Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives

Table 1 Diagnostic performance of transient elastography for prediction of esophageal varices or large esophageal varices

Ref.	No. of patients (etiology)	Endpoints	AUROC	Cutoffs (kPa)	Sensitivity	Specificity	PPV	NPV
Vizzutti et al[33]	47 (HCV)	EV	0.76	17.6	90%	43%	77%	66%
Castéra et al[38]	70 (HCV)	EV	0.84	21.5	76%	78%	68%	84%
		Large EV	0.87	30.5	77%	85%	56%	94%
Kazemi et al[40]	165 (CLD)	EV	0.83	13.9	95%	43%	57%	91%
		Large EV	0.84	19.0	91%	60%	48%	95%
Bureau et al[41]	89 (CLD)	EV	0.85	21.1	84%	71%	NA	NA
		Large EV	0.76	29.3	81%	61%	NA	NA
Pritchett et al[42]	211 (CLD)	EV	0.74	19.5	76%	66%	56%	82%
		Large EV	0.76	19.8	91%	56%	91%	55%
Nguyen-Khac et al[43]	183 (CLD)	Large EV	0.76	48.0	73%	73%	44%	90%
	58 (HCV/HBV)	Large EV	0.73	19.8	89%	55%	27%	97%
	103 (alcohol)	Large EV	0.77	47.2	85%	64%	44%	93%
Malik et al[44]	124 (CLD)	EV	0.85	20.0	NA	NA	80%	75%

AUROC: Area under the receiver operating characteristic curve; PPV: Positive predictive value; NPV: Negative predictive value; CLD: Chronic liver disease; EV: Esophageal varix; HCV: Hepatitis C virus; HBV: Hepatitis B virus; NA: Not available.

Table 2 Proposal of application of transient elastography in each clinical setting

Clinical setting	Role of TE
Prediction of portal hypertension	TE with platelet counts and spleen size complementary to HVPG
Prediction of esophageal varices	TE with platelet counts and spleen size complementary to endoscopy
Prediction of developing esophageal variceal bleeding	TE with platelet counts and spleen size
Prediction of developing portal hypertension-related complications	TE with platelet counts and spleen size
Prediction of developing hepatocellular carcinoma	TE
Prediction of developing postoperative hepatic insufficiency after surgical resection	TE
Prediction of developing recurrence of hepatocellular carcinoma after curative resection	TE
Monitoring of fibrotic burden during antiviral treatment	TE

TE: Transient elastography; HVPG: Hepatic venous pressure gradient.