Transient elastography for diagnosis of portal hypertension in liver cirrhosis

Lim, Joseph K.; Groszmann, F.R.C.P. Roberto J.

doi:10.1002/hep.21731

Cited by 60 publications

(43 citation statements)

References 110 publications

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“…above 10-12 mmHg), the development of portal hypertension becomes at least partially independent from the simple accumulation of fibrillar extracellular matrix responsible for the increase in liver stiffness. It is consistent with the pathophysiology of portal hypertension where several extra-hepatic factors such as the hyperdynamic circulation, the splanchnic vasodilatation, and the resistance opposed to portal blood flow by the portosystemic collaterals contribute to the rise in portal pressure [7,42]. Accordingly, TE is unlikely to be useful in the monitoring the hemodynamic response to drug therapy, the effect of which is mediated primarily by decreasing the splanchnic blood flow [4].…”

Section: Detection Of Clinically Significant Portal Hypertensionmentioning

confidence: 69%

Non invasive evaluation of portal hypertension using transient elastography

Castéra

Pinzani

Bosch

2012

Journal of Hepatology

290

224

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The development of portal hypertension is a common consequence of chronic liver diseases leading to the formation of esophageal and gastric varices responsible for variceal bleeding, associated with a high mortality rate, as well as other severe complications such as portosystemic encephalopathy and sepsis. Measurement of hepatic venous pressure gradient (HVPG) and upper GI endoscopy are considered the gold standards for portal hypertension assessment in patients with cirrhosis. However, both types of investigation are invasive and HVPG measurement is routinely available and/or performed with adequate standards only in expert centres. There is thus a need for non invasive methods able to predict, with acceptable diagnostic accuracy, the progression of portal hypertension toward the levels of clinically significant (i.e. HVPG ≥ 10 mmHg) and severe (HVPG ≥ 12 mmHg) as well as the presence and the size of oesophageal varices. Transient elastography (TE) is a novel non invasive technology that allows measuring liver stiffness and that has gained popularity over the past few years. Although TE has been initially proposed to assess liver fibrosis, a good correlation has been reported between liver stiffness values and HVPG as well as the presence of oesophageal varices, suggesting that it could be an interesting tool for the non invasive evaluation of portal hypertension. This review is aimed at discussing the advantages and limits of TE and the perspectives for its rationale use in clinical practice for the management of patients with portal hypertension.

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Section: Detection Of Clinically Significant Portal Hypertensionmentioning

confidence: 69%

Non invasive evaluation of portal hypertension using transient elastography

Castéra

Pinzani

Bosch

2012

Journal of Hepatology

290

224

View full text Add to dashboard Cite

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“…This could be explained by the fact that TE measures the initial rise of portal pressure caused by the accumulation of a fibrillar matrix, but not the complex hemodynamic changes of late portal hypertension [29] . Accordingly TE was not accurate in prediction of esophageal varices, with an AUROC ranging from 0.76 to 0.84 in various studies [29][30][31] . Although sensitivity was good (71%-96%) , specificity and positive predictive values (PPV) were low (60%-80% and 48%-54%) and overall accuracy was inferior compared to simple tests like platelet count/spleen diameter ratio [32] .…”

Section: When Transient Elastography Can Be Used As a First Line Exammentioning

confidence: 99%

“…In fact a good correlation between stiffness and hepatic-vein portal gradient (HVPG) was found only up to HVPG values of 10-12 mmHg, whereas for higher values the correlation was suboptimal [28] . This could be explained by the fact that TE measures the initial rise of portal pressure caused by the accumulation of a fibrillar matrix, but not the complex hemodynamic changes of late portal hypertension [29] . Accordingly TE was not accurate in prediction of esophageal varices, with an AUROC ranging from 0.76 to 0.84 in various studies [29][30][31] .…”

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confidence: 99%

Is transient elastography a useful tool for screening liver disease?

Poggio¹,

Colombo²

2009

WJG

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Transient elastography (TE) is a new non invasive tool for measuring liver stiffness, which is correlated to the histologic stage of liver fibrosis. Several studies in chronic liver disease (CLD) have determined a good accuracy of TE in predicting significant fibrosis and an optimal accuracy in predicting cirrhosis. Normal liver stiffness ranges between 3.3-7.8 KPa and using a cut off of 7.1 KPa, significant fibrosis and cirrhosis can be excluded with a very high negative predictive value (NPV). Positive predictive value (PPV) for the diagnosis of cirrhosis is lower using just a single scan but increases to 90% if high stiffness values are confirmed by a second independent scan. However the presence of fatty liver and metabolic syndrome slightly increases the readings and may reduce the accuracy of the test. It is uncertain if this increase is related to the presence of steatofibrosis or if it is caused by steatosis itself. TE can be used in screening patients attending the liver clinics to identify those with significant fibrosis or cirrhosis and may be particularly useful in discriminating HBV inactive carriers from chronic hepatitis B patients. TE, however, is not reliable in predicting the presence of esophageal varices in cirrhotics. Another potential indication for TE is the systematic screening of populations at high risk for CLD, such as intravenous drug users and alcoholics, but further studies are needed to determine its diagnostic accuracy in these settings. INTRODUCTIONTransient elastography (TE) is a new non invasive tool for measuring liver stiffness, which is correlated to the histologic stage of liver fibrosis [1] . The device (Fibroscan) generates an elastic wave by means of a vibrator applied to the thoracic wall at the level of the right liver lobe. The vibrator produces a shot and a low amplitude shear wave propagating through the liver parenchyma. The velocity of propagation is directly proportional to liver stiffness and is automatically calculated by the instrument. The range of measurements, expressed in kilopascals, varies from 2.5 to 74 KPa.Many studies have been published on the use of TE in patients with already diagnosed chronic liver disease (CLD) but few have addressed the issue of its possible use as a first line examination in the liver clinic or in facilities where patients at risk of liver disease are attending. HOW TO TAKE AND INTERPRET THE MEASUREMENTSIn order to obtain valid and reproducible measurements the probe should be placed at the center of the right liver lobe, two intercostal spaces below the upper liver margin and at the level of the anterior or middle axillary line. If measurements are taken below this point and too close to the lower liver edge both the percentage of valid shots and the median stiffness tend to decrease [2] . Ultrasound assistance to locate the upper liver margin is usually unnecessary if the patient is reasonably thin because the liver can be recognized by percussion alone. The device incorporates an M-mode window enabling the ope...

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“…However, TE is often not applicable in patients with obesity and ascites, and the results of TE are influenced by several additional factors like intrahepatic necroinflammatory activity, levels of aminotransferases and bilirubin, and patient position [17]. Nevertheless, TE has been proposed to be used in clinical practice to evaluate patients with chronic liver disease for the degree of PHT [18]. Since TE is methodically not able to directly assess extrahepatic factors that potentially contribute to PHT, we aimed to evaluate the changes in LS measured by TE in patients undergoing sequential measurement of HVPG prior and during treatment with NSBB.…”

Section: Introductionmentioning

confidence: 98%