Spleen Stiffness on Magnetic Resonance Elastography for the Detection of Portal Hypertension: A Systematic Review and Meta-Analysis

Ma Yiyi, Qian Xiaoqin, Zhang Lei, Ma Yiyi, Qian Xiaoqin, Zhang Lei

Abstract

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%, τ2=646.7688, P=0), and 46.92% (95% CI 20-59.33, I2=97%, τ2=1003.023, P=0) respectively. The specificity and sensitivity noted for MRI in determining SS were 0.721 and 0.747, respectively with an area-under the curve of 0.788. The estimated random effect models for specificity and sensitivity were 0.938 and 0.842, respectively.

Conclusion: The real-time MRE has acceptable specificity and sensitivity for diagnosing SS.

Keywords: Chronic liver disease; Elastography; Portal hypertension; Spleen stiffness.

Copyright © 2022 Yiyi et al. Published by Tehran University of Medical Sciences.

Figures

Fig. 1:
Fig. 1:
Prisma flowchart depicting the results of the literature search and study selection
Fig. 2:
Fig. 2:
Subgroup analysis with reference to spleen stiffness towards hypertension
Fig. 3:
Fig. 3:
Subgroup analysis with reference to age
Fig. 4:
Fig. 4:
Subgroup analysis with reference to continent
Fig. 5:
Fig. 5:
Specificity and sensitivity of MRI noted in various studies on PH
Fig. 6:
Fig. 6:
ROC curve demonstrating the specificity and sensitivity of MRI in various studies

References

    1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. (2019). Burden of liver diseases in the world. J Hepatol, 70:151–71.
    1. Paik JM, Golabi P, Younossi Y, Mishra A, Younossi ZM. (2020). Changes in the Global Burden of Chronic Liver Diseases from 2012 to 2017: The Growing Impact of NAFLD. Hepatology, 72:1605–16.
    1. Global Burden of Liver Disease: A True Burden on Health Sciences and Economies!! | World Gastroenterology Organisation [Internet]. [cited 2021 Jun 26].
    1. 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.
    1. 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.
    1. Giunta M, Conte D, Fraquelli M. (2016). Role of spleen elastography in patients with chronic liver diseases. World J Gastroenterol, 22:7857–67.
    1. 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.
    1. Pawluś A, Inglot MS, Szymańska K, et al. (2016). Shear wave elastography of the spleen: evaluation of spleen stiffness in healthy volunteers. Abdom Radiol (NY), 41:2169–2174.
    1. Cheng YW, Chang YC, Chen YL, Chen RC, Chou CT. (2019). Feasibility of measuring spleen stiffness with MR elastography and splenic volume to predict hepatic fibrosis stage. PLoS One, 14:e0217876.
    1. Hsu C, Caussy C, Imajo K, et al. (2019). Magnetic resonance vs. transient elastography analysis of patients with nonalcoholic fatty liver disease: A systematic review and pooled analysis of individual participants. Clin Gastroenterol Hepatol, 17:630–37.
    1. Page MJ, McKenzie JE, Bossuyt PM, et al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 10:89.
    1. Tsoris A, Marlar CA. Use of the Child-Pugh Score in liver disease. StatPearls [Internet]. 2021. Jan.
    1. Ronot M, Lambert S, Elkrief L, et al. (2014). Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifrequency MR elastography in liver cirrhosis. Eur Radiol, 24:1394–02.
    1. Yoon H, Shin HJ, Kim M-J, et al. (2019). Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis. World J Gastroenterol, 25:367–77.
    1. Shin SU, Lee JM, Yu MH, et al. (2014). Prediction of esophageal varices in patients with cirrhosis: usefulness of three-dimensional MR elastography with echo-planar imaging technique. Radiology, 272(1):143–53.
    1. Guo J, Büning C, Schott E, et al. (2015). In vivo abdominal magnetic resonance elastography for the assessment of portal hypertension before and after transjugular intrahepatic porto-systemic shunt implantation. Invest Radiol, 50:347–51.
    1. 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 autoimmune liver disease. Pediatr Radiol; 49:332–341.
    1. Morisaka H, Motosugi U, Ichikawa S, Sano K, Ichikawa T, Enomoto N. (2015). Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease. J Magn Reson Imaging; 41:117–124.
    1. 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 (NY), 46:526–33.
    1. Hu X, Huang X, Hou J, Ding L, Su C, Meng F. (2021) . Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis. Eur Radiol, 31:2392–404.
    1. 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.
    1. Tang A, Cloutier G, Szeverenyi NM, Sirlin CB. (2015). Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 1, Principles and Techniques. AJR Am J Roentgenol; 205:22–32.
    1. Mannelli L, Godfrey E, Joubert I, et al. (2010). MR elastography: Spleen stiffness measurements in healthy volunteers--preliminary experience. AJR Am J Roentgenol, 195:387–92.
    1. Venkatesh SK, Ehman RL. (2015). Magnetic Resonance Elastography of Abdomen. Abdom Imaging, 40:745–59.
    1. Singh R, Wilson MP, Katlariwala P, Murad MH, McInnes MD, Low G. (2021). Accuracy of liver and spleen stiffness on magnetic resonance elastography for detecting portal hypertension: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol, 32(2):237–45.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe