Ultrasonographic scoring system score versus liver stiffness measurement in prediction of cirrhosis.
OBJECTIVE
We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis.


METHODS
Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4±9.5 y, mean±SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0-F4) were evaluated.


RESULTS
The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0-F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS ≥6: LSM ≥17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4.


CONCLUSIONS
The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis.
Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
Kyoung Min
KM
Moon
Department of Nursing, Keimyung University College of Nursing, Daegu, Korea.
Gaeun
G
Kim
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. ; Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea. ; Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Soon Koo
SK
Baik
Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Eunhee
E
Choi
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. ; Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea. ; Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Moon Young
MY
Kim
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Hyoun A
HA
Kim
Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Mee Yon
MY
Cho
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Seung Yong
SY
Shin
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Jung Min
JM
Kim
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Hong Jun
HJ
Park
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Sang Ok
SO
Kwon
Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea.
Young Woo
YW
Eom
D000328:Adult; D019540:Area Under Curve; D054459:Elasticity Imaging Techniques; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D013154:Spleen / Q000033:anatomy & histology; D013162:Splenic Vein / Q000502:physiology
Biopsy; Cirrhosis; Elastography; Ultrasonography