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Prediction of high-risk esophageal varices in patients with chronic liver disease with point and 2D shear wave elastography: a systematic review and meta-analysis

  • Ultrasound
  • Published:
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Abstract

Objective

To assess the diagnostic performance of liver stiffness (LS) and spleen stiffness (SS) measured by point shear wave elastography (pSWE) and 2D shear wave elastography (2D-SWE) in the detection of high-risk esophageal varices (HREV) and to compare their diagnostic accuracy.

Methods

Through systematic search of PubMed, Embase, and Web of Science databases, we included 17 articles reporting the diagnostic performance of LS or SS measured by pSWE or 2D-SWE for HREV. We used a bivariate random-effects model to estimate pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), area under summary receiver operator characteristic curve (AUSROC), and diagnostic odds ratio (DOR).

Results

For LS, there was no significant difference between the pooled sensitivity, 0.89 (95% confidence interval CI, 0.81–0.94) vs. 0.8 (95% CI, 0.72–0.86) (p = 0.13), and specificity, 0.81 (95% CI, 0.73–0.87) vs. 0.73 (95% CI, 0.65–0.79) (p = 0.07) of pSWE and 2D-SWE. The AUSROC and DOR of pSWE were higher than those of 2D-SWE: 0.92 (95% CI, 0.89–0.94) vs. 0.84 (95% CI, 0.80–0.87), p = 0.03, 33 (95% CI, 25–61) vs. 11 (95% CI, 5–22), (p < 0.01). For SS, there was no significant difference between the pooled sensitivity 0.91 (95% CI, 0.78–0.96) vs. 0.89 (95% CI, 0.80–0.94) (p = 0.43); specificity, 0.79 (95% CI, 0.72–0.84) vs. 0.72 (95% CI, 0.63–0.79) (p = 0.06); and DOR, 35 (95% CI, 13–100) vs. 20 (95% CI, 8–50) (p = 0.16) of pSWE and 2D-SWE.

Conclusion

LS and SS measured by pSWE and 2D-SWE have good accuracy in predicting HREV.

Key Points

• There is modest difference between the diagnostic performance of LS and SS measured by pSWE and 2D-SWE.

• LS and SS measured by pSWE and 2D-SWE both have high sensitivity, specificity, and AUSROC for the evaluation of HREV in patients with CLD.

• pSWE and 2D-SWE are promising tools for noninvasive monitoring risk of esophageal varices bleeding of CLD patients.

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Abbreviations

2D-SWE :

2D shear wave elastography

AUSROC :

Area under summary receiver operator characteristic curve

BMI :

Body mass index

CI :

Confidence interval

CLD :

Chronic liver disease

DOR :

Diagnostic odds ratio

EGD :

Esophagogastroduodenoscopy

EV :

Esophageal varices

FN :

False negative

FP :

False positive

HREV :

High-risk esophageal varices

LREV :

Low-risk esophageal varices

LS :

Liver stiffness

MELD :

Model for end-stage liver disease

MRE :

Magnetic resonance elastography

NLR :

Negative likelihood ratio

PH :

Portal hypertension

PLR :

Positive likelihood ratio

pSWE :

Point shear wave elastography

QUADAS :

Quality Assessment of diagnostic accuracy studies

RC :

Red color sign

rDOR :

Relative diagnostic odds ratio

SS :

Spleen stiffness

TE :

Transient elastography

TN:

True negative

TP :

True positive

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Funding

This work was supported by Medical Science and Technology Project of Henan Province (202083109).

Author information

Authors and Affiliations

  1. Department of Ultrasonography, The Second Affiliated Hospital of Zhengzhou University, 2 Jing 8th Road, ZhengZhou, 450000, China

    Yue Liu, Xiao-guang Zhang, Yan-hua Zhen & Xue-feng Lu

  2. Department of Ultrasonography, Harbin Medical University Cancer Hospital, Harbin, 150080, China

    Hao-yan Tan

  3. Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Zhengzhou University, ZhengZhou, 450000, China

    Fan Gao

Authors
  1. Yue Liu
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  4. Yan-hua Zhen
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Correspondence to Xue-feng Lu.

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The scientific guarantor of this publication is Yue Liu.

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The authors declare no competing interests.

Statistics and biometry

One of the authors, Professor Xue-feng Lu, has significant statistical expertise.

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Written informed consent was not required for this study because this study was a meta-analysis.

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Institutional review board approval was not required because this study was a meta-analysis.

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• Retrospective

• multicenter study

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Liu, Y., Tan, Hy., Zhang, Xg. et al. Prediction of high-risk esophageal varices in patients with chronic liver disease with point and 2D shear wave elastography: a systematic review and meta-analysis. Eur Radiol 32, 4616–4627 (2022). https://doi.org/10.1007/s00330-022-08601-0

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