Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study

Christian Sebesta; Mathias Jachs; Lukas Hartl; Michael Schwarz; Lorenz Balcar; Benedikt S Hofer; Nina Dominik; Georg Kramer; Bernhard Scheiner; Albert F Stättermayer; Benedikt Simbrunner; Till Schöchtner; Friedrich Haimberger; Nicolas Balutsch; Michael Trauner; Mattias Mandorfer; Thomas Reiberger; David J M Bauer

doi:10.1111/liv.70261

Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study

Christian Sebesta, Mathias Jachs, Lukas Hartl, Michael Schwarz, Lorenz Balcar, Benedikt S Hofer, Nina Dominik, Georg Kramer, Bernhard Scheiner, Albert F Stättermayer, Benedikt Simbrunner, Till Schöchtner, Friedrich Haimberger, Nicolas Balutsch, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, David J M Bauer

Research output: Journal article (peer-reviewed) › Journal article

Abstract

BACKGROUND: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.

METHODS: 399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included.

RESULTS: While patients with alcohol-related liver disease (ALD; n = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction-associated steatohepatitis (MASH; n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; p = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG.

CONCLUSIONS: This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. Since MASH patients-after adjusting for liver disease severity-show higher SSM/LSM ratios and larger spleen diameters than ALD, our results support the concept of a presinusoidal component of PH in MASH patients.

Original language	English
Article number	e70261
Pages (from-to)	e70261
Journal	Liver International
Volume	45
Issue number	10
DOIs	https://doi.org/10.1111/liv.70261
Publication status	Published - Oct 2025
Externally published	Yes

Keywords

Humans
Prospective Studies
Male
Middle Aged
Spleen/diagnostic imaging
Female
Hypertension, Portal/physiopathology
Liver/diagnostic imaging
Elasticity Imaging Techniques
Adult
Aged
Fatty Liver/complications
Portal Pressure
Liver Diseases, Alcoholic/complications

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10.1111/liv.70261

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Sebesta, C., Jachs, M., Hartl, L., Schwarz, M., Balcar, L., Hofer, B. S., Dominik, N., Kramer, G., Scheiner, B., Stättermayer, A. F., Simbrunner, B., Schöchtner, T., Haimberger, F., Balutsch, N., Trauner, M., Mandorfer, M., Reiberger, T., & Bauer, D. J. M. (2025). Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study. Liver International, 45(10), e70261. Article e70261. https://doi.org/10.1111/liv.70261

@article{2dedefc06c34488bbec71381c34841f9,

title = "Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study",

abstract = "BACKGROUND: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.METHODS: 399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included.RESULTS: While patients with alcohol-related liver disease (ALD; n = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction-associated steatohepatitis (MASH; n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; p = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG.CONCLUSIONS: This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. Since MASH patients-after adjusting for liver disease severity-show higher SSM/LSM ratios and larger spleen diameters than ALD, our results support the concept of a presinusoidal component of PH in MASH patients.",

keywords = "Humans, Prospective Studies, Male, Middle Aged, Spleen/diagnostic imaging, Female, Hypertension, Portal/physiopathology, Liver/diagnostic imaging, Elasticity Imaging Techniques, Adult, Aged, Fatty Liver/complications, Portal Pressure, Liver Diseases, Alcoholic/complications",

author = "Christian Sebesta and Mathias Jachs and Lukas Hartl and Michael Schwarz and Lorenz Balcar and Hofer, \{Benedikt S\} and Nina Dominik and Georg Kramer and Bernhard Scheiner and St{\"a}ttermayer, \{Albert F\} and Benedikt Simbrunner and Till Sch{\"o}chtner and Friedrich Haimberger and Nicolas Balutsch and Michael Trauner and Mattias Mandorfer and Thomas Reiberger and Bauer, \{David J M\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Liver International published by John Wiley \& Sons Ltd.",

year = "2025",

month = oct,

doi = "10.1111/liv.70261",

language = "English",

volume = "45",

pages = "e70261",

journal = "Liver International",

issn = "1478-3223",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "10",

}

Sebesta, C, Jachs, M, Hartl, L, Schwarz, M, Balcar, L, Hofer, BS, Dominik, N, Kramer, G, Scheiner, B, Stättermayer, AF, Simbrunner, B, Schöchtner, T, Haimberger, F, Balutsch, N, Trauner, M, Mandorfer, M, Reiberger, T & Bauer, DJM 2025, 'Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study', Liver International, vol. 45, no. 10, e70261, pp. e70261. https://doi.org/10.1111/liv.70261

TY - JOUR

T1 - Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study

AU - Sebesta, Christian

AU - Jachs, Mathias

AU - Hartl, Lukas

AU - Schwarz, Michael

AU - Balcar, Lorenz

AU - Hofer, Benedikt S

AU - Dominik, Nina

AU - Kramer, Georg

AU - Scheiner, Bernhard

AU - Stättermayer, Albert F

AU - Simbrunner, Benedikt

AU - Schöchtner, Till

AU - Haimberger, Friedrich

AU - Balutsch, Nicolas

AU - Trauner, Michael

AU - Mandorfer, Mattias

AU - Reiberger, Thomas

AU - Bauer, David J M

PY - 2025/10

Y1 - 2025/10

N2 - BACKGROUND: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.METHODS: 399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included.RESULTS: While patients with alcohol-related liver disease (ALD; n = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction-associated steatohepatitis (MASH; n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; p = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG.CONCLUSIONS: This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. Since MASH patients-after adjusting for liver disease severity-show higher SSM/LSM ratios and larger spleen diameters than ALD, our results support the concept of a presinusoidal component of PH in MASH patients.

AB - BACKGROUND: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.METHODS: 399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included.RESULTS: While patients with alcohol-related liver disease (ALD; n = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction-associated steatohepatitis (MASH; n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; p = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG.CONCLUSIONS: This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. Since MASH patients-after adjusting for liver disease severity-show higher SSM/LSM ratios and larger spleen diameters than ALD, our results support the concept of a presinusoidal component of PH in MASH patients.

KW - Humans

KW - Prospective Studies

KW - Male

KW - Middle Aged

KW - Spleen/diagnostic imaging

KW - Female

KW - Hypertension, Portal/physiopathology

KW - Liver/diagnostic imaging

KW - Elasticity Imaging Techniques

KW - Adult

KW - Aged

KW - Fatty Liver/complications

KW - Portal Pressure

KW - Liver Diseases, Alcoholic/complications

UR - https://www.scopus.com/pages/publications/105014618644

U2 - 10.1111/liv.70261

DO - 10.1111/liv.70261

M3 - Journal article

C2 - 40884085

SN - 1478-3223

VL - 45

SP - e70261

JO - Liver International

JF - Liver International

IS - 10

M1 - e70261

ER -

Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study

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Keywords

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