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Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis

 Haesung Yoon  ;  Hyun Joo Shin  ;  Myung-Joon Kim  ;  Seok Joo Han  ;  Hong Koh  ;  Seung Kim  ;  Mi-Jung Lee 
 World Journal of Gastroenterology, Vol.25(3) : 367-377, 2019 
Journal Title
 World Journal of Gastroenterology 
Issue Date
Biliary atresia ; Kasai operation ; Magnetic resonance elastography ; Portal hypertension ; Splenic stiffness
BACKGROUND: A recent retrospective study confirmed that hepatic stiffness and splenic stiffness measured with magnetic resonance elastography (MRE) are strongly associated with the presence of esophageal varices. In addition, strong correlations have been reported between splenic stiffness values measured with MRE and hepatic venous pressure gradients in animal models. However, most studies have been conducted on adult populations, and previous pediatric MRE studies have only demonstrated the feasibility of MRE in pediatric populations, while the actual clinical application of spleen MRE has been limited. AIM: To assess the utility of splenic stiffness measurements by MRE to predict gastroesophageal varices in children. METHODS: We retrospectively reviewed abdominal MRE images taken on a 3T system in pediatric patients. Patients who had undergone Kasai operations for biliary atresia were selected for the Kasai group, and patients with normal livers and spleens were selected for the control group. Two-dimensional spin-echo echo-planar MRE acquisition centered on the liver, with a pneumatic driver at 60 Hz and a low amplitude, was performed to obtain hepatic and splenic stiffness values. Laboratory results for aspartate aminotransferase to platelet ratio index (APRI) were evaluated within six months of MRE, and the normalized spleen size ratio was determined with the upper normal size limit. All Kasai group patients underwent gastroesophageal endoscopy during routine follow-up. The Mann-Whitney U test, Kendall's tau b correlation and diagnostic performance analysis using the area under the curve (AUC) were performed for statistical analysis. RESULTS: The median spleen MRE value was 5.5 kPa in the control group (n = 9, age 9-18 years, range 4.7-6.4 kPa) and 8.6 kPa in the Kasai group (n = 22, age 4-18 years, range 5.0-17.8 kPa). In the Kasai group, the APRI, spleen size ratio and spleen MRE values were higher in patients with portal hypertension (n = 11) than in patients without (n = 11) (all P < 0.001) and in patients with gastroesophageal varices (n = 6) than in patients without (n = 16) (all P < 0.05), even though their liver MRE values were not different. The APRI (τ = 0.477, P = 0.007), spleen size ratio (τ = 0.401, P = 0.024) and spleen MRE values (τ = 0.426, P = 0.016) also correlated with varices grades. The AUC in predicting gastroesophageal varices was 0.844 at a cut-off of 0.65 (100% sensitivity and 75% specificity) for the APRI, and 0.844 at a cut-off of 9.9 kPa (83.3% sensitivity and 81.3% specificity) for spleen MRE values. CONCLUSION: At a cut-off of 9.9 kPa, spleen MRE values predicted gastroesophageal varices as well as the APRI and spleen size ratio in biliary atresia patients after the Kasai operation. However, liver MRE values were not useful for this purpose.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
고홍(Koh, Hong) ORCID logo https://orcid.org/0000-0002-3660-7483
김명준(Kim, Myung Joon) ORCID logo https://orcid.org/0000-0002-4608-0275
김승(Kim, Seung) ORCID logo https://orcid.org/0000-0003-4373-9828
신현주(Shin, Hyun Joo) ORCID logo https://orcid.org/0000-0002-7462-2609
윤혜성(Yoon, Haesung) ORCID logo https://orcid.org/0000-0003-0581-8656
이미정(Lee, Mi-Jung) ORCID logo https://orcid.org/0000-0003-3244-9171
한석주(Han, Seok Joo) ORCID logo https://orcid.org/0000-0001-5224-1437
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