title: New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension.
abstract: OBJECTIVE
  Transient elastography (TE) can non-invasively diagnose cirrhosis and portal hypertension (PHT). New TE reliability criteria suggest classifying measurements as very reliable (IQR/M < 0.1), reliable (IQR<0.3 or >0.3, if TE < 7.1 kPa) and poorly reliable (IQR/M > 0.3, if TE > 7.1 kPa). Compare traditional (reliable: success rate >60% + IQR/M ≤ 0.30) and new TE quality criteria (accurate: very reliable + reliable) regarding their diagnostic accuracy for cirrhosis and PHT and to identify potential confounders (age, aetiology, necroinflammatory activity, steatosis, siderosis, cholestasis, aminotransferases) of TE performance.
  
  
  METHODS
  Patients undergoing simultaneous measurements of TE, portal pressure (hepatic venous pressure gradient, HVPG) and liver biopsy were analysed.
  
  
  RESULTS
  Among 226 patients (48.7 ± 13.1 years, 74.7% male, 75.7% viral aetiology, 57% F3/F4), traditional TE quality criteria identified 71.6% reliable measurements, while new criteria yielded in 83.2% accurate results. Reliable TE values according to both criteria significantly correlated with fibrosis stage (r = 0.648 vs. r = 0.636) and HVPG (r = 0.836 vs. r = 0.846). Diagnostic accuracy for cirrhosis (cut-off >14.5 kPa) was 76.5% (AUC: 0.863) and 75.0% (AUC: 0.852) for traditional and new TE criteria, respectively, while for predicting HVPG ≥ 10 mmHg (>16.1 kPa), the accuracies were 88.9% (AUC: 0.957) and 89.8% (AUC: 0.962). New TE criteria allowed a better discrimination of reliable and non-reliable results for prediction of fibrosis and CSPH. Only aetiology and aminotransferases were independent confounders of the correlation of TE and fibrosis stage, while no confounder affected the correlation of TE and HVPG.
  
  
  CONCLUSIONS
  New reliability criteria for TE measurements increase the number of patients with accurate measurements without affecting diagnostic performance for detecting cirrhosis and portal hypertension. Aetiology of liver disease and aminotransferases should be considered when assessing liver fibrosis by TE.
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.
authors: Philipp
authors: P
authors: Schwabl
authors: Simona
authors: S
authors: Bota
authors: Petra
authors: P
authors: Salzl
authors: Mattias
authors: M
authors: Mandorfer
authors: Berit A
authors: BA
authors: Payer
authors: Arnulf
authors: A
authors: Ferlitsch
authors: Judith
authors: J
authors: Stift
authors: Friedrich
authors: F
authors: Wrba
authors: Michael
authors: M
authors: Trauner
authors: Markus
authors: M
authors: Peck-Radosavljevic
authors: Thomas
authors: T
authors: Reiberger
mesh_terms: D000328:Adult; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000592:standards*; D005260:Female; D005355:Fibrosis / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D000637:Transaminases / Q000378:metabolism
chemical_list: D000637:Transaminases
keywords: fibroscan; liver fibrosis; liver stiffness; portal hypertension; transient elastography