Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease

Authors

  • Ke-Qing Shi,

    1. Department of Infection and Liver Diseases, Liver Research Center, , The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
    2. Institute of Hepatology, Wenzhou Medical College, Wenzhou, China
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  • Yu-Chen Fan,

    1. Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
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  • Zhen-Zhen Pan,

    1. Department of Infection and Liver Diseases, Liver Research Center, , The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
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  • Xian-Feng Lin,

    1. Department of Infection and Liver Diseases, Liver Research Center, , The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
    2. School of the First Clinical Medical Sciences, Wenzhou Medical College, Wenzhou, China
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  • Wen-Yue Liu,

    1. Department of Infection and Liver Diseases, Liver Research Center, , The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
    2. School of the First Clinical Medical Sciences, Wenzhou Medical College, Wenzhou, China
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  • Yong-Ping Chen,

    1. Department of Infection and Liver Diseases, Liver Research Center, , The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
    2. Institute of Hepatology, Wenzhou Medical College, Wenzhou, China
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  • Ming-Hua Zheng

    Corresponding author
    1. Institute of Hepatology, Wenzhou Medical College, Wenzhou, China
    • Department of Infection and Liver Diseases, Liver Research Center, , The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
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Correspondence

Ming-Hua Zheng, MD, Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical College; Institute of Hepatology, Wenzhou Medical College, No. 2 Fuxue lane, Wenzhou 325000, China

Tel: +86 577-88078232

Fax: +86 577-88078262

e-mail: blueman1320@163.com

Abstract

Objectives

Transient elastography (TE), as a non-invasive method, has been studied for evaluation of portal hypertension in patients with chronic liver diseases (CLD) with variable results. We studied the performance of TE for detection of significant portal hypertension, oesophageal varices and large oesophageal varices using meta-analysis.

Methods

PubMed, the Cochrane Library, EMBASE and ISI web of Knowledge were searched. The studies published in English relating to the diagnostic value of TE for significant portal hypertension, oesophageal varices and large oesophageal varices in patients with CLD were collected.

Results

A total of 18 studies, which included 3644 patients were analysed. Summary sensitivity and specificity were 0.90 (95% confidence interval (CI), 0.81–0.95) and 0.79 (95% CI, 0.58–0.91) for significant portal hypertension, and 0.87 (95% CI, 0.80–0.92) and 0.53 (95% CI, 0.36–0.69) for oesophageal varices and 0.86 (95% CI, 0.71–0.94) and 0.59 (95% CI, 0.45–0.72) for large oesophageal varices respectively. The HSROCs were 0.93 for significant portal hypertension, 0.84 for oesophageal varices and 0.78 for large oesophageal varices respectively. TE was very informative with 81% probability of correctly detection significant portal hypertension following a ‘positive’ measurement (over the threshold value) and lowering the probability of disease to as low as 11% when ‘negative’ measurement (below the threshold value) when pre-test probability was 50% whereas, for oesophageal varices or large oesophageal varices, the probability of a correct diagnosis following a ‘positive’ measurement did not exceeded 70%.

Conclusions

TE could be used as a good screening tool for significant portal hypertension, but only moderate diagnostic utility for the prediction of oesophageal varices or large oesophageal varices.

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