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Diagnostic accuracy of transient elastography in diagnosing clinically significant portal hypertension in patients with chronic liver disease: a systematic review and meta-analysis

  • Special Feature: Review Article
  • Imaging-based diagnosis and management of cirrhosis/portal hypertension
  • Published:
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Abstract

Purpose

Liver stiffness measurement using transient elastography (TE-LSM) is a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for diagnosing clinically significant portal hypertension (CSPH). However, previous studies have yielded conflicting results. We evaluated the correlation between TE-LSM and HVPG and the performance of TE-LSM in diagnosing CSPH (HVPG ≥ 10 mmHg).

Methods

We conducted a systematic review and meta-analysis by searching PubMed and Scopus databases for relevant literature evaluating the clinical usefulness of TE for diagnosing CSPH in patients with chronic liver disease.

Results

Twenty-six studies (4337 patients with valid TE and HVPG) met our inclusion criteria. The median correlation coefficient of TE with HVPG was 0.70 (range 0.36–0.86). The weighted mean of optimal cut-off of liver stiffness value for diagnosing CSPH was 22.8 kPa (95% CI 22.7–23.0 kPa). The summary sensitivity and specificity were 79% (95% CI 74–84%) and 88% (95% CI 84–91%), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.91 (95% CI 0.88–0.93) according to the bivariate model. One limitation of the study was significant heterogeneity in the results of summary sensitivity and specificity (I2 83 and 74%, respectively). The heterogeneity could be explained by the variable liver stiffness cut-offs used in studies. The meta-regression plot revealed that as the optimal cut-off increased, the sensitivity decreased, the specificity increased, and vice versa.

Conclusions

Liver stiffness measurement using TE correlates well with HVPG, and a liver stiffness cut-off value of 22.8 kPa shows a high accuracy for diagnosing CSPH. Thus, use of TE should be integrated into clinical practice for noninvasive diagnosis of CSPH.

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References

  1. Sanyal AJ, Bosch J, Blei A, et al. Portal hypertension and its complications. Gastroenterology. 2008;134:1715–28.

    Article  PubMed  Google Scholar 

  2. Kumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: time to learn! Indian J Gastroenterol. 2008;27:74–80.

    PubMed  Google Scholar 

  3. Qi X, Berzigotti A, Cardenas A, et al. Emerging non-invasive approaches for diagnosis and monitoring of portal hypertension. Lancet Gastroenterol Hepatol. 2018;3:708–19.

    Article  PubMed  Google Scholar 

  4. Jung KS, Kim SU. Clinical applications of transient elastography. Clin Mol Hepatol. 2012;18:163–73.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Song J, Ma Z, Huang J, et al. Reliability of transient elastography-based liver stiffness for diagnosing portal hypertension in patients with alcoholic liver disease: a diagnostic meta-analysis with specific cut-off values. Ultraschall Med. 2020;41:60–8.

    Article  PubMed  Google Scholar 

  6. Song J, Ma Z, Huang J, et al. Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: a meta-analysis. Eur Radiol. 2018;28:5221–30.

    Article  PubMed  Google Scholar 

  7. Shi KQ, Fan YC, Pan ZZ, et al. Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver Int. 2013;33:62–71.

    Article  PubMed  Google Scholar 

  8. Rana R, Wang S, Li J, et al. Diagnostic accuracy of non-invasive methods detecting clinically significant portal hypertension in liver cirrhosis: a systematic review and meta-analysis. Minerva Med. 2020;111:266–80.

    Article  PubMed  Google Scholar 

  9. Kim G, Kim MY, Baik SK. Transient elastography versus hepatic venous pressure gradient for diagnosing portal hypertension: a systematic review and meta-analysis. Clin Mol Hepatol. 2017;23:34–41.

    Article  PubMed  PubMed Central  Google Scholar 

  10. You MW, Kim KW, Pyo J, et al. A meta-analysis for the diagnostic performance of transient elastography for clinically significant portal hypertension. Ultrasound Med Biol. 2017;43:59–68.

    Article  PubMed  Google Scholar 

  11. Salameh JP, Bossuyt PM, McGrath TA, et al. Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. BMJ. 2020;370: m2632.

    Article  PubMed  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339: b2535.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.

    Article  PubMed  Google Scholar 

  14. Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36.

    Article  PubMed  Google Scholar 

  15. Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med. 2001;20:2865–84.

    Article  CAS  PubMed  Google Scholar 

  16. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  PubMed  Google Scholar 

  17. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58:882–93.

    Article  PubMed  Google Scholar 

  18. Wallace BC, Dahabreh IJ, Trikalinos TA, et al. Closing the gap between methodologists and end-users: R as a computational back-end. J Stat Softw. 2012;49:1–15.

    Article  Google Scholar 

  19. Lemoine M, Katsahian S, Ziol M, et al. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment Pharmacol Ther. 2008;28:1102–10.

    Article  CAS  PubMed  Google Scholar 

  20. Reiberger T. The value of liver and spleen stiffness for evaluation of portal hypertension in compensated cirrhosis. Hepatol Commun. 2021;6:950–64.

    Article  PubMed  PubMed Central  Google Scholar 

  21. de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: report of the baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.

    Article  PubMed  Google Scholar 

  22. Rana R, Wang S, Li J, Basnet S, et al. Diagnostic accuracy of non-invasive methods detecting clinically significant portal hypertension in liver cirrhosis: a systematic review and meta-analysis. Minerva Med. 2020;111:266–80.

