Elastography-based screening for esophageal varices in patients with advanced chronic liver disease

Table 2 Point shear wave elastography for the prediction of varices

Ref.	Country	Study design	N	Etiology	Device	Cut-off (AUC) for EV	Sens/Spec/+LR/-LR/p for EV	Cut-off (AUC) for VNT	Se/Sp/+LR/-LR/p for VNT	Comments
Vermehren, Liver International 2011[41]	Germany	Prospective	166	Mixed	Acuson S2000	NR	NR	L-SWE: (0.58) S-SWE: (0.58) Youden: 4.13 m/s Highest NPV: 3.04 m/s	NR Youden: 35%/83%/2.06/0.78/PPV 54%/NPV 69% Highest NPV: 90%/25%/1.19/0,4/PPV 40%/NPV 81%	Cut-offs only calculated for S-SWE and TE, but not for L-SWE
Bota, Annals of Hepatology, 2012[39]	Romania	Prospective	145 Cirrhosis: 24	Mixed, healthy	Acuson S2000	NR	NR	L-SWE: 2.25 m/s (0.596) S-SWE: 2.55 m/s (0.578) PRED: 0.395 (0.721)	LSM: 93.4%/28.9%/PPV48.5%/NPV:85.7% SSM: 96.7%/21%/PPV:47.6%/NPV:53.1% PRED: 75%/61.8%/PPV:61.4%/NPV:69.6%/p=0.0001	VNT: Varices ≥grade 2
Ye, Journal of Ultrasound in Medicine, 2012[91]	China	Prospective	264, cirrhosis: 141	Chronic HBV, healthy	Acuson S2000	L-SWE: 3.16 m/s (0.83)	84.1%/81.0%/NR	L-SWE: 3.39 m/s (0.83)	78.9%/78.3%	Main focus on liver stiffness evaluation VNT: Varices ≥grade 3
Takuma et al. Gastroenterology 2013[42]	Japan	Prospecttive	340	Mixed	Acuson S2000	S-SWE: cirrhosis: 3.17 m/s (0.933) Comp.: 3.18 m/s (0.934) Decomp: 3.22 m/s (0.936) Viral: 3.18 m/s (0.937) Nonviral: 3.24 m/s (0.923) L-SWE: NR (0.746)	98.4%/60.1%/2.468/0.025/PPV 61.0%/NPV 98.4%/acc. 75.0% 98.4%/63.4%/2.689/0.025/PPV: 50.4%/NPV: 99.0%/acc: 73.0% 98.6%/50.0%/1.971/0.029/PPV: 75.8%/NPV: 85.7%/acc: 79.8% 98.9%/59.9%/2.464/0.019/PPV: 57.5%/NPV: 99.0%/acc: 73.7% 97.7%/65.2%/2.808/0.036/PPV: 57.5%/NPV: 99.0%/acc: 73.7%	S-SWE: cirrhosis: 3.30 m/s (0.930) Comp: 3.30 m/s (0.921) Decomp: 3.45 m/s (0.934); S-Viral: 3.30 m/s (0.924); Nonviral: 3.41 m/s (0.944)	98.9%/62.9%/2.661/0.018/PPV 47.8%/NPV 99.4%/acc. 72.1% 97.5%/66.7%/2.925/0.038/PPV: 38.6%/NPV: 99.2%/acc: 72.1% 97.9%/73.1%/3.643/0.029/PPV: 71.9%/NPV: 98.0%/acc: 83.3% 98.2%/63.8%/2.243/0.029/PPV: 43.2%/NPV: 99.2%/acc: 71.3% 96.9%/71.9%/2.267/0.043/PPV: 66.0%/NPV: 97.6%/acc: 80.9%	No cut-offs for L-SWE reported - significantly superior S-SWE results
Mori, BioMed Research International 2013[92]	Japan	Prospective	33 cirrhosis: 24	Mixed, including healthy	Acuson 2000	NR	NR	NR	NR	Neither liver nor spleen stiffness correlated with presence of EV
Salzl, Ultraschall in der Medizin, 2014[36]	Austria	Prospective	88	Mixed	Acuson S2000	L-SWE: 2.74 m/s (0.743)	62.5%/89.5%/PPV: 91.5%/NPV: 56.9%	NR	NR	Size of EV was not defined
