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©The Author(s) 2019.
World J Gastroenterol. Jan 21, 2019; 25(3): 308-329
Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.308
Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.308
Table 1 Studies on transient elastography for the prediction of varices
| Author, journal, year of publication | Country | Study design | Etiology | N Patients included % with EV % with VNT | TE-Cut-offs and AUC EV/VNT | Main conclusions (Specificity/Sensitivity, PPV/NPV) | |
| Foucher, Gut, 2006[16] | France | Prospective | Mixed | EV: VNT: | 144 42 (29%) 85 (59%) | LSM: n/a 27.5 kPa, AUC 0.73 | LSM: EV: n/a VNT: Sens. 88%, Spec. 53%, PPV: 45%, NPV: 90% |
| Kazemi, J Hepatol, 2006[15] | France | Prospective | Mixed | EV: VNT | Total: 165 74 (44.8%) 47 (28.5%) | LSM: 13.9 kPa, AUC: 0.84 19.0 kPa, AUC 0.83, | LSM: EV: Sens. 92%, Spec. 39%, PPV 55%, NPV 85% VNT: Sens. 89%, Spec. 59%, PPV 47%, NPV: 93% |
| Vizzutti, Hepatology, 2007[80] | Italy | Prospective | HCV | EV: VNT | Total: 61 30 (49.2%) 18 (38.2%) | LSM: 17.6 kPa, AUC 0.76 27.4 kPa, AUC 0.76 | LSM: EV: Sens. 90%, spec. 43%, PPV 77%, NPV 66% VNT: Sens. 70%, spec. 78%, PPV 90%, NPV 55% |
| Bureau, Aliment Pharmacol Ther, 2008[81] | France | Prospective | Mixed | EV: VNT | Total: 150 64 (42.6%) 43 (28.6%) | LSM: EV: 21.1 kPa, AUC 0.85 VNT/large: 29.3 kPa, AUC 0.76 | LSM: EV: sens. 84%, spec. 71% VNT: sens. 81%, spec. 61% |
| Castéra, J Hepatol, 2009[82] | France | Prospective | HCV | EV: VNT | Total: 70 25 (35.7%) 15 (21.4%) | LSM: 13.9 kPa, 17.6 kPa, 21.5 kP; AUC 0.96 19 kPa, 21.5 kPa; 30 kPa, AUC 0.87 | LSM: Cut-off 13.9 kPa: Sens. 96%, Spec. 39%, PPV 49%, NPV 94% Cut-off 17.6 kPa: Sens. 84%, Spec. 61%, PPV 57%, NPV 86% Cut-off 21.5 kPa: Sens. 76%, Spec. 78%, PPV 68%, NPV 84% Cut-off 19.0 kPa: Sens. 85%, Spec. 62%, PPV 35%, NPV 94% Cut-off 21.5 kPa: Sens. 85%, Spec. 68%, PPV 39%, NPV 95% Cut-off 30.5 kPa: Sens. 77%, Spec. 5%, PPV 56%, NPV 94%10 |
| Nguyen-Khac, Alcohol Clin Exp Res; 2010[20] | France | Prospective | Mixed | EV: VNT | Total: 183 NR 41 (22%) | LSM: 48 kPa; AUC 0.75 ALD: 47.2 kPa, AUC 0.77 Viral: 19.8 kPa, AUC 0.73 | LSM: Sens. 73%, Spec. 73%, PPV 44%, NPV 90% ALD: Sens. 85%, Spec. 64%, PPV 44%, NPV 93% Viral: Sens. 89%, Spec. 55%, PPV 27%, NPV 96% |
| Stefanescu, J Gastroenterol Hepatol, 2011[18] | Romania | Prospective | ALD and/or HCV or healthy controls | EV: VNT | Total: 137 116 (85%) 60 (44%) | LSM: EV: 28 kPa, AUC 0.75 SSM: EV: 46.4 kPa, AUC 0.78 LSM + SSM: EV: LSM 19 kPa, SSM 55 kPa NR | LSM: Sens. 74%, Spec. 64%, PPV 92%, NPV 31% SSM: Sens. 84%, Spec. 71%, PPV 94%, NPV 46% LSM (19 kPa) + SSM (55 kPa): Sens. 93%, Spec. 40%, PPV 95%, NPV 33% NR |
| Stefanescu, J Gastrointestin Liver Dis, 2011[83] | Romania | Prospective | ALD and/or HCV | EV: VNT | Total: 231 157 (68%) 68 (30%) | LSM: 19 kPa, AUC 0.66 38 kPa, AUC 0.69 | LSM: Sens. 84%, Spec. 32%, PPV 72%, NPV 49% Sens. 56%, Spec. 75%, PPV 47%, NPV 81% |
| Chen, J Gastroenterol Hepatol, 2012[84] | China | Prospective | HBV | EV: VNT | Total: 222 96 (43%) 82 (40%) | LSM: NR All 17.1 kPa, AUC 0.73 ALT >5 x ULN: 36.1 kPa, AUC 0.92 CPC A, rule-out EV : 7.9 kPa, AUC 0.79 CPC A, rule-in 34.6 kPa, AUC 0.79 | LSM: NR Cut-off 17.1 kPa: Sens. 90%, Spec. 44%, PPV 47%, NPV: 88% Cut-off 36.1 kPa: PPV 73%, NPV 100% Cut-off 7.9 kPa: Sens. 97%, NPV 95% Cut-off 34.6 kPa: Spec. 94%, PPV 73% LSPS: Cut-off 3.5: Sens. 78%, NPV 86% (exclusion) Cut-off 5.5: Spec. 90%, PPV 76% (inclusion) |
| Wang, J Gastroenterol Hepatol, 2012[85] | Taiwan | Prospective | HBV | EV: VNT | Total: 126 48 (38%) 13 (10%) | LSM: 12.0 kPa, AUC 0.79 21.0 kPa, AUC 0.87 | LSM: Sens. 67%, Spec. 77%, PPV 64%, NPV 79% Sens. 77%, Spec. 87%, PPV 40%, NPV 97% |
| Colecchia, Gastroenterology, 2012[32] | Italy | Prospective | HCV | EV: VNT: | Total: 100 53 (53%) 26 (26%) | LSM (AUC 0.90): cut-off 16.4 kPa cut-off 25.0 kPa SSM (AUC 0.94): cut-off 41.3 kPa cut-off 55.0 kPa NR | LSM: Sens. 96%, Spec. 60% (rule out) Sens. 57%, Spec. 98% (rule in) SSM: Sens. 98%, Spec. 66% (rule out) Sens. 72%, Spec. 96% (rule in) NR |
| Sporea, Med Ultrason, 2013[86] | Romania | Prospective | Viralalcoholic | EV: VNT: | Total: 697 387 (54.5%) 273 (39.1%) | NR All: 29.5 kPa (0.871) Alcohol: 32.5 kPa (0.836) Viral: 24.8 kPa (0.867) | NR Sens. 77.5%, Spec. 86.9% Sens. 85.0%, Spec. 74.6% Sens. 81.0%, Spec. 80.7% |
| Calvaruso, J Viral Hepat, 2013[33] | Italy | Prospective | HCV | EV: VNT: | Total: 96 54 (56.3%) 26 (27.1%) | LSM:17.0 kPa, AUC 0.71 Modified SSM (0-150kPa): 50.0kPa, AUC 0.70 LSM: 19.0 kPa, AUC 0.71 Modified SSM (0-150kPa): 54.0 kPa, AUC 0.82 | LSM: Sens. 71%, Spec. 57%, PPV 67%, NPV 62% Modified SSM: Sens. 65%, Spec. 61%, PPV: 69%, NPV: 57% LSM: Sens. 72% Spec. 55%, PPV 38%, NPV 84% Modified SSM: Sens. 80%, Spec. 70%, PPV: 47%, NPV: 90% |
| Shi, Liver Int, 2013[87] | China | Meta-analysis | Mixed Sub-analyses for viral etiologies | EV: VNT: | Total: 3644 1786 (49.0%) 1166 (32.0%) | LSM (pooled): 15.1-28.0 kPa; AUC 0.84 17.8-48.0 kPa; AUC 0.78 | LSM (pooled): Sens. 87%, Spec. 53%, PPV 79%, NPV 64% Sens. 86%, Spec. 59%,, PPV 79%, NPV 66% |
| Sharma, Am J Gastroenterol, 2013[30] | India | Prospective | Mixed | EV: VNT: | Total: 174 124 (71.3%) 78 (44.8%) | LSM: 27.3 kPa, AUC 0.91; SSM: 40.8 kPa, AUC 0.90 NR | LSM: Sens. 91%, Spec. 72%, PPV 89%, NPV 76%, SSM: Sens. 94%, Spec. 76%, PPV 91%, NPV 84% |
| Hassan, Gastroenterol Hepatol, 2014[88] | Egypt | Prospective | HCV | EV: VNT: | Total: 62 50 (81%) 32 (52%) | LSM: 18.2 kPa, AUC 0.79 22.4 kPa, AUC 0.80 | LSM: Sens. 82%, Spec. 73%, PPV 89%, NPV 49% Sens. 84%, Spec. 72%, PPV 84%, NPV 72% |
| Binţinţan, Med Ultrason, 2015[21] | Romania | Prospective | ViralALD | EV: VNT: | Total: 60 47 (78%) 32 (53%) | LSM: 15 kPa, AUC 0.96 28.8 kPa, AUC 0.90 | LSM: Sens. 95%, Spec. 100%, PPV 100%, NPV 86% Sens. 87%, Spec. 83%, PPV: 84%, NPV: 86% |
| Hu, Ultrasound Med Biol, 2015[89] | China | Prospective | Viral | EV: VNT: | Total: 200 110 (55%) 69 (35%) | LSM: 20.3 kPa, AUC 0.84 25.6 kPa, AUC 0.86 | LSM: Sens. 84%, Spec. 73%, PPV 72%, NPV: 91% Sens. 86%, Spec. 72%, PPV 79%, NPV: 81% |
| Li et al. Rev Esp Enferm Dig 2016[90] | International | Meta-analysis | Mixed | EV: VNT: | Total: 2,994 Studies: 20 NR NR | LSM NR 14.5-48.0 kPa (0.83) | LSM Sens 81%, Spec 71%, |
| Wong, J Dig Dis, 2016[17] | Hong Kong | Prospective | Chronic HBV | EV: VNT: | Total: 144 31 (21.5%) 2 (1.4%) | LSM: (0.690) Rule out: 6.8 kPa Rule in: 20.8 kPa SSM: (0.736) Rule out: 21.4 kPa Rule in: 50.5 kPa NR | Sens. 90.3%, Spec 29.2%, PPV 25.9%, NPV 91.7% Sens. 29.0%, Spec. 90.3%, PPV 45.0%, NPV 82.3% Sens. 90.3%, Spec 43.4%, PPV 30.4%, NPV 94.2% Sens. 45.2%, Spec. 90.3%, PPV 56.0%, NPV 85.7% NR |
| Maurice, J Hepatol, 2016 [22] | United Kingdom | Retrospective | Mixed | EV: VNT: | Total: 310 72 (23%) 15 (5%) | LSM: 20 kPa, AUC 0.686 LSM (20 kPa) and PLT (150 G/L): AUC 0.746 | Sens. 67%, Spec. 55%, PPV 7%, NPV 97% Sens. 87%, Spec. 34%, PPV 6%, NPV 98% |
| Abraldes, Hepatology, 2016 [19] | International | Retrospective | Mixed | EV: VNT: | Total: 518 217 (42%) 67 (13%) | NR (AUC 0.71) LSM: 14.0 kPa (AUC 0.67) LSM (20 kPa) and PLT (150 G/L): AUC 0.76 | NR NR NR |
| Marot, Liver Int, 2017[25] | International | Meta-analysis | Mixed | EV: VNT | Total: 3364 NR (49.0%) NR (32.0%) | LSM: 20 kPa: AUC: NR LSM (20 kPa) and PLT (150 G/L): AUC: NR | LSM and PLT (150 G/L): Sens. 89%, Spec. 38%, PPV: 43%, NPV: 86% Sens. 93%, Spec. 30%, PPV 14%, NPV 97% |
| Pu, World J Gastroenterol, 2017[26] | International | Meta-analysis | Mixed | EV: VNT: | Total: 2697 NR NR | LSM (pooled): 20 kPa, AUC 0.83 30 kPa, AUC: 0.83 | LSM: Pooled: Sens. 84%, Spec. 62%, Cut-off 20 kPa: Sens. 83%, Spec. 68%, PPV: n/a, NPV: n/a Pooled: Sens. 78%, Spec. 76%, Cut-off 30 kPa: Sens. 73%, Spec. 74%, PPV: n/a, NPV: n/a |
| Llop, J Gastroenterol Hepatol, 2017[23] | Spain | Retrospective analysis of prospective data | Mixed | EV: VNT: | Total: 161 25 (15.5%) NR | LSM: 20.0 kPa, AUC: NR LSM (20 kPa) and Plt (150 G/L), AUC: NR | LSM: Sens. 76%, Spec. 71%, PPV: 32%, NPV: 94% LSM+Plt: Sens. 88%, Spec. 38%, PPV 21%, NPV 94% |
