Are different cut-off values of liver stiffness assessed by Transient Elastography according to the etiology of liver cirrhosis for predicting significant esophageal varices?

Sporea, Ioan; Raţiu, Iulia; Bota, Simona; Şirli, Roxana; Jurchis, A.

doi:10.11152/mu.2013.2066.152.is1ir2

Cited by 25 publications

(16 citation statements)

References 26 publications

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“…The remaining 91 potentially eligible reports were screened for further evaluation. Of those, after exclusion for irrelevant contents, no full-text and insufficient data, ultimately 15 papers[16-30] were included for the meta-analysis and included 12 English papers, 1 Korean[23] paper and 2 Chinese papers[20,21]. …”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Pu¹,

Shi²,

Wang³

et al. 2017

WJG

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AIMTo investigate the diagnostic accuracy of FibroScan (FS) in detecting esophageal varices (EV) in cirrhotic patients.METHODSThrough a systemic literature search of multiple databases, we reviewed 15 studies using endoscopy as a reference standard, with the data necessary to calculate pooled sensitivity (SEN) and specificity (SPE), positive and negative LR, diagnostic odds ratio (DOR) and area under receiver operating characteristics (AUROC). The quality of the studies was rated by the Quality Assessment of Diagnostic Accuracy studies-2 tool. Clinical utility of FS for EV was evaluated by a Fagan plot. Heterogeneity was explored using meta-regression and subgroup analysis. All statistical analyses were conducted via Stata12.0, MetaDisc1.4 and RevMan5.RESULTSIn 15 studies (n = 2697), FS detected the presence of EV with the summary sensitivities of 84% (95%CI: 81.0%-86.0%), specificities of 62% (95%CI: 58.0%- 66.0%), a positive LR of 2.3 (95%CI: 1.81-2.94), a negative LR of 0.26 (95%CI: 0.19-0.35), a DOR of 9.33 (95%CI: 5.84-14.92) and an AUROC of 0.8262. FS diagnosed the presence of large EV with the pooled SEN of 0.78 (95%CI: 75.0%-81.0%), SPE of 0.76 (95%CI: 73.0%-78.0%), a positive and negative LR of 3.03 (95%CI: 2.38-3.86) and 0.30 (95%CI: 0.23-0.39) respectively, a summary diagnostic OR of 10.69 (95%CI: 6.81-16.78), and an AUROC of 0.8321. A meta-regression and subgroup analysis indicated different etiology could serve as a potential source of heterogeneity in the diagnosis of the presence of EV group. A Deek’s funnel plot suggested a low probability for publication bias.CONCLUSIONUsing FS to measure liver stiffness cannot provide high accuracy for the size of EV due to the various cutoff and different etiologies. These limitations preclude widespread use in clinical practice at this time; therefore, the results should be interpreted cautiously given its SEN and SPE.

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Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Pu¹,

Shi²,

Wang³

et al. 2017

WJG

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“…Discrepancies in the optimal cutoff stiffness values among groups with different etiologies of cirrhosis have been observed (57-59). However, our sample size was not sufficient to detect significant variation in the liver stiffness between different etiologies of NAFLD/NASH and HCV.…”

Section: Discussionmentioning

confidence: 99%

Hepatic MR Elastography: Clinical Performance in a Series of 1377 Consecutive Examinations

Yin¹,

Glaser²,

Talwalkar³

et al. 2016

Radiology

249

229

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Purpose To assess the technical success rate and diagnostic performance of liver MR elastography (MRE) in a retrospective study of clinical patients. Materials and Methods This retrospective study was IRB approved with informed consent. A total of 1377 consecutive MRE examinations in 1287 patients for clinical indications were included from 2007 to 2010. Medical records were used to retrieve MRE-assessed liver stiffness, histological analysis, blood work and other liver disease related information. Nonparametric Kruskal-Wallis tests and analysis of covariance methods were used to evaluate the diagnostic values and relationships of the collected data. Results Hepatic MRE had a success rate of 94.4% (1300/1377) and reproducible measurements (r=0.9716, p<0.0001) in our study cohort with a complex patient profile and multiple interpreters. Body mass index had no significant effect on the success rate (p=0.2). In 289 patients with liver biopsy performed within 1 year of the MRE exam date, MRE-assessed liver stiffness is significantly higher in advanced fibrosis stages (F3-4) than mild to moderate fibrosis stages (F0-1-2) (5.93±2.31 versus 3.35±1.44 kPa, p<0.0001). Liver stiffness is associated with many factors other than fibrosis extent, including etiology of fibrosis (viral hepatitis C versus nonalcoholic fatty liver disease, p=0.025), inflammation (severe versus mild to moderate, p=0.03), and hepatic metabolic and synthetic function (no versus intermediate fibrosis, p≤0.01). Conclusion In our general clinical practice environment, hepatic MRE is a very robust imaging method with a high success rate for a broad spectrum of patients. It also demonstrates the complex association between liver stiffness and hepatic pathophysiology.

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“…Ten studies did not provide sufficient information to be able to ascertain if the investigators that performed the endoscopy were unaware of the LS value, or vice versa, which put them at risk of review bias (8,9, 14,15,18,21,23,24,29,30). The time interval between the performance of EGD and the performance of the TE was too long in 2 studies (28,30) and undefined in 8 studies (8,14,15,(20)(21)(22)24,25), putting them at risk of disease progression bias.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

Yang

et al. 2016

Rev Esp Enferm Dig

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Background and purpose: Transient elastography (TE) has been shown to be a valuable tool for the prediction of large esophageal varices. However, the conclusions have not been always consistent throughout the different studies. Therefore, we performed a further meta-analysis in order to evaluate the diagnostic accuracy of transient elastography for the prediction of large esophageal varices.Methods: We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL in The Cochrane Library without time restriction. The strategy we used was "(fibroscan OR transient elastography OR stiffness) AND esophageal varices". Accuracy measures such as pooled sensitivity, specificity, among others, were calculated using Meta-DiSc statistical software.Results: Twenty studies (2,994 patients) were included in our meta-analysis. The values of pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio were as follows: 0.81 (95% CI, 0.79-0.84), 0.71 (95% CI, 0.69-0.73), 2.63 (95% CI, 2.15-3.23), 0.27 (95% CI, 0.22-0.34) and 10.30 (95% CI, 7.33-14.47). The area under the receiver operating characteristics curve was 0.83. The Spearman correlation coefficient was 0.246 with a p-value of 0.296, indicating the absence of any significant threshold effects. In our subgroup analysis, the heterogeneity could be partially explained by the geographical origin of the study or etiology; or it could be partially explained blindingly, through the appropriate interval and cut-off value of the liver stiffness (LS).Conclusions: Transient elastography could be used as a valuable non-invasive screening tool for the prediction of large esophageal varices. However, since LS cut-off values vary throughout the different studies and significant heterogeneity also exists among them, we need more reasonable approaches or flow diagram in order to improve the operability of this technology.

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Are different cut-off values of liver stiffness assessed by Transient Elastography according to the etiology of liver cirrhosis for predicting significant esophageal varices?

Abstract: LS cut-off values assessed by TE for predicting significant EV are significantly higher in patients with alcoholic cirrhosis as compared with patients with liver cirrhosis of viral etiology.

Cited by 25 publications

References 26 publications

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Hepatic MR Elastography: Clinical Performance in a Series of 1377 Consecutive Examinations

Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

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