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Liver stiffness by two-dimensional shear wave elastography for screening high-risk varices in patients with compensated advanced chronic liver disease

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 09 April 2024

An Author Correction to this article was published on 01 February 2024

This article has been updated

Abstract

Objectives

To investigate the usefulness of the criteria with liver stiffness (LS) measured by two-dimensional shear wave elastography (2D-SWE) and platelet count (PLT) for ruling out high-risk varices in patients with compensated advanced chronic liver disease (cACLD).

Methods

A total of 661 patients with cACLD had successfully undergone 2D-SWE and endoscopy screening. We analyzed risk factors for the presence of high-risk varices and compared proportions of patients who were spared endoscopy when used the predicting criteria with LS (ranged from 16 to 25 kPa) and PLT (ranged from 80 × 109/L to 150 × 109/L).

Results

PLT, albumin, LS were found to be independent predictors of high-risk varices. The LS values for ruling out and ruling in high-risk varices were 14.0 kPa and 24.8 kPa, respectively. When the Baveno VI criteria LS < 20 kPa and PLT > 150 × 109/L were used, the high-risk varices miss rate was 2.1%, while the saved endoscopy rate only was 19.2%. The new criteria that LS < 16 kPa and PLT > 100 × 109/L saved 30.4–34.6% endoscopy with 0–3.2% high-risk varices miss rate in the subgroup analysis stratified according to the types of underlying liver disease.

Conclusions

The Baveno VI criteria can be applied to LS measurement by 2D-SWE. The new criteria that LS < 16 kPa and PLT > 100 × 109/L could be a potential model to spare more endoscopy screening with < 5% high-risk varices miss rate.

Key Points

• LS measured by 2D-SWE is reliable predictive factor for predicting all-size varices and high-risk varices in patients with compensated advanced chronic liver disease.

• LS measured by 2D-SWE < 16 kPa and PLT > 100 × 109 /L, which can spare more endoscopy than Baveno VI criteria with < 5% high-risk varices miss rate.

• The Baveno VI criteria can be applied to LS measurement by 2D-SWE.

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Abbreviations

2D-SWE:

Two-dimensional shear wave elastography

AIH:

Autoimmune liver disease

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AUROC:

Areas under receiver operating characteristic curve

cACLD:

Compensated advanced chronic liver disease

CI:

Confidence index

CSPH:

Clinically significant portal hypertension

HVPG:

Hepatic venous pressure gradient

INR:

International normalized ratio

LS:

Liver stiffness

MELD:

Model for end-stage liver disease

NPV:

Negative predictive value

PBC:

Primary biliary cholangitis

PLT:

Platelet count

PPV:

Positive predictive value

PT:

Prothrombin time

TE:

Transient elastography

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Funding

This study has received funding: Post-Doctor Research Project, West China Hospital, Sichuan University (No. 2019HXBH045) and China Postdoctoral Science Foundation (No. 2020M673263).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, People’s Republic of China

    Yuling Yan, Xian Xing, Xiaoze Wang & Li Yang

  2. Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, Chengdu, People’s Republic of China

    Yuling Yan, Xian Xing, Xiaoze Wang & Li Yang

Authors
  1. Yuling Yan
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  2. Xian Xing
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  3. Xiaoze Wang
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  4. Li Yang
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Correspondence to Li Yang.

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The scientific guarantor of this publication is Li Yang.

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The authors declare no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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• retrospective.

• diagnostic and prognostic study.

• performed at one institution.

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The original online version of this article was revised: Some results in Table 3 Section "High-risk varices" row "Rule in" were incorrect. The correct Table 3 is as follows. The revised entries have been emphasized for purposes of clarity: Rule in24.836.1%95.1%75.0%78.5%78.1%

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Yan, Y., Xing, X., Wang, X. et al. Liver stiffness by two-dimensional shear wave elastography for screening high-risk varices in patients with compensated advanced chronic liver disease. Eur Radiol 32, 2078–2088 (2022). https://doi.org/10.1007/s00330-021-08280-3

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