{"title":"瞬态弹性图测量脾刚度预测门脉高压患儿静脉曲张。","authors":"Janvi Sirwani, Samarendra Mahapatro, Aditi Kumar, Ranjan Patel, Manas Kumar Panigrahi","doi":"10.1002/jpn3.70215","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Splenic stiffness measurement by transient elastography for predicting varices in children with portal hypertension.\",\"authors\":\"Janvi Sirwani, Samarendra Mahapatro, Aditi Kumar, Ranjan Patel, Manas Kumar Panigrahi\",\"doi\":\"10.1002/jpn3.70215\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":16694,\"journal\":{\"name\":\"Journal of Pediatric Gastroenterology and Nutrition\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-09-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Gastroenterology and Nutrition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jpn3.70215\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Gastroenterology and Nutrition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jpn3.70215","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:评价脾专用振动控制瞬变弹性成像(VCTE)脾刚度测量(SSM)对临床明显门静脉高压症(CEPH)患儿静脉曲张及需要治疗的静脉曲张(VNT)的诊断准确性。方法:在这项单中心前瞻性横断面研究中,年龄6个月至14岁的门静脉高压症患儿符合CEPH标准。SSM采用脾脏特异性(100 Hz)探头的VCTE测量。食管胃十二指肠镜(EGD)检测静脉曲张及危险分层。使用受者操作特征分析和列联表评估诊断性能。结果:连续93例CEPH患儿行EGD, 90例成功获得SSM。发病年龄中位数(四分位数间距)为6(3-10)岁。EGD发现静脉曲张79例(87.8%),VNT 57例(63.3%)。有静脉曲张的儿童的SSM中值高于无静脉曲张的儿童(37.9 kPa vs. 17.9 kPa); p结论:在CEPH儿童中,脾脏专用VCTE估计SSM在预测静脉曲张和VNT方面具有相当高的准确性。将SSM纳入临床实践有助于儿童门静脉高压症的筛查和治疗。
Splenic stiffness measurement by transient elastography for predicting varices in children with portal hypertension.
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.
期刊介绍:
The Journal of Pediatric Gastroenterology and Nutrition (JPGN) provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition.