Abstract
ABSTRACT
Background and Aims
Assessing liver congestion and portal hypertension (PHT) in Budd–Chiari syndrome (BCS) remains challenging. We evaluated liver and spleen stiffness measurements (LSM, SSM) obtained by transient elastography as non‐invasive tools for identifying clinically meaningful liver congestion in BCS.
Methods
This retrospective study included consecutive patients with BCS followed at our unit. At each visit, patients were classified as having a controlled or uncontrolled clinical status based on clinical, biochemical, imaging and/or hemodynamic data, by absence or presence of clinically significant PHT. LSM and SSM were independently obtained at all visits and diagnostic performance for classifying clinical status was assessed using receiver operating characteristic (ROC) analysis.
Results
Sixty‐six patients were included with a median follow‐up of 65.5 months (range:2–182): 34 had persistently controlled status, 11 persistently uncontrolled, 14 initially uncontrolled improved to sustained controlled status and 7 showed fluctuating status. Two‐hundred eighty‐nine
LSM
were obtained during periods of controlled clinical status (median:15.
1 kPa
,
IQR
:10.9–19.9) and 203 during uncontrolled status (median: 41.
1 kPa
,
IQR
: 34.8–64.5).
LSM
discriminated controlled from uncontrolled status (
AUC
0.985).
LSM
cut‐off of 25
kPa
yielded 97.5% sensitivity, 92.5% specificity, 97.6% negative predictive value and 90% positive predictive value.
SSM
showed good discrimination (
AUC
0.854), with values ≤ 30
kPa
ruling out and > 40
kPa
ruling in uncontrolled status, but accuracy was inferior to
LSM
.
LSM
values rapidly decreased following liver congestion resolution after interventional procedures.
Conclusions
In BCS, LSM shows excellent concordance with clinical status and periodic assessment may facilitate clinical management. SSM provides complementary information but does not outperform LSM.