| Wong, Liver Int, 2018[27] | Hong Kong | Prospective | Mixed | EV: VNT: | TE exam.: 264 51 (18.6%) 11 (4.0%) | LSM:20.0 kPa, AUC: NR LSM (20 kPa) and Plt (150 G/L): AUC: NR SSM: 41.3 kPa; AUC: NR | LSM: Sens: 96%, Spec.: 26%, PPV: 47%, NPV: 91% LSM+PLT: Sens. 91%, Spec.: 18.1%, PPV: 10%, NPV: 96% NR |
| Manatsathit, J Gastroenterol Hepatol, 2018[31] | USA | Meta-analysis | Mixed | EV: VNT: | LSM: 4,337 SSM: 1,1119 LSM: 1681 (56%) SSM: 968 (51%) LSM: 1466 (34%) SSM: 383 (34%) | LSM (pooled): cut-offs NR; AUC 0.82 SSM (pooled): cut-offs NR; AUC: 0.90 LSM (pooled): cut-offs NR; AUC 0.83 SSM (pooled): cut-offs NR; AUC 0.81 | LSM (pooled): Sens. 84%, Spec. 64% SSM (pooled): Sens. 91% Spec. 66% LSM: Sens. 85%, Spec. 64% SSM: Sens. 90%, Spec. 73% LSM: Sens. 85%, Spec. 63% SSM: Sens. 87%, Spec. 52% |
| Petta, J Hepatol, 2018[28] | Italy | Retrospective analysis of prospective data | NAFLD/NASH | EV: VNT: | Total: 790 249 (31.5%) 91 (11.5%) | NR LSM: 20 kPa + Plt 150 G/L: AUC LSM 25 kPa + Plt 110 G/L: AUC LSM 30 kPa + Plt 110 G&L: | NR Validation set: Sens. 37%, spec. 96%, PPV:18%, NPV:0.96 XL probe, Validation set: Sens. 93%, spec. 51%, PPV: 18%, NPV:98% M probe, validation set: Sens. 78%, spec. 68%, PPV:27%, NPV:96% |
| Colecchia, J Hepatol, 2018[34] | Italy | Prospective + retrospective validation cohort | Mixed | EV: VNT: | Total: 498 252 (50.6%) 100 (20.1%) | NR LSM: AUC: 0.768 LSM (20 kPa) + Plt (150 G/L): AUC 0.732 SSM: 46 kPa: AUC 0.847 LSM (20 kPa)+Plt (150 G/L)+SSM (46 kPa):AUC 0.787 | NR NR Sens. 98%, Spec. 26%, NPV 98% Sens. 98%, Spec. 44%, NPV 99% Sens. 96%, Spec. 53%, NPV 98% |
Table 2 Point shear wave elastography for the prediction of varices
| Ref. | Country | Study design | N | Etiology | Device | Cut-off (AUC) for EV | Sens/Spec/+LR/-LR/p for EV | Cut-off (AUC) for VNT | Se/Sp/+LR/-LR/p for VNT | Comments |
| Vermehren, Liver International 2011[41] | Germany | Prospective | 166 | Mixed | Acuson S2000 | NR | NR | L-SWE: (0.58) S-SWE: (0.58) Youden: 4.13 m/s Highest NPV: 3.04 m/s | NR Youden: 35%/83%/2.06/0.78/PPV 54%/NPV 69% Highest NPV: 90%/25%/1.19/0,4/PPV 40%/NPV 81% | Cut-offs only calculated for S-SWE and TE, but not for L-SWE |
| Bota, Annals of Hepatology, 2012[39] | Romania | Prospective | 145 Cirrhosis: 24 | Mixed, healthy | Acuson S2000 | NR | NR | L-SWE: 2.25 m/s (0.596) S-SWE: 2.55 m/s (0.578) PRED: 0.395 (0.721) | LSM: 93.4%/28.9%/PPV48.5%/NPV:85.7% SSM: 96.7%/21%/PPV:47.6%/NPV:53.1% PRED: 75%/61.8%/PPV:61.4%/NPV:69.6%/p=0.0001 | VNT: Varices ≥grade 2 |
