title: Transient elastography improves detection of liver cirrhosis compared to routine screening tests.
abstract: OBJECTIVE
  To investigate the diagnostic significance of transient elastography (TE) in a daily routine clinical setting in comparison to clinical signs, laboratory parameters and ultrasound.
  
  
  METHODS
  TE, ultrasound, laboratory parameters and cutaneous liver signs were assessed in 291 consecutive patients with chronic liver disease of various aetiologies who underwent liver biopsy in daily routine.
  
  
  RESULTS
  Sensitivity of TE for the detection of liver cirrhosis was 90.4%, compared to 80.1% for ultrasound, 58.0% for platelet count and 45.1% for cutaneous liver signs (P < 0.0001 for comparisons with histology). AUROC for TE was 0.760 (95%CI: 0.694-0.825). Combination of TE with ultrasound increased sensitivity to 96.1% and AUROC to 0.825 (95%CI: 0.768-0.882). TE correlated with laboratory parameters of cirrhosis progression like albumin (r = -0.43), prothrombin time (r = -0.44), and bilirubin (r = 0.34; P < 0.001 for each). Particularly, in patients with Child Pugh score A or normal platelet count TE improved sensitivity for the detection of liver cirrhosis compared to ultrasound by 14.1% (P < 0.04) and 16.3% (P < 0.02), respectively.
  
  
  CONCLUSIONS
  Transient elastography is superior to routine diagnostic tests allowing detection of liver cirrhosis in additional 10%-16% of patients with chronic liver disease that would have been missed by clinical examinations.
authors.affiliation: Thomas Göbel, Janine Schadewaldt-Tümmers, Dieter Häussinger, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Göbel
authors.affiliation: Thomas Göbel, Janine Schadewaldt-Tümmers, Dieter Häussinger, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Schadewaldt-Tümmers
authors.affiliation: Thomas Göbel, Janine Schadewaldt-Tümmers, Dieter Häussinger, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Lucas
authors.initials: L
authors.lastname: Greiner
authors.affiliation: Thomas Göbel, Janine Schadewaldt-Tümmers, Dieter Häussinger, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Poremba
authors.affiliation: Thomas Göbel, Janine Schadewaldt-Tümmers, Dieter Häussinger, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
authors.affiliation: Thomas Göbel, Janine Schadewaldt-Tümmers, Dieter Häussinger, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Erhardt
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003955:Diagnostic Tests, Routine / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
chemical_list: D015415:Biomarkers
keywords: Chronic hepatitis; Fibroscan; Liver cirrhosis; Liver disease; Transient elastography