Open AccessRevisiting the accuracy of splenomegaly by sonography in patients with chronic hepatitis B
Author(s) -
Tung WeiLing,
Yang ChunHsun,
Tseng PoLin,
Hung ChaoHung,
Wang JingHoung,
Chen ChienHung,
Hu TsungHui,
Lu ShengNan,
Xu HuangWei
Publication year - 2020
Publication title -
advances in digestive medicine
Language(s) - English
Resource type - Journals
ISSN - 2351-9800
DOI - 10.1002/aid2.13143
Subject(s) - medicine , cirrhosis , receiver operating characteristic , hilum (anatomy) , gastroenterology , fibrosis , liver biopsy , biopsy , hepatitis b , pathological , chronic hepatitis , ultrasound , radiology , virus , immunology
In Taiwan, the National Health Insurance Scheme reimburses lifelong antiviral agents for cirrhotic patients with hepatitis B virus (HBV) DNA higher than 2000 IU/mL. However, the requirement of image diagnosis is ultrasonographic cirrhosis with splenomegaly. The current study aimed to evaluate the validity of splenomegaly in the diagnosis of chronic hepatitis B (CHB)‐related liver cirrhosis (LC). Eliminated by exclusive criteria, 684 of 743 consecutive CHB patients with available liver biopsy reports were enrolled as the all populations group (Group all). Ultrasound cirrhosis score (UCS) was used to demonstrate the severity of liver fibrosis. A score of 7 as the best cut‐off point in the prediction of CHB‐related LC has been proposed by our previous report. Based on UCS ≥7, 222 patients were selected as the advanced fibrosis populations group (Group fibrosis). The splenic index (SI), the product of two vertical distances from the splenic surface to hilum, was measured retrospectively from the ultrasonographic pictures mostly close to the biopsy day. Splenomegaly is defined as SI ≥20. In Group all and Group fibrosis, the prevalence of pathological LC was 26.2% (179/684) and 64.4% (143/222), respectively. The area under receiver operating characteristic (ROC) curve of the SI in the diagnosis of LC was 72.3% and 68.2% for Group all and Group fibrosis, respectively. Using 20 as a cut‐off value, the accuracy was 73.1% and 60.8%. Based on the ROC curve, the best cut‐off point of the SI should be 17 (sensitivity: 70.4%, specificity: 63.4%) and 18 (sensitivity: 65.7%, specificity: 64.6%), respectively. Splenomegaly is not a good noninvasive surrogate in the diagnosis of LC in patients with CHB.