box plot of the LSM and grade of varices revealed no discrimination power. Hepatic shear wave stiffness was marginally useful in predicting the presence of varices. But the discriminating power of LSM among the grades of varices was poor. CONCLUSION We found marginal utility of LSM in predicting the presence of EGV. However, contrary to the existing knowledge, in our study, we found no correlation between liver stiffness measurement and grade of EGV. The liver stiffness measurement is not a reliable predictor of portal hypertension. CLINICAL RELEVANCE/APPLICATION In advanced fibrosis, liver stiffness measurements in isolation does not seem to predict the clinical severity of portal hypertension. The additional assessment of splenic stiffness should be considered.