Spleen Stiffness to Liver Stiffness Ratio and Disease Etiology

Both liver stiffness (LS) and spleen stiffness (SS) are widely used to noninvasively assess liver fibrosis and portal hypertension, respectively. However, the impact of disease etiology, namely, the localization of inflammation (portal versus lobular), on SS/LS remains unclear so far. Recent data indicate that SS is significantly higher in patients with hepatitis C (HCV) as compared to alcoholic liver disease (ALD) (42.0 vs. 32.6 kPa, P < 0.0001) despite a lower mean LS in HCV. Moreover, the SS to LS ratio was significantly higher in HCV (3.8 vs. 1.72) throughout all fibrosis stages. Notably, spleen length linearly increased with SS and the relation between SS and SL was identical in HCV and ALD. In contrast, livers were much larger in ALD at comparable LS. In a prognostic cohort, ALD patients had higher LS values, predominantly presented for jaundice and liver failure was the major cause of death. In contrast, spleens were larger in HCV with variceal bleeding, which was the major cause of decompensation. Thus, combined LS and SS measurements provide additional information about disease etiology and disease-specific complications.