Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis
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OBJECTIVES: To systematically review studies on the diagnostic accuracy of spleen stiffness measurement (SSM) for the detection of clinical significant portal hypertension (CSPH), severe portal hypertension (SPH), esophageal varices (EV), and high-risk esophageal varices (HREV) in patients with chronic liver diseases (CLD). METHODS: Through a systematic search, we identified 32 studies reporting the accuracy of SSM for the diagnosis of portal hypertension (PH) and/or EV in adults with CLD. A bivariate random-effects model was performed to estimate pooled sensitivity, specificity, likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratios (DOR). The clinical utility of SSM was evaluated by Fagan plot. RESULTS: A total of 32 studies assessing 3952 patients were included in this meta-analysis. The pooled sensitivities of SSM were 0.85 (95% confidence interval (CI), 0.69-0.93) for CSPH; 0.84 (95% CI, 0.75-0.90) for SPH; 0.90 (95% CI, 0.83-0.94) for any EV; and 0.87 (95% CI, 0.77-0.93) for HREV. The pooled specificities of SSM were 0.86 (95% CI, 0.74-0.93) for CSPH; 0.84 (95% CI, 0.72-0.91) for SPH; 0.73 (95% CI, 0.66-0.79) for EV; and 0.66 (95% CI, 0.53-0.77) for HREV. Summary PPV and NPV of SSM for detecting HREV were 0.54 (95% CI, 0.47-0.62) and 0.88 (95% CI, 0.81-0.95), respectively. CONCLUSIONS: Our meta-analysis suggests that SSM could be used as a helpful surveillance tool in management of CLD patients and was quite useful for ruling out the presence of HREV thereby avoiding unnecessary endoscopy. KEY POINTS: • SSM could be used to rule out the presence of HREV in patients with CLD thereby avoiding unnecessary endoscopy. • SSM has significant diagnostic value for CSPH and SPH with high sensitivity and specificity in patients with CLD. • SSM could be used as a helpful surveillance tool for clinicians managing CLD patients.
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Spleen stiffness measurement by VCTE correlates with hepatic venous pressure gradient and predicts the presence of varices needing treatment.
“Spleen stiffness measurement by VCTE has been shown to correlate with hepatic venous pressure gradient and predict the presence of varices needing treatment. 479,480”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [479]
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- Authors
- Hu, X., Huang, X., Hou, J., Ding, L., Su, C., & Meng, F.
- Affiliations
- Capital Medical University (CN)
- Corresponding author
- Meng, Fankun
- Venue
- European Radiology
- Published
- 2020-09-24
- Volume
- 31
- Issue
- 4
- Pages
- 2392-2404
- ISSN
- 0938-7994 (ISSN-L)
- 1432-1084
- PMC
- PMC7979650
- OpenAlex
- W3088363933
- Cited by
- 82
- References
- 64
- Citations by year
- 2026: 13 · 2025: 8 · 2024: 18 · 2023: 14 · 2022: 24 · 2021: 5
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-11-18)
- Open access
- hybrid
- doi.org
- Locations
- European Radiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- the National Science and Technology Major Project (2018ZX10302205-005)
- the national science and technology major project of China during the 13th Five-year plan period (2017ZX10201101)
- the National Natural Science Foundation of China (No. 81701984)
- the Beijing Excellent Talent Plan (2018000021223ZK04)
- 2018 Beijing Youan Hospital Scientific Research Project for Young & Middle-Aged Talent's Cultivation (YNKTTS20180106)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Esophageal Cancer Research and Treatment
- Keywords
- spleen stiffness measurement, portal hypertension, esophageal varices, chronic liver disease, diagnostic accuracy, non-invasive diagnosis, endoscopic surveillance, liver fibrosis, liver cirrhosis, sensitivity and specificity, likelihood ratios, clinical utility
- MeSH terms
- Adult, Esophageal and Gastric Varices, Humans, Hypertension, Portal, Liver, Liver Cirrhosis, Predictive Value of Tests, Spleen, Elasticity Imaging Techniques
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