Diagnostic Advances
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2016; 22(35): 7857-7867
Published online Sep 21, 2016. doi: 10.3748/wjg.v22.i35.7857
Role of spleen elastography in patients with chronic liver diseases
Mariangela Giunta, Dario Conte, Mirella Fraquelli
Mariangela Giunta, Dario Conte, Mirella Fraquelli, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
Mariangela Giunta, Dario Conte, Mirella Fraquelli, Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
Author contributions: Giunta M, Conte D and Fraquelli M designed research and wrote the manuscript; Giunta M and Fraquelli M performed research; all authors approved the paper.
Conflict-of-interest statement: No financial support to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mirella Fraquelli, MD, PhD, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy. mfraquelli@yahoo.it
Telephone: +39-25-5033369 Fax: +39-02-50320410
Received: July 5, 2016
Peer-review started: July 6, 2016
First decision: July 29, 2016
Revised: August 16, 2016
Accepted: August 30, 2016
Article in press: August 30, 2016
Published online: September 21, 2016
Processing time: 71 Days and 17.8 Hours
Abstract

The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations.

Keywords: Cirrhosis; Spleen stiffness; Elastography; Portal hypertension; Transient elastography

Core tip: Spleen elastography is an attractive tool used as an alternative and/or complementary method to assess liver fibrosis, portal hypertension and complications related to cirrhosis. There are several elastography techniques to measure spleen stiffness, all characterized by non-invasiveness and repeatability. Current data from the literature show the higher accuracy of spleen stiffness as compared to liver stiffness, in predicting major complications of cirrhosis. Thus, despite some limitations, spleen stiffness seems to be a better prognostic predictor in patients with chronic liver disease.