Morishita, Journal of Gastroenterology 2014[93]	Japan	Prospective	181	Chronic HCV	Acuson S2000	L-SWE: 2.05 m/s (0.890)	Training set: 83%/76%/PPV: 78%/NPV: 81% Validation set: 83%/77%/PPV 59%/NPV: 92%	L-SWE: 2.39 m/s (0.868)	Training set: 81%/82%/PPV: 69%/NPV: 89% Validation set: 83%/77%/PPV: 59%/NPV: 92%
Park, PloS ONE, 2015[94]	South Korea	Prospective	143	Mixed	Acuson S2000	L-SWE: 2.08 m/s (0.769) ASPS: 1.67 (0.903)	64.9%/81.1%/3.44/0.43/PPV 54.5%/NPV: 86.9% 81.1%/84.0%/5.06/0.23/PPV 63.8%/NPV: 92.7%	L-SWE: 1.90 (0.786) ASPS: 2.83 (0.946)	85%/67.5%/2.61/0.22/PPV: 29.8%/NPV: 96.5% 90%/94.3%/15.81/0.11/PPV: 72.0%/NPV: 98.3%	High discriminative power of ASPS confirmed in validation cohort
Attia, Ultraschall in der Medizin, 2015[95]	Germany	Prospective	78	Mixed	Acuson S2000	L-SWE (HVPG ≥10mmHg): 2.29 m/s (0.840) L-SWE (HVPG ≥12mmHg): 2.70 m/s (0.878) S-SWE (HVPG≥10mmHg):2.55 m/s(0.899) S-SWE (HVPG≥12mmHg):2.71 m/s (9.31)	91%/85%/6.08/0.1/<0.001/PPV 95%/NPV 74% 93%/77%/400/0.09/<0.001/PPV 89%/NPV 85% 95%/90%/9.06/0.05/<0.001/PPV 97%/NPV 85% 95%/92%/11.86/0.06/<0.001/PPV97%/NPV 89%	NR	NR	SSM independently predicted presence of CSPH+EV
Kim, Medicine, 2015[96]	Korea	Prospective	125	Mixed	Acuson S2000	L-SWE: cutoff NR (0.747) S-SWE: 3.16 m/s(0.785)	NR 87.0%/60.4%/PPV 77.9%/NPV 64.4%	L-SWE: cutoff NR (0.687) S-SWE: 3.40 m/s (0.762)	NR 78.9%/63.0%/PPV 60.3%/NPV 80.7%	VNT: medium-large varices
Park, Medical Ultrasound, 2016[97]	South Korea	Prospective	366	ALD or viral	iU22	L-SWE: NR S-SWE: 29.9 kPa (0.859)	L-SWE:NR S-SWE: 58.1%/79.1%/<0.001/PPV:81.6%/NPV:82.8%	NR	NR	High rate of unreliable results (25%) No significant correlation with L-SWE
Wiles, Clinical Radiology, 2018[98]	UK	Prospective	58	Mixed	Acuson S2000	NR	NR	NR	NR	ARFI not suitable to predict GOV (P = 0.15)
Lucchina et al. Ultrasound Med Biol 2018[38]	Italy	Prospective	42	Mixed	iU22	L-SWE: 12.27 kPa (0.913)S-SWE: 23.87kPa (0.675)	100%/66.67%/NR 73,81%/59.52%/NR	NR	NR	High rate of inconclusive results (22%)

AUC: Area under the (receiver operating) curve; CSPH: Clinically significant portal hypertension; LSM: Liver stiffness measurement; L-SWE: Liver shear wave elastography esophageal varices; TE: Transient elastography; Plt: Platelet count; VNT: Varices needing treatment; Se: Sensitivity; SSM: Spleen stiffness measurement; Sp: Specificity; +LR: Positive likelihood ratio; -LR: Negative likelihood ratio; NR: Not reported; S-SWE: Spleen share wave elastography; ASPS: ARFI-spleen diameter to platelet ratio; ARFI: Acoustic radiation force impulse; PRED: Prediction of significant EV score.