Ultrasonographic evaluation & elastography in clinically doubtful cirrhosis

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Journal of Hepatology
Volume 52, Issue 6, June 2010, Pages 846-853
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doi:10.1016/j.jhep.2009.12.031 | How to Cite or Link Using DOI
Copyright © 2010 European Association for the Study of the Liver Published by
Elsevier Ireland Ltd.
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Research Article
Ultrasonographic evaluation of liver surface and transient elastography in
clinically doubtful cirrhosis


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Annalisa Berzigotti1, 2, 3, Juan G. Abraldes1, 3, Puneeta Tandon1, Eva Erice1,
Rosa Gilabert2, 3, Juan Carlos García-Pagan1, 3 and Jaime Bosch1, 3, ,
1 Hepatic Hemodynamic Laboratory, Liver Unit, Barcelona, Spain
2 Centre de Diagnostic per l’Imatge, Hospital Clinic, Institut
d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of
Barcelona, Spain
3 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y
Digestivas (CIBERehd), University of Barcelona, Spain
Received 30 September 2009;  revised 29 December 2009;  accepted 30 December
2009.  Available online 15 March 2010.
Refers to:  Diagnosing cirrhosis non-invasively: Sense the stiffness but
don’t forget the nodules!
Journal of Hepatology, Volume 52, Issue 6, June 2010, Pages 786-787,
Laurent Castera
PDF (183 K)

Referred to by:  Diagnosing cirrhosis non-invasively: Sense the stiffness but
don’t forget the nodules!
Journal of Hepatology, Volume 52, Issue 6, June 2010, Pages 786-787,
Laurent Castera
PDF (183 K)


Background & Aims
Both transient elastography (TE) and left lobe liver surface (LLS) ultrasound
may non-invasively detect cirrhosis (LC). We aimed to examine the diagnostic
value of these methods in patients with a suspicion but not a definite
diagnosis of cirrhosis.

Methods
We enrolled 90 patients with clinical suspicion of cirrhosis and a strong
co-existing differential diagnosis requiring further invasive evaluation. They
underwent hepatic venous pressure gradient (HVPG) measurement ± transjugular
liver biopsy, LLS and TE. Images of LLS were digitally post-processed to
obtain a numerical value (quantitative LLS, qLLS). TE <12 kPa was considered
to exclude LC, 18 kPa diagnosed LC, and 12–18 kPa indeterminate. Technical
failures were considered ‘indeterminate’. Diagnosis of cirrhosis was
confirmed by histology (84%) or by clinical data and HVPG 10 mm Hg. Diagnostic
accuracy was evaluated by positive and negative likelihood ratios (+LR and
−LR).

Results
Cirrhosis was diagnosed in 44 patients. There were 14 technical failures with
TE and 1 with LLS (p = 0.001). TE and LLS had similar diagnostic accuracy but
gave complementary information: TE was mildly more accurate than LLS to rule
out LC (−LR: 0.08 vs. 0.10), while it was less accurate to rule it in (+LR
5.05 vs. 11.15). Their combination offered the best diagnostic performance
(+LR 9.15; −LR 0.06).

Conclusions
LLS is more technically applicable than TE. In patients with clinical
suspicion of cirrhosis, LLS is the best non-invasive method to diagnose
cirrhosis, while TE is preferable to rule it out. The combination of both
holds the best diagnostic accuracy.

Abbreviations: LC, liver cirrhosis; TE, transient elastography; LLS, left lobe
liver surface; AUROC, area under the receiver operating characteristic curve;
HVPG, hepatic venous pressure gradient; TJLB, transjugular liver biopsy



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