Splenic stiffness measurement by transient elastography for predicting varices in children with portal hypertension.

Abstract

Objective: To evaluate the diagnostic accuracy of splenic stiffness measurement (SSM) using spleen-dedicated vibration-controlled transient elastography (VCTE) for predicting varices and varices needing treatment (VNT) in children with clinically evident portal hypertension (CEPH).

Methods: In this single-centre prospective cross-sectional study, children aged 6 months to 14 years with portal hypertension meeting the criteria for CEPH were eligible. SSM was measured using the VCTE with a spleen-specific (100 Hz) probe. Esophagogastroduodenoscopy (EGD) was performed to detect varices and risk stratification. Diagnostic performance was assessed using receiver operating characteristic analysis and contingency tables.

Results: Ninety-three consecutive children with CEPH underwent EGD, and successful SSM acquisition was achieved in 90 cases. The median (interquartile range) age of presentation was 6 (3-10) years. EGD identified varices in 79 (87.8%) and VNT in 57 (63.3%). Children with varices had higher median SSM values than those without (37.9 vs. 17.9 kPa; p <  0.001). Among those with varices, SSM values were higher in high-risk than in low-risk cases (42.9 vs. 21.9 kPa; p <  0.001). SSM demonstrated good accuracy for predicting varices (area under the curve: 0.86, 95% confidence interval: 0.76-0.97) with a sensitivity of 75.9% (65.0%-84.9%) and specificity of 90.9% (58.7%-99.8%) at a threshold of 31.1 kPa. For VNT, accuracy was 0.838 (0.702-0.877), with a sensitivity of 87.7% (76.3%-94.9%) and specificity of 72.7% (54.5%-86.7%) at the SSM cut-off of 31.4 kPa.

Conclusion: In children with CEPH, spleen-dedicated VCTE estimated SSM to have a reasonably high accuracy in predicting varices and VNT. Integrating SSM into clinical practice could assist in the screening and management of portal hypertension in children.