The Value Of Acoustic Radiation Force Impulse For Diagnosing Esophageal Varices And Esophagealvarices Bleeding In HBV-related Cirrhotic Patients

ObjectiveIn this study,we measured the shear wave velocity of liver and spleen of HBV-related cirrhotic patients using acoustic radiation force impulse(ARFI)technique and compared the differences of routine ultrasonic presentations among different groups according to the results of upper gastrointestinal endoscopy.We explored the value of routine ultrasound and acoustic radiation force impulse technique in the assessment of the existence of esophageal varices and the risk of esophageal varices bleeding in patients with HBV-related cirrhosis.MethodsAccording to the criteria we set,a total of one hundred and nine HBV-related cirrhotic patients who underwent ultrasound examination,upper gastrointestinal endoscopy and laboratory examination in Shandong Provincial Qianfoshan Hospital during November 2017 to June 2018 were enrolled and divided into different groups according to the results of endoscopy.The shear wave velocities of liver and spleen were measured using ARFI technique and compared.The risk of esophageal varices bleeding was the golden standard and the receiver operator characteristic curve was depicted to detect the diagnostic value of liver and spleen stiffness in predicting esophageal varices and esophageal varices bleeding.ResultsAccording to the result of endoscopy,there were significant differences in total bilirubin,albumin,prothrombin time,portal vein diameter,spleen length,spleen thickness,SWVL,SWVS between patients with or without esophageal varices.There were significant differences in total bilirubin,albumin,prothrombin time,portal vein diameter,SWVS among different degrees of esophageal varices.But there was significant difference just in the spleen stiffness between patients of EV-G1 and EV-G2,EV-G1 and EV-G3,EV-G2 and EV-G3.The spleen stiffness was positively related to the degree of esophageal varices(p=0.788,P<0.05).According to the risk of esophageal varices bleeding,patients were divided into two groups.There was significant difference of SWVs between patients with low and high risk of esophageal varices bleeding.The AUC of SWVs in diagnosing high-risk esophageal varices bleeding was 0.948,and the cut-off value was 3.20m/s,sensitivity value was 92.7%,specificity value was 86.8%,positive predictive value was 80.4%,negative predictive value was 93.6%,accuracy was 88.1%.Conclusions1.Routine ultrasound and acoustic radiation force impulse technique could be used to assess the presence of esophageal varices.2.SWVs was positively related to the degree of esophageal varices and was elevated as the severity of esophageal varices increased.3.The shear wave velocities of patients of high-risk esophageal varices bleeding were higher than that of low-risk esophageal varices bleeding.SWVs could be used to predict the risk of esophageal varices bleeding to guide clinical treatment.