Spleen stiffness accurately tracks early and sustained portal pressure changes after transjugular intrahepatic portosystemic shunt

Figure 1 Flowchart depicting the inclusion process for the study population. TIPS: Transjugular intrahepatic portosystemic shunt; VCTE: Vibrationcontrolled transient elastography; LSM: Liver stiffness measurement; SSM: Spleen stiffness measurement.

Figure 2 Changes in portocaval pressure gradient, liver stiffness measurement, and spleen stiffness measurement before and after transjugular intrahepatic portosystemic shunt. A: Portocaval pressure gradient; B: Spleen stiffness measurement; C: Liver stiffness measurement. PPG: Portocaval pressure gradient; LSM: Liver stiffness measurement; SSM: Spleen stiffness measurement. ^aP < 0.001. ns: Non-significant.

Figure 3 Individual values of portocaval pressure gradient measured immediately before and after transjugular intrahepatic portosystemic shunt and of spleen stiffness measurement and liver stiffness measurement measured within 3 days before and after transjugular intrahepatic portosystemic shunt. A: Individual values of portocaval pressure gradient measured immediately before and after transjugular intrahepatic portosystemic shunt (TIPS); B: Individual values of spleen stiffness measurement measured within 3 days before and after TIPS; C: Individual values of liver stiffness measurement measured within 3 days before and after TIPS. ^aP < 0.001. Pre-PPG: Portocaval pressure gradient before transjugular intrahepatic portosystemic shunt placement; Pre-SSM: Spleen stiffness measurement before transjugular intrahepatic portosystemic shunt placement; Pre-LSM: Liver stiffness measurement before transjugular intrahepatic portosystemic shunt placement.

Figure 4 Correlation analyses between spleen stiffness measurement before transjugular intrahepatic portosystemic shunt placement/Δ spleen stiffness measurement and portocaval pressure gradient before transjugular intrahepatic portosystemic shunt placement/Δ spleen stiffness measurement. A: Spleen stiffness measurement before transjugular intrahepatic portosystemic shunt placement exhibited a moderate positive correlation with Portocaval pressure gradient before transjugular intrahepatic portosystemic shunt placement (pre-PPG) (r = 0.41, P < 0.001); B: Δ Spleen stiffness measurement was strongly negative correlated with ΔPPG (r = -0.57, P < 0.001). Pre-PPG: Portocaval pressure gradient before transjugular intrahepatic portosystemic shunt placement; Pre-SSM: Spleen stiffness measurement before transjugular intrahepatic portosystemic shunt placement; Pre-LSM: Liver stiffness measurement before transjugular intrahepatic portosystemic shunt placement.

Figure 5 Diagnostic performance of liver stiffness measurement and spleen stiffness measurement for predicting good transjugular intrahepatic portosystemic shunt hemodynamic response. A: Receiver operating characteristic curves for transjugular intrahepatic portosystemic shunt (TIPS) hemodynamic response; B: Indicator distributions of spleen stiffness measurement before transjugular intrahepatic portosystemic shunt placement, liver stiffness measurement after transjugular intrahepatic portosystemic shunt placement, spleen stiffness measurement before transjugular intrahepatic portosystemic shunt placement, spleen stiffness measurement after transjugular intrahepatic portosystemic shunt placement, Δ spleen stiffness measurement and Δ liver stiffness measurement between good or poor group in predicting a successful hemodynamic response to TIPS. ROC: Receiver operating characteristic; TIPS: Transjugular intrahepatic portosystemic shunt; Pre-SSM: Spleen stiffness measurement before transjugular intrahepatic portosystemic shunt placement; Pre-LSM: Liver stiffness measurement before transjugular intrahepatic portosystemic shunt placement; Post-SSM: Spleen stiffness measurement after transjugular intrahepatic portosystemic shunt placement; Post-LSM: Liver stiffness measurement after transjugular intrahepatic portosystemic shunt placement.

Figure 6 Decision curve analysis for predicting good hemodynamic response to transjugular intrahepatic portosystemic shunt. TIPS: Transjugular intrahepatic portosystemic shunt.