Spleen Stiffness Measurement (SSM) in the Assessment of Portal Hypertension and Varices: The Baveno VII Approach
The Role of SSM in Non-Invasive Assessment of Portal Hypertension
According to the WFUMB Guideline on Liver Multiparametric Ultrasound (Ferraioli et al., 2024), the combined Baveno VII algorithm and spleen stiffness measurement (SSM) improve the non-invasive diagnosis of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD) — based on the work of Dajti E. et al. (Am J Gastroenterol 2022).
Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver diseases (Zykus R. et al., BMC Gastroenterol 2015).
SSM and Prediction of Esophageal Varices
Several studies cited in the EFSUMB Course Book (Sporea et al., 2018) and EFSUMB Guidelines Non-Hepatic (Săftoiu et al., 2019) have demonstrated the value of SSM in assessing esophageal varices in cirrhosis:
| Study | Clinical Application |
|---|---|
| Sharma P. et al. (Am J Gastroenterol 2013) | Spleen stiffness in predicting esophageal varices in cirrhosis |
| Colecchia A. et al. (J Hepatol 2014) | SSM for predicting clinical complications in compensated HCV cirrhosis |
| Colecchia A. et al. (Gastroenterology 2012) | SSM for assessing portal hypertension and the presence of varices in HCV cirrhosis |
| Stefanescu H. et al. (2011) | SSM using FibroScan for non-invasive assessment of esophageal varices |
Methodological Aspects
SSM can be performed using transient elastography (FibroScan) and two-dimensional shear-wave elastography (2D-SWE). Real-time shear-wave elastography has been studied for its applicability, reproducibility, and accuracy for CSPH (Procopet B. et al., J Hepatol 2015). Specific diagnostic thresholds for SSM within the Baveno VII algorithm are not provided in the given excerpts [to be clarified].
Frequently asked questions
What is the purpose of SSM in the context of Baveno VII?
The combined Baveno VII + SSM algorithm improves the non-invasive diagnosis of clinically significant portal hypertension in compensated advanced chronic liver disease (WFUMB, 2024; Dajti et al., 2022).
Can SSM indicate the presence of esophageal varices?
Yes, several studies have demonstrated the value of SSM in predicting esophageal varices in cirrhosis (Sharma et al., 2013; Colecchia et al., 2012).
What methods are used to measure spleen stiffness?
Transient elastography (FibroScan) and real-time shear-wave elastography; the latter has been evaluated for applicability, reproducibility, and accuracy for CSPH (Procopet et al., 2015).
What are the threshold values for SSM according to Baveno VII?
Specific numerical thresholds are not provided in the given excerpts [to be clarified from Baveno VII and WFUMB 2024 primary sources].