Ultrasound-based elastography methods for predicting the presence of esophageal varices in patients with alcoholic liver cirrhosis

Background Liver stiffness (LS) measurement by elastographic methods is a noninvasive technique for the evaluation of liver fibrosis, which could also be used for predicting the presence of esophageal varices (EV) in patients with liver cirrhosis. Aim The aim of this study was to evaluate two ultrasound based elastographic methods as non-invasive markers for predicting the presence of EV, in a cohort of alcoholic liver cirrhosis patients. Material and Method The study included 77 patients diagnosed with compensated alcoholic liver cirrhosis, who underwent both upper endoscopy and LS assessment by two elastographic methods -Transient Elastography (TE) (Fibroscan/EchoSens) and Point shear wave elastography - Virtual Touch Tissue Quantification (VTQ) (Siemens Acuson S2000). Reliable LS measurements were defined for both methods as the median values of 10 measurements with an interquartile range/median ratio (IQR/M) Results 56 patients out of 77 had valid measurements by both elastographic methods and were included in the final analysis, 40/56 patients with EV. The best cut-off values to rule out the presence of EV in our cohort of alcoholic liver cirrhosis patients, with a NPV of 100% were: ≤ 20.1 kPa for TE (AUROC – 0.9; sensitivity-100%; specificity- 28%; PPV- 56%; NPV- 100%, Lr- 0, LR+1.38) and ≤ 2.1 m/s for VTQ (AUROC – 0.85; sensitivity-100%; specificity- 18%; PPV- 52%; NPV- 100%, Lr- 0, LR+1.21). Conclusion Using for TE the cut-off value ≤ 20.1 kPa and VTQ ≤ 2.1 m/s we can rule out quite accurately the presence of EV in patients with alcoholic liver cirrhosis.