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New Tools for the Noninvasive Assessment of Cirrhosis

  • Management of the Cirrhotic Patient (NS Reau and A Cardenas, Section editors)
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Abstract

The diagnosis of cirrhosis and portal hypertension is critical for the correct management and follow-up of patients with chronic liver disease. Non-invasive methods to safely replace liver biopsy and hepatic venous pressure gradient measurement have been increasingly studied in the last 20 years. This review summarizes the available data regarding validated non-invasive methods to diagnose cirrhosis and clinically significant portal hypertension, and provides insight on new technologies (including different elastography techniques, novel imaging methods and combination of tests) that substantially improve the diagnostic armamentarium in this field.

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References

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  1. Bedossa P. Liver biopsy. Gastroenterol Clin Biol. 2008;32:4–7.

    Article  PubMed  CAS  Google Scholar 

  2. Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis. Hepatology. 2010;51:1445–9. Provides insight on staging of chronic liver disease by opinion leaders in this field.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Hytiroglou P, Snover DC, Alves V, et al. Beyond “cirrhosis”: a proposal from the International Liver Pathology Study Group. Am J Clin Pathol. 2012;137:5–9.

    Article  PubMed  Google Scholar 

  4. Bosch J, Abraldes JG, Berzigotti A, Garcia-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol. 2009;6:573–82.

    Article  PubMed  CAS  Google Scholar 

  5. D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.

    Article  PubMed  Google Scholar 

  6. Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010;362:823–32.

    Article  PubMed  CAS  Google Scholar 

  7. Berzigotti A. Transient elastography and prognosis of cirrhosis. Hepatology. 2012;55:1629–31.

    Article  PubMed  Google Scholar 

  8. Gluud C, Brok J, Gong Y, Koretz RL. Hepatology may have problems with putative surrogate outcome measures. J Hepatol. 2007;46:734–42.

    Article  PubMed  Google Scholar 

  9. Berzigotti A, Gilabert R, Abraldes JG, et al. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis. Am J Gastroenterol. 2008;103:1159–67.

    Article  PubMed  CAS  Google Scholar 

  10. Thabut D, Imbert-Bismut F, Cazals-Hatem D, et al. Relationship between the Fibrotest and portal hypertension in patients with liver disease. Aliment Pharmacol Ther. 2007;26:359–68.

    Article  PubMed  CAS  Google Scholar 

  11. Qamar AA, Grace ND, Groszmann RJ, et al. Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis. Hepatology. 2008;47:153–9.

    Article  PubMed  Google Scholar 

  12. Garcia-Tsao G, Escorsell A, Zakko M, et al. Predicting the presence of significant portal hypertension and varices in compensated cirrhotic patients. 26 ed. 1997. 360.

  13. Pilette C, Oberti F, Aube C, et al. Non-invasive diagnosis of esophageal varices in chronic liver diseases. J Hepatol. 1999;31:867–73.

    Article  PubMed  CAS  Google Scholar 

  14. Schepis F, Camma C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology. 2001;33:333–8.

    Article  PubMed  CAS  Google Scholar 

  15. Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med. 2001;161:2564–70.

    Article  PubMed  CAS  Google Scholar 

  16. 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  PubMed  CAS  Google Scholar 

  17. Zein CO, Lindor KD, Angulo P. Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis. Hepatology. 2004;39:204–10.

    Article  PubMed  Google Scholar 

  18. Ghany MG, Lok AS, Everhart JE, et al. Predicting clinical and histologic outcomes based on standard laboratory tests in advanced chronic hepatitis C. Gastroenterology. 2010;138:136–46.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  19. Giannini E, Botta F, Borro P, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52:1200–5.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  20. Berzigotti A, Seijo S, Arena U, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology. 2013;144:102–11. Study comparing different non-invasive methods to assess CSPH and esophageal varices in compensated cirrhosis; the combination of liver stiffness by transient elastography, spleen diameter by ultrasound and platelet count resulted the best method to diagnose both.

