Objective To investigate the diagnostic value of the spleen stiffness using Acoustic Radiation Force Impulse (ARFI) elatography combined platelet count (PC) in predicting the presence of esophageal varices in patients with hepatitis B virus-related cirrhosis. Methods 232 patients with hepatitis B virus-related cirrhosis were included, the subjects were underwent endoscopy, liver function, blood count, as well as spleen stiffness by ARFI elatography using a ultrasonic instrument named ACUSON S2000. ARFI elatography of spleen was performed in all patients. The patients were divided into no espophageal varices group and esophageal varices group, and the difference between the two groups was compared. Referring to the endoscopy, the spleen stiffness and the platelet count value were assessed by using Receiver Operating Characteristic (ROC) curve analysis. The corresponding cut-off values, sensitivity and specificity were also calculated and compared. Results The mean values of ARFI of spleen were 3.52 (3.16-3.87) m/s and 2.91 (2.35-3.35) m/s in patients with esophageal varices group and without esophageal varices group(P＜0.01). The mean values of PC were 62 (41-88.25) and 129.5 (87.25-196.25) 109/L in patients with esophageal varices group and without esophageal varices group (P＜0.001). Accordingly, the areas under the ROC curves (AUROC) for ARFI of spleen, ARFI of spleen combined platelet count were 0.76 and 0.83 for predicting esophageal varices in patients with hepatitis B virus-related cirrhosis (P = 0.0021), respectively. Conclusions ARFI of spleen combined with PC can improve the diagnostic performance for predicting the presence of esophageal varices in hepatitis B-related cirrhosis.