| Ye, Journal of Ultrasound in Medicine, 2012[91] | China | Prospective | 264, cirrhosis: 141 | Chronic HBV, healthy | Acuson S2000 | L-SWE: 3.16 m/s (0.83) | 84.1%/81.0%/NR | L-SWE: 3.39 m/s (0.83) | 78.9%/78.3% | Main focus on liver stiffness evaluation VNT: Varices ≥grade 3 |
| Takuma et al. Gastroenterology 2013[42] | Japan | Prospecttive | 340 | Mixed | Acuson S2000 | S-SWE: cirrhosis: 3.17 m/s (0.933) Comp.: 3.18 m/s (0.934) Decomp: 3.22 m/s (0.936) Viral: 3.18 m/s (0.937) Nonviral: 3.24 m/s (0.923) L-SWE: NR (0.746) | 98.4%/60.1%/2.468/0.025/PPV 61.0%/NPV 98.4%/acc. 75.0% 98.4%/63.4%/2.689/0.025/PPV: 50.4%/NPV: 99.0%/acc: 73.0% 98.6%/50.0%/1.971/0.029/PPV: 75.8%/NPV: 85.7%/acc: 79.8% 98.9%/59.9%/2.464/0.019/PPV: 57.5%/NPV: 99.0%/acc: 73.7% 97.7%/65.2%/2.808/0.036/PPV: 57.5%/NPV: 99.0%/acc: 73.7% | S-SWE: cirrhosis: 3.30 m/s (0.930) Comp: 3.30 m/s (0.921) Decomp: 3.45 m/s (0.934); S-Viral: 3.30 m/s (0.924); Nonviral: 3.41 m/s (0.944) | 98.9%/62.9%/2.661/0.018/PPV 47.8%/NPV 99.4%/acc. 72.1% 97.5%/66.7%/2.925/0.038/PPV: 38.6%/NPV: 99.2%/acc: 72.1% 97.9%/73.1%/3.643/0.029/PPV: 71.9%/NPV: 98.0%/acc: 83.3% 98.2%/63.8%/2.243/0.029/PPV: 43.2%/NPV: 99.2%/acc: 71.3% 96.9%/71.9%/2.267/0.043/PPV: 66.0%/NPV: 97.6%/acc: 80.9% | No cut-offs for L-SWE reported - significantly superior S-SWE results |
| Mori, BioMed Research International 2013[92] | Japan | Prospective | 33 cirrhosis: 24 | Mixed, including healthy | Acuson 2000 | NR | NR | NR | NR | Neither liver nor spleen stiffness correlated with presence of EV |
| Salzl, Ultraschall in der Medizin, 2014[36] | Austria | Prospective | 88 | Mixed | Acuson S2000 | L-SWE: 2.74 m/s (0.743) | 62.5%/89.5%/PPV: 91.5%/NPV: 56.9% | NR | NR | Size of EV was not defined |
| Morishita, Journal of Gastroenterology 2014[93] | Japan | Prospective | 181 | Chronic HCV | Acuson S2000 | L-SWE: 2.05 m/s (0.890) | Training set: 83%/76%/PPV: 78%/NPV: 81% Validation set: 83%/77%/PPV 59%/NPV: 92% | L-SWE: 2.39 m/s (0.868) | Training set: 81%/82%/PPV: 69%/NPV: 89% Validation set: 83%/77%/PPV: 59%/NPV: 92% | |
| Park, PloS ONE, 2015[94] | South Korea | Prospective | 143 | Mixed | Acuson S2000 | L-SWE: 2.08 m/s (0.769) ASPS: 1.67 (0.903) | 64.9%/81.1%/3.44/0.43/PPV 54.5%/NPV: 86.9% 81.1%/84.0%/5.06/0.23/PPV 63.8%/NPV: 92.7% | L-SWE: 1.90 (0.786) ASPS: 2.83 (0.946) | 85%/67.5%/2.61/0.22/PPV: 29.8%/NPV: 96.5% 90%/94.3%/15.81/0.11/PPV: 72.0%/NPV: 98.3% | High discriminative power of ASPS confirmed in validation cohort |
| Attia, Ultraschall in der Medizin, 2015[95] | Germany | Prospective | 78 | Mixed | Acuson S2000 | L-SWE (HVPG ≥10mmHg): 2.29 m/s (0.840) L-SWE (HVPG ≥12mmHg): 2.70 m/s (0.878) S-SWE (HVPG≥10mmHg):2.55 m/s(0.899) S-SWE (HVPG≥12mmHg):2.71 m/s (9.31) | 91%/85%/6.08/0.1/<0.001/PPV 95%/NPV 74% 93%/77%/400/0.09/<0.001/PPV 89%/NPV 85% 95%/90%/9.06/0.05/<0.001/PPV 97%/NPV 85% 95%/92%/11.86/0.06/<0.001/PPV97%/NPV 89% | NR | NR | SSM independently predicted presence of CSPH+EV |
