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

Table 4 Magnetic resonance elastography for prediction of varices

Author, Journal, Year	Liver/Spleen	Patient N	Etiology	Cut-offs for EV (AUC)	EV: Sens/Spec/+LR/-LR/acc/p	Cut-offs for VNT (AUC)	VNT: Sens/Spec/+LR/-LR/acc/p	Prevalence of EV and VNT	Comment
Ronot et al. Eur Radiol 2014[63]	yes/yes	36	mixed	NR	NR	Gl, 84 Hz: 4.2 kPa (0.93)	54%/100%/PPV: 33%/NPV: 79%/P = 0.001	Any EV: 75%; VNT: 72%	Liver MRE not predictive of EV or VNT. Advantage of 3D multifrequency MRE
Sun et al. J Magn Reson Imaging 2014[62]	yes/no	126	mixed	L-MRE: 4.63 kPa (0.859)	NR	L-MRE: 5.803 kPa (0.810)	L-MRE: 96%/60%/n.r.	Any EV: 49%; VNT: 19%	Pearson correlation coefficient between liver stiffness and EV: 0.63 (P < 0.0001).
Shin et al. Radiology 2014[61]	yes/yes	139	mixed	L-MRE: 4.58 kPa (0.821) S-MRE: 7.23 kPa (0.833)	L-MRE: 87.4%/65.6%/n.r. S-MRE: 85.8%/65.4%/n.r.	L-MRE: 4.81 kPa (0.755) S-MRE: 7.60 kPa (0.750)	L-MRE: 84.4%/56.7%/n.r S-MRE: 68.3%/61.6%/n.r.	Any EV: 56%; VNT: 32%	Data cross-validated; several false-positive diagnoses of EV and VNT due to high liver stiffness and non-esophageal collaterals; 11 cases of false-negative diagnoses of EV: pre-hepatic PHT, iron deposition, large ascites.
Matsui, Journal of Gastroenterology and Hepatology, 2018[100]	yes/no	627	mixed	MRE: 4.2 kPa (0.85) PLT: 18*104 (0.77)	MRE: 85%/69%/PPV 32%/NPV 96% MRE + PLT: 93%/43%/PPV 22%/NPV 96%	MRE: 4.2 kPa (0.85) PLT: 18*104 (0.77)	MRE: 94%/65%/PPV 17%/ NPV 99% MRE + PLT: 100%/35%/PPV 10%/ NPV 100%	Any EV: 15.6% VNT: 4.5%	3T device; also validated Baveno VI criteria (1) and modified Baveno VI criteria (30); excellent performance in NAFLD and viral hepatitis
Bookwalter, Abdominal Radiology, 2018[101]	yes/no	55	PSC	6.27 kPa (NR)	Sens. 100%/Spec. 76.7%	NR	NR	NR	Several sequences, 2D and 3D modes, at 1,5T and 3T; Varices assessed by global LSM
Kim, European Radiologist, 2017[102]	yes/no	84	NR	GRE-MRE: (0.948) SE-EPI-MRE: (0.914)	NR	GRE-MRE: 4.493 kPa (0.752) SE-EPI-MRE: 5.880 kPa (0.839)	NR	Any EV: 17.9% VNT: 8.3%	Neither SE-EPI-, nor GRE-MRE reached significance regarding diagnostic performance

AUC: Area under the (receiver operating) curve; CSPH: Clinically significant portal hypertension; LSM: Liver stiffness measurement; EV: Esophageal varices; MRE: Magnetic resonance elastography; TE: Transient elastography; Plt: Platelet count; VNT: Varices needing treatment; NR: Not reported; SSM: Spleen stiffness measurement; SE-EPI: Spin-echo echoplanar imaging; GRE: Gradient recalled echo.