    Article  PubMed  Google Scholar 

  23. Carrión JA, Navasa M, Bosch J, et al. Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl. 2006;12:1791–8.

    Article  PubMed  Google Scholar 

  24. Vizzutti F, Arena U, Romanelli RG, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology. 2007;45:1290–7.

    Article  PubMed  Google Scholar 

  25. Bureau C, Metivier S, Peron JM, et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease. Aliment Pharmacol Ther. 2008;27:1261–8.

    Article  CAS  PubMed  Google Scholar 

  26. Sánchez-Conde M, Miralles P, Bellón JM, et al. Use of transient elastography (FibroScan®) for the noninvasive assessment of portal hypertension in HIV/HCV-coinfected patients. J Viral Hepat. 2011;18:685–91.

    Article  PubMed  Google Scholar 

  27. Colecchia A, Montrone L, Scaioli E, et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology. 2012;143:646–54.

    Article  PubMed  Google Scholar 

  28. Llop E, Berzigotti A, Reig M, et al. Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors. J Hepatol. 2012;56:103–8.

    Article  PubMed  Google Scholar 

  29. Reiberger T, Ferlitsch A, Payer BA, et al. Noninvasive screening for liver fibrosis and portal hypertension by transient elastography–a large single center experience. Wien Klin Wochenschr. 2012;124:395–402.

    Article  PubMed  Google Scholar 

  30. Berzigotti A, Seijo S, Arena U, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology. 2013;144:102-111.e1.

    Article  PubMed  Google Scholar 

  31. Hong WK, Kim MY, Baik SK, et al. The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data. Clin Mol Hepatol. 2013;19:370–5.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Augustin S, Millán L, González A, et al. Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: a prospective study. J Hepatol. 2014;60:561–9.

    Article  PubMed  Google Scholar 

  33. Salzl P, Reiberger T, Ferlitsch M, et al. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index. Ultraschall Med. 2014;35:528–33.

    Article  CAS  PubMed  Google Scholar 

  34. Cho EJ, Kim MY, Lee JH, et al. Diagnostic and prognostic values of noninvasive predictors of portal hypertension in patients with alcoholic cirrhosis. PLoS ONE. 2015;10: e0133935.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Elkrief L, Rautou PE, Ronot M, et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology. 2015;275:589–98.

    Article  PubMed  Google Scholar 

  36. Kitson MT, Roberts SK, Colman JC, et al. Liver stiffness and the prediction of clinically significant portal hypertension and portal hypertensive complications. Scand J Gastroenterol. 2015;50:462–9.

    Article  PubMed  Google Scholar 

  37. Procopet B, Cristea VM, Robic MA, et al. Serum tests, liver stiffness and artificial neural networks for diagnosing cirrhosis and portal hypertension. Dig Liver Dis. 2015;47:411–6.

    Article  PubMed  Google Scholar 

  38. Schwabl P, Bota S, Salzl P, et al. New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension. Liver Int. 2015;35:381–90.

    Article  PubMed  Google Scholar 

  39. Zykus R, Jonaitis L, Petrenkienė V, et al. Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: a prospective cohort study. BMC Gastroenterol. 2015;15:183.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hametner S, Ferlitsch A, Ferlitsch M, et al. The VITRO score (Von Willebrand factor antigen/thrombocyte ratio) as a new marker for clinically significant portal hypertension in comparison to other non-invasive parameters of fibrosis including ELF test. PLoS ONE. 2016;11: e0149230.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Kumar A, Khan NM, Anikhindi SA, et al. Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: a study of 326 patients from India. World J Gastroenterol. 2017;23:687–96.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Procopet B, Fischer P, Horhat A, et al. Good performance of liver stiffness measurement in the prediction of postoperative hepatic decompensation in patients with cirrhosis complicated with hepatocellular carcinoma. Med Ultrason. 2018;20:272–7.

    Article  PubMed  Google Scholar 

  43. Salavrakos M, Piessevaux H, Komuta M, et al. Fibroscan reliably rules out advanced liver fibrosis and significant portal hypertension in alcoholic patients. J Clin Gastroenterol. 2019;53:772–8.

    Article  PubMed  Google Scholar 

  44. Pons M, Augustin S, Scheiner B, et al. Noninvasive diagnosis of portal hypertension in patients with compensated advanced chronic liver disease. Am J Gastroenterol. 2021;116:723–32.

    Article  PubMed  Google Scholar 

  45. Ryu SR, Yoo JJ, Kang SH, et al. The cut-off value of transient elastography to the value of hepatic venous pressure gradient in alcoholic cirrhosis. Clin Mol Hepatol. 2021;27:197–206.

    Article  PubMed  Google Scholar 

  46. Souhami A, Sartoris R, Rautou PE, et al. Similar performance of liver stiffness measurement and liver surface nodularity for the detection of portal hypertension in patients with hepatocellular carcinoma. JHEP Rep. 2020;2: 100147.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Stefanescu H, Rusu C, Lupsor-Platon M, et al. Liver stiffness assessed by ultrasound shear wave elastography from general electric accurately predicts clinically significant portal hypertension in patients with advanced chronic liver disease. Ultraschall Med. 2020;41:526–33.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India

    Ashish Kumar, Anil Arora, Praveen Sharma, Shrihari Anil Anikhindi, Naresh Bansal, Mandhir Kumar, Piyush Ranjan, Munish Sachdeva & Shivam Khare

  2. Department of Gastroenterology, Juntendo University, Tokyo, Japan

    Hitoshi Maruyama

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  1. Ashish Kumar
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Correspondence to Ashish Kumar.

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Kumar, A., Maruyama, H., Arora, A. et al. Diagnostic accuracy of transient elastography in diagnosing clinically significant portal hypertension in patients with chronic liver disease: a systematic review and meta-analysis. J Med Ultrasonics 49, 333–346 (2022). https://doi.org/10.1007/s10396-022-01239-x

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