RUOLO DELL¿ELASTOGRAFIA TRANSIENTE (FIBROSCAN) EPATICA E SPLENICA NEL PREDIRE LA SEVERITA¿ DI MALATTIA EPATICA IN PAZIENTI CON EPATOPATIA CRONICA POST-VIRALE

Abstract Liver transient elastography, Fibroscan, in measuring the stiffness, is a reliable, noninvasive predictor of disease severity in chronic liver disease of viral aetiology. Owing to the relationships among severity of chronic liver disease , portal hypertension and spleen involvement, the assessment of splenic stiffness may have an added value in staging chronic liver disease . Of 132 chronic liver disease patients of viral aetiology, (CLD) 48 with myeloproliferative disorders (MD) and 64 healthy volunteers (HV), were concurrently investigated by both liver and spleen stiffness. Liver disease severity was staged by liver biopsy (score Metavir) taken concurrently with Fibroscan examination and upper gastrointestinal tract endoscopy for gastro-oesophageal varices. The spleen Fibroscan inter-observer agreement was analysed by an intra-class correlation coefficient (ICC); the liver and spleen transient elastography accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. Spleen transient elastography failed in 22 CLD (16.6%), 12 (25%) MD and 12 (18%) HV. In the three groups, the ICC was 0.89 (0.84-0.92), 0.90 (0.85-0.94) and 0.86(0.80-0.91), respectively. In the CLD group, liver transient elastography and spleen transient elastography independently predicted significant fibrosis (OR 5.2 and 4.6) and cirrhosis (OR 7.8 and 9.1), but both transient elastographies were independent from liver necroinflammation and steatosis. The NPV of spleen transient elastography for gastro-oesophageal varices was 100% using a 48 kPa cut-off. Spleen stiffness can be assessed using transient elastography, its value increasing as the liver disease progresses.In liver cirrhosis patients spleen stiffness can predict the presence, but not the grade of esophageal varices, which can be better predicted if both spleen and liver stiffness measurements are used.