    Article  PubMed  Google Scholar 

  21. Giannini EG, Botta F, Borro P, et al. Application of the platelet count/spleen diameter ratio to rule out the presence of oesophageal varices in patients with cirrhosis: a validation study based on follow-up. Dig Liver Dis. 2005;37:779–85.

    Article  PubMed  CAS  Google Scholar 

  22. Stefanescu H, Grigorescu M, Lupsor M, et al. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. J Gastroenterol Hepatol. 2011;26:164–70. First study reporting the feasibility of spleen stiffness measurement by transient elastography.

    Article  PubMed  Google Scholar 

  23. Ying L, Lin X, Xie ZL, Hu YP, Shi KQ. Performance of platelet count/spleen diameter ratio for diagnosis of esophageal varices in cirrhosis: a meta-analysis. Dig Dis Sci. 2012;57:1672–81.

    Article  PubMed  Google Scholar 

  24. Chawla S, Katz A, Attar BM, et al. Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review. Eur J Gastroenterol Hepatol. 2012;24:431–6.

    PubMed  Google Scholar 

  25. Nunes D, Fleming C, Offner G, et al. Noninvasive markers of liver fibrosis are highly predictive of liver-related death in a cohort of HCV-infected individuals with and without HIV infection. Am J Gastroenterol. 2010;105:1346–53.

    Article  PubMed  Google Scholar 

  26. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.

    Article  PubMed  Google Scholar 

  27. Nguyen-Khac E, Chatelain D, Tramier B, et al. Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests. Aliment Pharmacol Ther. 2008;28:1188–98.

    Article  PubMed  CAS  Google Scholar 

  28. Castera L, Le Bail B, Roudot-Thoraval F, et al. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol. 2009;50:59–68.

    Article  PubMed  Google Scholar 

  29. Sebastiani G, Tempesta D, Fattovich G, et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study. J Hepatol. 2010;53:630–8.

    Article  PubMed  Google Scholar 

  30. Naveau S, Gaude G, Asnacios A, et al. Diagnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver disease. Hepatology. 2009;49:97–105.

    Article  PubMed  Google Scholar 

  31. Vergniol J, Foucher J, Terrebonne E, et al. Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C. Gastroenterology 2011;140:2150-9, 2159.

    Google Scholar 

  32. Imbert-Bismut F, Ratziu V, Pieroni L, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet. 2001;357:1069–75.

    Article  PubMed  CAS  Google Scholar 

  33. Friedrich-Rust M, Rosenberg W, Parkes J, et al. Comparison of ELF. FibroTest and FibroScan for the non-invasive assessment of liver fibrosis. BMC Gastroenterol. 2010;10:103.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Naveau S, Raynard B, Ratziu V, et al. Biomarkers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease. Clin Gastroenterol Hepatol. 2005;3:167–74.

    Article  PubMed  Google Scholar 

  35. Thabut D, Trabut JB, Massard J, et al. Non-invasive diagnosis of large oesophageal varices with FibroTest in patients with cirrhosis: a preliminary retrospective study. Liver Int. 2006;26:271–8.

    Article  PubMed  Google Scholar 

  36. Cales P, Oberti F, Michalak S, et al. A novel panel of blood markers to assess the degree of liver fibrosis. Hepatology. 2005;42:1373–81.

    Article  PubMed  Google Scholar 

  37. Lichtinghagen R, Pietsch D, Bantel H, et al. The Enhanced Liver Fibrosis (ELF) score: normal values, influence factors and proposed cut-off values. J Hepatol. 2013;59:236–42. Describes important factors that influence ELF performance.

    Article  PubMed  Google Scholar 

  38. Mayo MJ, Parkes J, Ms-Huet B, et al. Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay. Hepatology. 2008;48:1549–57.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Molleken C, Sitek B, Henkel C, et al. Detection of novel biomarkers of liver cirrhosis by proteomic analysis. Hepatology. 2009;49:1257–66.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Seijo S, Lozano JJ, Alonso C, et al. Metabolomics discloses potential biomarkers for the noninvasive diagnosis of idiopathic portal hypertension. Am J Gastroenterol. 2013;108:926–32.