| Kim, Medicine, 2015[96] | Korea | Prospective | 125 | Mixed | Acuson S2000 | L-SWE: cutoff NR (0.747) S-SWE: 3.16 m/s(0.785) | NR 87.0%/60.4%/PPV 77.9%/NPV 64.4% | L-SWE: cutoff NR (0.687) S-SWE: 3.40 m/s (0.762) | NR 78.9%/63.0%/PPV 60.3%/NPV 80.7% | VNT: medium-large varices |
| Park, Medical Ultrasound, 2016[97] | South Korea | Prospective | 366 | ALD or viral | iU22 | L-SWE: NR S-SWE: 29.9 kPa (0.859) | L-SWE:NR S-SWE: 58.1%/79.1%/<0.001/PPV:81.6%/NPV:82.8% | NR | NR | High rate of unreliable results (25%) No significant correlation with L-SWE |
| Wiles, Clinical Radiology, 2018[98] | UK | Prospective | 58 | Mixed | Acuson S2000 | NR | NR | NR | NR | ARFI not suitable to predict GOV (P = 0.15) |
| Lucchina et al. Ultrasound Med Biol 2018[38] | Italy | Prospective | 42 | Mixed | iU22 | L-SWE: 12.27 kPa (0.913)S-SWE: 23.87kPa (0.675) | 100%/66.67%/NR 73,81%/59.52%/NR | NR | NR | High rate of inconclusive results (22%) |
Table 3 Two-dimensional shear wave elastography for the prediction of varices
| Ref. | Country | Study design | Nr. | Etiology | Model | Cut-off (AUC) for EV | Sens/Spec/+LR/-LR/p for EV | Cut-off (AUC) for VNT | Se/Sp/+LR/-LR/p for VNT | Comment |
| Kim, Liver International, 2015[51] | Korea | Prospective | 92 | Mixed | Aixplorer | L-SWE: All patients: 26.3 kPa (0.683) Compensated cirrhosis: 14.2 kPa (0.925) | L-SWE: All patients: 61.4%/75.0%/PPV 89.6%/NPV 35.7%/P = 0.004 Compensated cirh.: 87.5%/90.0%/PPV 93.3%/NPV 81.8%/ P < 0.001 | NR | NR | Main focus on prediction of PHT/CSPH |
| Grgurevic, Croatian Medical Journal 2015[53] | Croatia | Retrospective | 44 | Mixed | Aixplorer | L-SWE: 19.7 kPa (0.796) S-SWE: 30.3 kPa (0.790) | L-SWE: 83.3%/66.6%/2.5/0.25/0.037 S-SWE: 79.6%/75.8%/3.3/0.27/0.009 | NR | NR | |
| Kasai Journal of Medical Ultrasonics, 2015[54] | Japan | Retrospective | 273 | Mixed | Aixplorer | Cut-off: NR AUC: (0.807) | NR | NR | NR | No cut-offs or sensitivity analyses reported; varices: ≥ grade 2 |
| Elkrief et al. Radiology 2015[56] | France | Prospective | 79 | Mixed | Aixplorer | NR | NR | NR | NR | EV not evaluated; Neither L-SWE, nor S-SWE, nor L-TE, nor LSPS predictive of VNT, but predictive of CSPH |
| Cassinotto, Digestive Liver Disease 2015[99] | France | Prospective | 401 | Mixed | Aixplorer | NR | NR | L-SWE: 12.8 (0.70) S-SWE: 25.6 (0.75) | L-SWE: 92%/36%/1.44/0.22/NR/PPV: 44%/NPV: 90% S-SWE: 94%/36%/1.47/0-17/NR/PPV:50%/NPV:90% | |
