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DOI:10.2214/AJR.07.3504
AJR 2009; 193:122-127
© American Roentgen Ray Society

Original Research

Feasibility of In Vivo MR Elastographic Splenic Stiffness Measurements in the Assessment of Portal Hypertension

Jayant A. Talwalkar1, Meng Yin2, Sudhakar Venkatesh2,3, Phillip J. Rossman2, Roger C. Grimm2, Armando Manduca2, Anthony Romano4, Patrick S. Kamath1 and Richard L. Ehman2

1 Advanced Liver Diseases Study Group, Department of Gastroenterology and Hepatology, Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN.
2 Center for Advanced Imaging Research, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.
3 Present address: Department of Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
4 Naval Research Laboratory, Washington, DC.

OBJECTIVE. Liver stiffness is associated with portal hypertension in patients with chronic liver disease. However, the relation between spleen stiffness and clinically significant portal hypertension remains unknown. The purposes of this study were to determine the feasibility of measuring spleen stiffness with MR elastography and to prospectively test the technique in healthy volunteers and in patients with compensated liver disease.

MATERIALS AND METHODS. Spleen stiffness was measured with MR elastography in 12 healthy volunteers (mean age, 37 years; range, 25-82 years) and 38 patients (mean age, 56 years; range, 36-60 years) with chronic liver disease of various causes. For patients with liver disease, laboratory findings, spleen size, presence and size of esophageal varices, and liver histologic results were recorded. Statistical analyses were performed to assess all measurements.

RESULTS. MR elastography of the spleen was successfully performed on all volunteers and patients. The mean spleen stiffness was significantly lower in the volunteers (mean, 3.6 ± 0.3 kPa) than in the patients with liver fibrosis (mean, 5.6 ± 5.0 kPa; range, 2.7-19.2 kPa; p < 0.001). In addition, a significant correlation was observed between liver stiffness and spleen stiffness for the entire cohort (r2 = 0.75; p < 0.001). Predictors of spleen stiffness were splenomegaly, spleen volume, and platelet count. A mean spleen stiffness of 10.5 kPa or greater was identified in all patients with esophageal varices.

CONCLUSION. MR elastography of the spleen is feasible and shows promise as a quantitative method for predicting the presence of esophageal varices in patients with advanced hepatic fibrosis.

Keywords: esophageal varices • liver fibrosis • MR elastography • portal hypertension • spleen stiffness


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