    Article  PubMed  CAS  Google Scholar 

  41. Colli A, Fraquelli M, Andreoletti M, et al. Severe liver fibrosis or cirrhosis: accuracy of US for detection–analysis of 300 cases. Radiology. 2003;227:89–94.

    Article  PubMed  Google Scholar 

  42. Gaiani S, Gramantieri L, Venturoli N, et al. What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy. J Hepatol. 1997;27:979–85.

    Article  PubMed  CAS  Google Scholar 

  43. Rossi S, Rosa L, Ravetta V, et al. Contrast-enhanced versus conventional and color Doppler sonography for the detection of thrombosis of the portal and hepatic venous systems. AJR Am J Roentgenol. 2006;186:763–73.

    Article  PubMed  Google Scholar 

  44. Berzigotti A, Piscaglia F. Ultrasound in portal hypertension–part 1. Ultraschall Med. 2011;32:548–68.

    Article  PubMed  CAS  Google Scholar 

  45. Berzigotti A, Piscaglia F. Ultrasound in portal hypertension--part 2--and EFSUMB recommendations for the performance and reporting of ultrasound examinations in portal hypertension. Ultraschall Med. 2012;33:8–32. Comprehensive review and recommendations for the use of ultrasound for portal hypertension.

    Article  PubMed  CAS  Google Scholar 

  46. Abraldes JG, Gilabert R, Turnes J, et al. Utility of color Doppler ultrasonography predicting tips dysfunction. Am J Gastroenterol. 2005;100:2696–701.

    Article  PubMed  Google Scholar 

  47. Vilgrain V, Lebrec D, Menu Y, Scherrer A, Nahum H. Comparison between ultrasonographic signs and the degree of portal hypertension in patients with cirrhosis. Gastrointest Radiol. 1990;15:218–22.

    Article  PubMed  CAS  Google Scholar 

  48. Berzigotti A, Merkel C, Magalotti D, et al. New abdominal collaterals at ultrasound: a clue of progression of portal hypertension. Dig Liver Dis. 2008;40:62–7.

    Article  PubMed  CAS  Google Scholar 

  49. Berzigotti A, Zappoli P, Magalotti D, et al. Spleen enlargement on follow-up evaluation: a noninvasive predictor of complications of portal hypertension in cirrhosis. Clin Gastroenterol Hepatol. 2008;6:1129–34.

    Article  PubMed  Google Scholar 

  50. Maroto A, Gines A, Salo J, et al. Diagnosis of functional kidney failure of cirrhosis with Doppler sonography: prognostic value of resistive index. Hepatology. 1994;20:839–44.

    Article  PubMed  CAS  Google Scholar 

  51. Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med. 2013;34:11–29. Comprehensive review and recommendations for the use of contrast-enhanced ultrasound for liver assessment.

    PubMed  CAS  Google Scholar 

  52. Staub F, Tournoux-Facon C, Roumy J, et al. Liver fibrosis staging with contrast-enhanced ultrasonography: prospective multicenter study compared with METAVIR scoring. Eur Radiol. 2009;19:1991–7.

    Article  PubMed  CAS  Google Scholar 

  53. Kim MY, Suk KT, Baik SK, et al. Hepatic vein arrival time as assessed by contrast-enhanced ultrasonography is useful for the assessment of portal hypertension in compensated cirrhosis. Hepatology. 2012;56:1053–62.

    Article  PubMed  Google Scholar 

  54. Berzigotti A, Nicolau C, Bellot P, et al. Evaluation of regional hepatic perfusion (RHP) by contrast-enhanced ultrasound in patients with cirrhosis. J Hepatol. 2011;55:307–14.

    Article  PubMed  Google Scholar 

  55. Eisenbrey JR, Dave JK, Halldorsdottir VG, et al. Chronic liver disease: noninvasive subharmonic aided pressure estimation of hepatic venous pressure gradient. Radiology. 2013;268:581–8.

    Article  PubMed  Google Scholar 

  56. Kim SH, Kim YJ, Lee JM, et al. Esophageal varices in patients with cirrhosis: multidetector CT esophagography–comparison with endoscopy. Radiology. 2007;242:759–68.

