Comparison of three cut-offs to diagnose clinically significant portal
hypertension by liver stiffness in chronic viral liver diseases:
Received: 8 January 2018 /Revised: 3 April 2018 /Accepted: 11 April 2018
European Society of Radiology 2018
Background Transient elastography-based liver stiffness value (TE-LSV) has been investigated for assessing clinically signifi-
cant portal hypertension (CSPH). The aetiology of CSPH is an important factor determining TE-LSV. There is insufficient
evidence for selecting cut-off values.
Aims This study performed a meta-analysis to compare the three most widely used cut-off values (around 13.6 kPa, 18 kPa and
22kPa) of TE-LSV for the diagnosis of CSPH in patients with chronic viral liver disease.
Methods The PubMed, Ovid, Web of Science and Cochrane Library databases were searched. Diagnostic data for cut-off values
around 13.6 kPa, 18 kPa and 22 kPa in each included study were extracted. The bivariate model was performed to estimate
pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-).
Results Eleven studies assessing 910 patients were included in this meta-analysis. Pooled sensitivities of cut-off values around
13.6 kPa, 18 kPa and 22 kPa were 0.96 (95% CI 0.93–0.97), 0.85 (0.81–0.89) and 0.74 (0.66–0.80), respectively; pooled
specificities were 0.60 (0.47–0.75), 0.80 (0.71-0.87) and 0.94 (0.86–0.97), respectively. Pooled LR+ values were 2.4 (1.6–
3.7), 4.4 (2.9–6.8) and 11.5 (5.5–23.5) for cut-off values around 13.6 kPa, 18 kPa and 22 kPa, respectively, for pooled LR-
values of 0.07 (0.04–0.13), 0.17 (0.12–0.25) and 0.28 (0.22–0.36), respectively.
Conclusion Cut-off values around 13.6 kPa (high sensitivity) and 22 kPa (high specificity) could be used as screening and
confirmation tools, respectively, in the diagnosis of CSPH. Overall, the cut-off value around 22 kPa showed the best performance.
Jinzhen Song and Zida Ma contributed equally to this study.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-018-5478-z) contains supplementary
material, which is available to authorized users.
* Yan Lu o
* Qiang Lu
Department of Ultrasound, West China Hospital of Sichuan
University, Chengdu, China
Department of Gastrointestinal Surgery, West China Hospital of
Sichuan University, Chengdu, China
Laboratory of Clinical Ultrasound Imaging Drug Research, West
China Hospital of Sichuan University, Chengdu, China
Department of Obstetrics and Gynecology, West China Second
University Hospital of Sichuan University, Chengdu, China
Division of Gastroenterology and Hepatology, Department of
Internal Medicine III, Medical University of Vienna, Vienna, Austria
Department of Gastroenterology, Lithuanian University of Health
Sciences, Kaunas, Lithuania
Department of Gastroenterology, Sir Ganga Ram Hospital, New
Department of Gastroenterology, Alfred Hospital,