Indirect prediction of liver fibrosis by quantitative measurement of spleen stiffness using the FibroScan system.

OBJECTIVES: To evaluate quantitative measurement of spleen stiffness for indirect assessment of liver fibrosis in patients with chronic hepatitis B and to correlate spleen stiffness with liver stiffness using pathologic examination as a reference standard.

METHODS: Sixty patients with clinically confirmed chronic hepatitis B (n = 54) and liver cirrhosis (n = 6) were enrolled. Quantitative stiffness measurements (kilopascals) were obtained from spleen and liver parenchyma with the FibroScan system (Echosens, Paris, France). Correlation analyses were performed between spleen and liver stiffness and between spleen stiffness and liver fibrosis stages. The diagnostic performance of spleen stiffness for indirect prediction of liver fibrosis was estimated by receiver operating characteristic curves.

RESULTS: Both spleen and liver stiffness increased as liver fibrosis progressed. Spleen stiffness values had a positive correlation with liver stiffness values in all patients (Pearson r = 0.810; P < .001). The correlation between spleen stiffness and fibrosis stages was statistically significant (Spearman r = 0.833; P < .001). The areas under the receiver operating characteristic curves for spleen stiffness were 0.902 (95% confidence interval [CI], 0.825-0.978) for stage S1 (fibrous portal expansion and limited perisinusoidal or lobular fibrosis) or higher, 0.927 (95% CI, 0.852-1.0) for S2 (periportal fibrosis and few fibrous septa but intact architecture) or higher, 0.962 (95% CI, 0.918-1.0) for S3 (numerous fibrous septa with architectural distortion but no obvious cirrhosis) or higher, and 0.983 (95% CI, 0.957-1.0) for S4 (cirrhosis) (all P < .001). The differences between the areas under the curves for spleen and liver stiffness in liver fibrosis staging were not statistically significant (P = .115-.756).

CONCLUSIONS: Quantitative measurement of spleen stiffness is a feasible and promising technique for estimating liver fibrosis. The overall diagnostic performance of spleen stiffness for liver fibrosis staging is comparable with that of liver stiffness.