    Article  PubMed  Google Scholar 

  57. Kim YJ, Raman SS, Yu NC, et al. Esophageal varices in cirrhotic patients: evaluation with liver CT. AJR Am J Roentgenol. 2007;188:139–44.

    Article  PubMed  Google Scholar 

  58. Perri RE, Chiorean MV, Fidler JL, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology. 2008;47:1587–94.

    Article  PubMed  Google Scholar 

  59. Matsuo M, Kanematsu M, Kim T, et al. Esophageal varices: diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage. AJR Am J Roentgenol. 2003;180:461–6.

    Article  PubMed  Google Scholar 

  60. Van Beers BE, Materne R, Annet L, et al. Capillarization of the sinusoids in liver fibrosis: noninvasive assessment with contrast-enhanced MRI in the rabbit. Magn Reson Med. 2003;49:692–9.

    Article  PubMed  Google Scholar 

  61. Annet L, Materne R, Danse E, et al. Hepatic flow parameters measured with MR imaging and Doppler US: correlations with degree of cirrhosis and portal hypertension. Radiology. 2003;229:409–14.

    Article  PubMed  Google Scholar 

  62. 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 

  63. Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960–74.

    Article  PubMed  Google Scholar 

  64. Berzigotti A, Seijo S, Arena U, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology. 2013;144:102–11.

    Article  PubMed  Google Scholar 

  65. Carrion 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 

  66. 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  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  68. 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 

  69. 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 

  70. Robic MA, Procopet B, Metivier S, et al. Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. J Hepatol. 2011;55:1017–24.

    Article  PubMed  Google Scholar 

  71. Kim SU, Ahn SH, Park JY, et al. Prediction of postoperative hepatic insufficiency by liver stiffness measurement (FibroScan((R))) before curative resection of hepatocellular carcinoma: a pilot study. Hepatol Int. 2008;2:471–7.

    Article  PubMed Central  PubMed  Google Scholar 

  72. Masuzaki R, Tateishi R, Yoshida H, et al. Prospective risk assessment for hepatocellular carcinoma development in patients with chronic hepatitis C by transient elastography. Hepatology. 2009;49:1954–61.

    Article  PubMed  Google Scholar 

  73. Arena U, Vizzutti F, Corti G, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47:380–4.

    Article  PubMed  CAS  Google Scholar 

  74. Millonig G, Reimann FM, Friedrich S, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008;48:1718–23.

    Article  PubMed  Google Scholar 

  75. Colli A, Pozzoni P, Berzuini A, et al. Decompensated Chronic Heart Failure: Increased Liver Stiffness Measured by Means of Transient Elastography. Radiology. 2010;257:872–8.

    Article  PubMed  Google Scholar 

  76. Millonig G, Friedrich S, Adolf S, et al. Liver stiffness is directly influenced by central venous pressure. J Hepatol. 2010;52:206–10.

    Article  PubMed  Google Scholar 

  77. Arena U, Platon ML, Stasi C, et al. Liver stiffness is influenced by a standardized meal in patients with chronic hcv hepatitis at different stages of fibrotic evolution. Hepatology. 2013;58:65–72.

    Article  PubMed  CAS  Google Scholar 

  78. Berzigotti A, de Gottardi A, Vukotic R, et al. Effect of meal ingestion on liver stiffness in patients with cirrhosis and portal hypertension. PLoS One. 2013;8:e58742.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  79. Castera L, Pinzani M, Bosch J. Non invasive evaluation of portal hypertension using transient elastography. J Hepatol. 2012;56:696–703. Comprehensive review of the rationale and evidence for the use of transient elastography for portal hypertension.

    Article  PubMed  Google Scholar 

  80. Reiberger T, Ferlitsch A, Payer BA, et al. Non-selective beta-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis. J Gastroenterol. 2012;47:561–8.

    Article  PubMed  CAS  Google Scholar 

  81. 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. Study comparing liver and spleen stiffness by transient elastography to assess CSPH and esophageal varices in compensated cirrhosis.