| Kim et al. Journal of Ultrasound in Medicine 2016[55] | Korea | Retrospective | 103 | Mixed | Aixplorer | L-SWE: 13.9 kPa (0.887) | 75%/88.9%/6.75/0.28/< 0.001 | 16.1 kPa (0.880) | 84.6%/85.6%/5.86/0.18/< 0.001 |
Table 4 Magnetic resonance elastography for prediction of varices
| Author, Journal, Year | Liver/Spleen | Patient N | Etiology | Cut-offs for EV (AUC) | EV: Sens/Spec/+LR/-LR/acc/p | Cut-offs for VNT (AUC) | VNT: Sens/Spec/+LR/-LR/acc/p | Prevalence of EV and VNT | Comment |
| Ronot et al. Eur Radiol 2014[63] | yes/yes | 36 | mixed | NR | NR | Gl, 84 Hz: 4.2 kPa (0.93) | 54%/100%/PPV: 33%/NPV: 79%/P = 0.001 | Any EV: 75%; VNT: 72% | Liver MRE not predictive of EV or VNT. Advantage of 3D multifrequency MRE |
| Sun et al. J Magn Reson Imaging 2014[62] | yes/no | 126 | mixed | L-MRE: 4.63 kPa (0.859) | NR | L-MRE: 5.803 kPa (0.810) | L-MRE: 96%/60%/n.r. | Any EV: 49%; VNT: 19% | Pearson correlation coefficient between liver stiffness and EV: 0.63 (P < 0.0001). |
| Shin et al. Radiology 2014[61] | yes/yes | 139 | mixed | L-MRE: 4.58 kPa (0.821) S-MRE: 7.23 kPa (0.833) | L-MRE: 87.4%/65.6%/n.r. S-MRE: 85.8%/65.4%/n.r. | L-MRE: 4.81 kPa (0.755) S-MRE: 7.60 kPa (0.750) | L-MRE: 84.4%/56.7%/n.r S-MRE: 68.3%/61.6%/n.r. | Any EV: 56%; VNT: 32% | Data cross-validated; several false-positive diagnoses of EV and VNT due to high liver stiffness and non-esophageal collaterals; 11 cases of false-negative diagnoses of EV: pre-hepatic PHT, iron deposition, large ascites. |
| Matsui, Journal of Gastroenterology and Hepatology, 2018[100] | yes/no | 627 | mixed | MRE: 4.2 kPa (0.85) PLT: 18*104 (0.77) | MRE: 85%/69%/PPV 32%/NPV 96% MRE + PLT: 93%/43%/PPV 22%/NPV 96% | MRE: 4.2 kPa (0.85) PLT: 18*104 (0.77) | MRE: 94%/65%/PPV 17%/ NPV 99% MRE + PLT: 100%/35%/PPV 10%/ NPV 100% | Any EV: 15.6% VNT: 4.5% | 3T device; also validated Baveno VI criteria (1) and modified Baveno VI criteria (30); excellent performance in NAFLD and viral hepatitis |
| Bookwalter, Abdominal Radiology, 2018[101] | yes/no | 55 | PSC | 6.27 kPa (NR) | Sens. 100%/Spec. 76.7% | NR | NR | NR | Several sequences, 2D and 3D modes, at 1,5T and 3T; Varices assessed by global LSM |
| Kim, European Radiologist, 2017[102] | yes/no | 84 | NR | GRE-MRE: (0.948) SE-EPI-MRE: (0.914) | NR | GRE-MRE: 4.493 kPa (0.752) SE-EPI-MRE: 5.880 kPa (0.839) | NR | Any EV: 17.9% VNT: 8.3% | Neither SE-EPI-, nor GRE-MRE reached significance regarding diagnostic performance |
- Citation: Paternostro R, Reiberger T, Bucsics T. Elastography-based screening for esophageal varices in patients with advanced chronic liver disease. World J Gastroenterol 2019; 25(3): 308-329
- URL: https://www.wjgnet.com/1007-9327/full/v25/i3/308.htm
- DOI: https://dx.doi.org/10.3748/wjg.v25.i3.308