Spleen Stiffness Measurement (SSM) in Elastography: Non-Invasive Prediction of Esophageal Varices and Cirrhosis Decompensation

Spleen stiffness measurement (SSM) reflects changes in portal hypertension and is considered a non-invasive tool for assessing the presence of esophageal varices in patients with liver cirrhosis. In the literature cited in the WFUMB, ACR-SRU, and EFSUMB guidelines, SSM has been evaluated using various elastography methods.

SSM Measurement Methods

Several elastographic technologies are used for measuring spleen stiffness:

• Transient elastography (Fibroscan) — used for non-invasive assessment of esophageal varices in cirrhosis (Stefanescu et al., 2011; Colecchia et al., 2012).
• Point shear-wave elastography (pSWE) — feasibility and reproducibility of spleen stiffness measurement in chronic liver diseases and prognostic value for portal hypertension were evaluated (Fraquelli et al.).
• 2D shear-wave elastography (2D-SWE, supersonic imaging) — used for predicting the presence of esophageal varices in cirrhosis (Stefanescu et al., 2017) and for assessing clinically significant portal hypertension (Procopet et al., 2015).

Clinical Application

SSM, in combination with liver stiffness, has been used to predict high-risk varices in patients with compensated liver cirrhosis (Fofiu et al., 2021). Splenic parameters are considered non-invasive indicators of portal hypertension, complementing traditional diagnostics (Ahmad et al., 2020).

Specific diagnostic thresholds for SSM (in kPa or m/s) are not provided in the excerpts — [specify] from primary sources.

Limitations

The reliability and reproducibility of SSM in chronic liver diseases have been studied separately (Fraquelli et al.); the applicability of the method for predicting clinically significant portal hypertension depends on the elastography technology used [specify reliability criteria].