    Article  PubMed  Google Scholar 

  82. Sharma P, Kirnake V, Tyagi P, et al. Spleen stiffness in patients with cirrhosis in predicting esophageal varices. Am J Gastroenterol. 2013;108:1101–7.

    Article  PubMed  Google Scholar 

  83. Calvaruso V, Bronte E, Conte F, et al. Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis. J Viral Hepat 2013;20(12):867-74. doi:10.1111/jvh.12114.

    Google Scholar 

  84. Castera L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828–35.

    PubMed  Google Scholar 

  85. Cassinotto C, Lapuyade B, Ait-Ali A, et al. Liver Fibrosis: Noninvasive Assessment with Acoustic Radiation Force Impulse Elastography--Comparison with FibroScan M and XL Probes and FibroTest in Patients with Chronic Liver Disease. Radiology 2013;269(1):283-92. doi:10.1148/radiol.13122208.

  86. Piscaglia F, Marinelli S, Bota S, et al. The role of ultrasound elastographic techniques in chronic liver disease: Current status and future perspectives. Eur J Radiol 2013. doi:10.1016/j.ejrad.2013.06.009. Comprehensive review of the rationale and evidence for the use of sonoelastography for liver diseases.

  87. Bota S, Herkner H, Sporea I, et al. Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int. 2013;33:1138–47.

    Article  PubMed  Google Scholar 

  88. Nierhoff J, Chavez Ortiz AA, Herrmann E, Zeuzem S, Friedrich-Rust M. The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol 2013;23(11):3040-53. doi:10.1007/s00330-013-2927-6.

    Google Scholar 

  89. Vermehren J, Polta A, Zimmermann O, et al. Comparison of acoustic radiation force impulse imaging with transient elastography for the detection of complications in patients with cirrhosis. Liver Int. 2012;32:852–8.

    Article  PubMed  Google Scholar 

  90. Takuma Y, Nouso K, Morimoto Y, et al. Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices. Gastroenterology. 2013;144:92–101. First paper reporting the accuracy of spleen stiffness by ARFI for diagnosing esophageal varices.

    Article  PubMed  Google Scholar 

  91. Muller M, Gennisson JL, Deffieux T, Tanter M, Fink M. Quantitative viscoelasticity mapping of human liver using supersonic shear imaging: preliminary in vivo feasibility study. Ultrasound Med Biol. 2009;35:219–29.

    Article  PubMed  Google Scholar 

  92. Ferraioli G, Tinelli C, Dal Bello B, et al. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology. 2012;56:2125–33.

    Article  PubMed  Google Scholar 

  93. Poynard T, Munteanu M, Luckina E, et al. Liver fibrosis evaluation using real-time shear wave elastography: applicability and diagnostic performance using methods without a gold standard. J Hepatol. 2013;58:928–35.

    Article  PubMed  Google Scholar 

  94. Yin M, Chen J, Glaser KJ, Talwalkar JA, Ehman RL. Abdominal magnetic resonance elastography. Top Magn Reson Imaging. 2009;20:79–87.

    Article  PubMed Central  PubMed  Google Scholar 

  95. Castera L. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology. 2012;142:1293–302.

    Article  PubMed  Google Scholar 

  96. Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol. 2010;53:1013–21.

    Article  PubMed  Google Scholar 

  97. Berzigotti A, Abraldes JG, Tandon P, et al. Ultrasonographic evaluation of liver surface and transient elastography in clinically doubtful cirrhosis. J Hepatol. 2010;52:846–53.

    Article  PubMed  Google Scholar 

  98. Kim BK, Han KH, Park JY, et al. A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol. 2010;105:1382–90.

    Article  PubMed  Google Scholar 

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Bogdan Procopet and Annalisa Berzigotti declare that they have no conflicts of interest.

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Procopet, B., Berzigotti, A. New Tools for the Noninvasive Assessment of Cirrhosis. Curr Hepatology Rep 13, 14–23 (2014). https://doi.org/10.1007/s11901-014-0215-9

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