Transient elastography: Kill two birds with one stone?

Table 1 Diagnostic performance and suggested cutoff values of liver stiffness measurement for the diagnosis of histologic cirrhosis (F4)

Ref.	Biopsies (n)	Prevalence of cirrhosis (F4)	Etiologies	Proposed cutoff values (kPa)	Sensitivity	Specificity	NPV	PPV	Positive LR	Negative LR	AUROC
Castéra et al[4], 2005	183	25%	HCV	12.5	87%	91%	95%	77%	9.7	0.1	0.95
Fraquelli et al[23], 2007	200	12%	All	11.9	91%	89%	98%	53%	8.3	0.1	0.9
Arena et al[24], 2008	150	19.3%	HCV	14.8	94%	92%	98%	73%	11.3	0.07	0.99
Ziol et al[25], 2005	251	19%	HCV	14.6	86%	96%	97%	78%	23.1	0.1	0.97
Chan et al[26], 2009	161	25%	HBV	13.4	60%	93%	88%	75%	85	0.43	0.93
Marcellin et al[27], 2009	173	8%	HBV	11	93%	87%	99%	38%	7	0.08	0.93
Wong et al[28], 20101	238	23.5%	HBV	9.0 (normal ALT) 12.0 (elevated ALT)	54%	99%	67%	98%	3.3	0.7	0.88
de Lédinghen et al[29], 2006	72	23.6%	HCV-HIV	11.8	100%	92.7%	82%	100%	13.7	0	0.97
Nobili et al[30], 20081	52	5.8%	NAFLD	10.2	100%	100%	100%	100%	∞	0	1
Wong et al[31], 2010	246	10.1%	NAFLD	10.3	92%	88%	99%	46%	7.5	0.09	0.95
Nahon et al[32], 2008	174	53.7%	ALD	22.7	84%	83%	82%	85%	5.24	0.19	0.87
Corpechot et al[33], 2006	95 (66 PBC, 29 PSC)	16%	PBC/PSC	17.3	93%	95%	99%	78%	18.6	0.1	0.96
Carrión et al[34], 2006	124	11%	HCV-LT	12.5	100%	87%	100%	50%	7.7	0	0.98
Witters et al[36], 2009	66	NA	Cystic fibrosis	6.5	100%	81%	NA	NA	NA	NA	0.92
Coco et al[75], 2007	228	20.2%	HCV/HBV	14	78%	98%	82%	98%	39	0.2	0.96
Ganne-Carrié et al[106], 2006	775	15.5%	All	14.6	79%	95%	96%	74%	15.8	0.1	0.95
Foucher et al[107], 2006	354	13.3%	All	17.6	77%	97%	92%	91%	25.7	0.2	0.96
Gómez-Domínguez et al[108], 2006	94	17%	All	16	89%	96%	98%	80%	22.3	0.1	0.94
Vergara et al[109], 2007	169	38.5%	HCV-HIV	14.6	93%	88%	94%	86%	7.8	0.1	0.95
Rigamonti et al[110], 2008	95	17%	HCV-LT	12	93%	93%	99%	74%	14	0.1	0.9
Yoneda et al[111], 2007	67	7.5%	NAFLD	17	100%	98%	95%	64%	50	0	0.99

¹Cut-off values proposed for advanced fibrosis (F3 or above). ALD: Alcoholic liver disease; ALT: Alanine aminotransferase; AUROC: Area under receiver operating characteristics curves; HBV: Hepatitis B virus infection; HCV: Hepatitis C virus infection; HCV-HIV: Hepatitis B virus and human immunodeficiency virus co-infection; HCV-LT: Hepatitis C virus infection recurrence after liver transplantation; LR: Likelihood ratio; NAFLD: Non-alcoholic fatty liver disease; PBC: Primary biliary cirrhosis; PSC: Primary sclerosing cholangitis; NPV: Negative predictive value; PPV: Positive predictive value; NA: Not available..

Table 2 Diagnostic performance and suggested cutoff values of controlled attenuation parameter for the diagnosis of liver steatosis

Ref.	Biopsies (n)	Study design	Etiologies	AUROC≥S1 (11%)	AUROC≥S2 (34%)	AUROC≥S3 (67%)	Cutoff values for≥S1 (dB/m)	Sen	Spe	NPV	PPV	Cutoff values for≥S2 (dB/m)	Sen	Spe	NPV	PPV	Cutoff values for≥S3 (dB/m)	Sen	Spe	NPV	PPV
Sasso et al[21], 2010	115	Retrospective	All	0.91	0.95	0.89	238	91%	81%	87%	87%	259	89%	86%	92%	80%	292	100%	78%	100%	28%
de Lédinghen et al[39], 2012	112	Prospective	All	0.84	0.86	0.93	215					252					296
Myers et al[40], 2012	153	Prospective	All	0.81			283	76%	79%	64%	87%
Beaugrand et al[41], 2010	74	Retrospective	ALD	0.81	0.87	0.82
Beaugrand et al[42], 2010	96	Retrospective	ALD/NAFLD	0.86	0.87	0.77
Cardoso et al[43], 2010	133	Retrospective	CHB	0.82	0.81	-
Sasso et al[44], 2012	615	Retrospective	CHC	0.8	0.86	0.88

ALD: Alcoholic liver disease; AUROC: Area under receiver operating characteristics curves; NPV: Negative predictive value; PPV: Positive predictive value; Sen: Sensitivity; Spe: Specificity; NAFLD: Non-alcoholic fatty liver disease; CHB: Chronic hepatitis B; CHC: Chronic hepatitis C.

Table 3 Liver stiffness measurement and the risk of hepatocellular carcinoma in chronic hepatitis B or C patients

Chronic hepatitis B patients		Chronic hepatitis C patients
LSM (kPa)	HR of HCC	LSM (kPa)	HR of HCC
≤ 10.0	Referent	≤ 8.0	Referent
10.1-15.0	17	8.1-13.0	3.1
15.1-20.0	21	13.1-18.0	4.7
20.1-25.0	26	18.1-23.0	5.6
> 25.0	46	> 23.0	6.6

LSM: Liver stiffness measurement; HCC: Hepatocellular carcinoma.

Table 4 The characteristic of the new S and XL probes comparing to M probe

Probe	Frequency of ultrasound (MHz)	Depth (mm)
S	5	15-40
M	3.5	25-65
XL	2.5	35-75