Journal article
2D shear wave liver elastography by Aixplorer to detect portal hypertension in cirrhosis: An individual patient data meta-analysis.
- Thiele M Department of Gastroenterology and Hepatology and OPEN Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Hugger MB Department of Gastroenterology and Hepatology and OPEN Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Kim Y Department of Radiology, College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea.
- Rautou PE Centre de recherche sur l'inflammation, Inserm, Université de Paris, Paris, France.
- Elkrief L Centre de recherche sur l'inflammation, Inserm, Université de Paris, Paris, France.
- Jansen C Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- Verlinden W Department of Gastroenterology Hepatology, University Hospital Antwerp & Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- Allegretti G Unit of Internal Medicine, Hospital S.Orsola-Malpighi, University of Bologna, Bologna, Italy.
- Israelsen M Department of Gastroenterology and Hepatology and OPEN Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Stefanescu H Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
- Piscaglia F Unit of Internal Medicine, Hospital S.Orsola-Malpighi, University of Bologna, Bologna, Italy.
- García-Pagán JC Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and CIBEREHD, University of Barcelona, Barcelona, Spain.
- Franque S Department of Gastroenterology Hepatology, University Hospital Antwerp & Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- Berzigotti A Hepatology, UVCM, Inselspital, University of Bern, Bern, Switzerland.
- Castera L Centre de recherche sur l'inflammation, Inserm, Université de Paris, Paris, France.
- Jeong WK Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Trebicka J Department of Gastroenterology and Hepatology and OPEN Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Krag A Department of Gastroenterology and Hepatology and OPEN Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- 2020-03-18
Published in:
- Liver international : official journal of the International Association for the Study of the Liver. - 2020
Aixplorer
Decompensated liver disease
compensated advanced chronic liver disease
liver vein catheterization
supersonic shear imagine
English
BACKGROUND & AIMS
Liver stiffness measured with 2-dimensional shear wave elastography by Supersonic Imagine (2DSWE-SSI) is well-established for fibrosis diagnostics, but non-conclusive for portal hypertension.
METHODS
We performed an individual patient data meta-analysis of 2DSWE-SSI to identify clinically significant portal hypertension (CSPH), severe portal hypertension and large varices in cirrhosis patients, using hepatic venous pressure gradient and upper endoscopy as reference. We used meta-analytical integration of diagnostic accuracies with optimized rule-out (sensitivity-90%) and rule-in (specificity-90%) cut-offs.
RESULTS
Five studies from seven centres shared data on 519 patients. After exclusion, we included 328 patients. Eighty-nine (27%) were compensated and 286 (87%) had CSPH. 2DSWE-SSI < 14 kPa ruled out CSPH with a summary AUROC (sROC), sensitivity and specificity of 0.88, 91% and 37%, and correctly classified 85% of patients, with minimal between-study heterogeneity. The false negative rate was 60%, of which decompensated patients accounted for 78%. 2DSWE-SSI ≥ 32 kPa ruled in CSPH with sROC, sensitivity, specificity and correct classifications of 0.83, 47%, 89% and 55%. In a subgroup analysis, the 14 kPa cut-off showed consistent sensitivity and higher specificity for patients with compensated cirrhosis, without ascites, viral aetiology or BMI < 25 kg/m2 . 2DSWE-SSI ruled out severe portal hypertension and large varices with fewer correctly classified and lower sROC, and with minimal benefit for ruling in.
CONCLUSION
Liver stiffness using 2-dimensional shear wave elastography below 14 kPa may be used to rule out clinically significant portal hypertension in cirrhosis patients, but this would need validation in populations of compensated liver disease. 2DSWE-SSI cannot predict varices needing treatment.
Liver stiffness measured with 2-dimensional shear wave elastography by Supersonic Imagine (2DSWE-SSI) is well-established for fibrosis diagnostics, but non-conclusive for portal hypertension.
METHODS
We performed an individual patient data meta-analysis of 2DSWE-SSI to identify clinically significant portal hypertension (CSPH), severe portal hypertension and large varices in cirrhosis patients, using hepatic venous pressure gradient and upper endoscopy as reference. We used meta-analytical integration of diagnostic accuracies with optimized rule-out (sensitivity-90%) and rule-in (specificity-90%) cut-offs.
RESULTS
Five studies from seven centres shared data on 519 patients. After exclusion, we included 328 patients. Eighty-nine (27%) were compensated and 286 (87%) had CSPH. 2DSWE-SSI < 14 kPa ruled out CSPH with a summary AUROC (sROC), sensitivity and specificity of 0.88, 91% and 37%, and correctly classified 85% of patients, with minimal between-study heterogeneity. The false negative rate was 60%, of which decompensated patients accounted for 78%. 2DSWE-SSI ≥ 32 kPa ruled in CSPH with sROC, sensitivity, specificity and correct classifications of 0.83, 47%, 89% and 55%. In a subgroup analysis, the 14 kPa cut-off showed consistent sensitivity and higher specificity for patients with compensated cirrhosis, without ascites, viral aetiology or BMI < 25 kg/m2 . 2DSWE-SSI ruled out severe portal hypertension and large varices with fewer correctly classified and lower sROC, and with minimal benefit for ruling in.
CONCLUSION
Liver stiffness using 2-dimensional shear wave elastography below 14 kPa may be used to rule out clinically significant portal hypertension in cirrhosis patients, but this would need validation in populations of compensated liver disease. 2DSWE-SSI cannot predict varices needing treatment.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1111/liv.14439
- PMID 32180327
- Persistent URL
- https://sonar.ch/global/documents/90105
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