Liver and Spleen Stiffness as Non‐Invasive Tools Assessing Liver Congestion in Patients With Budd‐Chiari Syndrome

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.