Prediction Of Esophageal Varices In Patients With Cirrhosis By Ultrasound Two-dimensional Shear Wave Elastography

Objective: Noninvasive elastography can be employed to assess the efficacy of two-dimensional shear wave elastography(2D-SWE)in predicting esophageal varices(EV)in cirrhotic patients by gauging the stiffness of their liver and spleen.To compare the diagnostic performance of 2D-SWE and transient elastography(TE)in cirrhotic patients with esophageal varices.Meanwhile,the differences of liver and spleen elasticity values in patients with liver cirrhosis of different etiologies were analyzed.Methods: 288 From December 2021 to January 2023 Nanchang ninth Hospital chose 205 males and 83 females to be admitted as patients with liver cirrhosis.Our hospital diagnosed all the patients,meeting the most recent criteria of liver cirrhosis.All the patients were examined by gastroscopy and the degree of esophageal varices was recorded.The liver stiffness value(LSM)was measured by TE within one week,i.e.TE-LSM.2D-SWE was employed to quantify both the liver and spleen stiffness values.The 2D-SWE detector has two detection modes:sound touch elastography(STE)and sound touch quantification(STQ).The results of STE-LSM,STE-SSM and STQ-SSM can be obtained respectively.Ultimately,the diagnosis of gastroscopy will be used as the gold standard to evaluate the patient’s condition.By drawing receiver operating curve(ROC),the efficacy of TE and 2D-SWE in predicting the extent of esophageal varices in those with liver cirrhosis was compared,and the cut-off values of LSM and SSM for those with varying levels of esophageal varices were calculated.Additionally,the liver and spleen elasticity values were gauged in various cirrhotic groups.Results:1.Out of 288 people with liver cirrhosis,207 were afflicted with hepatitis B,with 65 having no EV and 142 having EV(including 51 with mild EV,40 with moderate EV,and 51 with severe EV).No noteworthy disparity was observed between the four EV groups of no,mild,moderate,and severe(P>0.05)in terms of age,gender,height,weight,and BMI.2.Significant differences(all P<0.05)were observed between TE-LSM values in the moderate EV group and severe EV group,as well as those in the mild EV group and no EV group.The TE-LSM values of the severe EV group were greater than those of the moderate EV group,though the disparity was not statistically significant(P>0.05).Moreover,the STE-LSM,STE-SSM and STQ-SSM parameters in the severe EV group were higher than those of the no EV group.The distinctions between the mild and moderate groups were statistically noteworthy(all P<0.001).3.There were 51 cases in severe EV group and 156 cases in non-severe(mild,moderate and none)EV group.A statistical significance between the two groups was demonstrated by a univariate analysis of each parameter in the study,with TE-LSM,STE-LSM,STE-SSM and STQ-SSM all being statistically significant(all P<0.001).A multivariate regression analysis revealed that TE-LSM,STE-LSM and STQ-SSM were all independent risk factors for severe esophageal varices in those with liver cirrhosis(all P<0.05).4.The AUC for severe EV in patients with cirrhosis diagnosed by TE-LSM was0.789(95% CI:0.721～0.857).When the optimal cut-off value was 15.45 k Pa,Se and Sp were 51.3% and 90.2% respectively(P<0.001).The area under the STE-LSM curve was 0.872(95%CI:0.820～0.925),when the best cut-off value was 16.73 k Pa,Se and Sp were 67.9% and 88.2% respectively,P<0.001;The AUC of STQ-SSM was0.888(95% CI:0.829～ 0.948),when the optimal cut-off value was 29.97 k Pa,Se and Sp were 96.8% and 72.5% respectively,P<0.001;The AUC of TE-LSM+STQ-SSM was 0.919(95% CI:0.874～0.964);The AUC of STE-LSM+STQ-SSM was 0.938(95%CI:0.901～0.976)。5.Among 288 patients with esophageal varices,207 were hepatitis B,5Significant differences in liver stiffness and spleen hardness were observed between the mixed cirrhosis and hepatitis B and C groups(P<0.001).Of the patients with different etiologies of liver cirrhosis,16 had alcoholic liver disease,3 nonalcoholic fatty liver disease,21 primary biliary cholangitis,5 autoimmune hepatitis,5hepatolenticular degeneration,2 schistosomiasis,20 mixed factors,and 4 cryptogenic liver disease.Liver stiffness in the alcoholic cirrhosis group was notably higher than that of the hepatitis B and C groups(P<0.05).Conclusion:1.Liver hardness is more specific in predicting esophageal varices,while spleen hardness is more sensitive and effective.2.The 2D-SWE technique can accurately gauge the extent of esophageal varices in those suffering from liver cirrhosis,and the amalgamation of liver and spleen stiffness can augment the diagnostic effectiveness of forecasting severe esophageal varices in those with liver cirrhosis.3.2D-SWE was superior to TE in predicting severe esophageal varices in cirrhotic patients.4.The liver and spleen stiffness values of patients with cirrhosis of different causes are different.