Ultrasonographic evaluation of liver surface and transient elastography in clinically doubtful cirrhosis

Background & Aims: Both transient elastography (TE) and left lobe liver surface (LLS) ultrasound may non-invasively detect cirrhosis (LC). We aimed to examine the diagnostic value of these methods in patients with a suspicion but not a definite diagnosis of cirrhosis. Methods: We enrolled 90 patients with clinical suspicion of cirrhosis and a strong co-existing differential diagnosis requiring further invasive evaluation. They underwent hepatic venous pressure gradient (HVPG) measurement +/- transjugular liver biopsy, LLS and TE. Images of LLS were digitally post-processed to obtain a numerical value (quantitative LLS, qLLS). TE <12 kPa was considered to exclude LC, >= 18 kPa diagnosed LC, and 12-18 kPa indeterminate. Technical failures were considered 'indeterminate'. Diagnosis of cirrhosis was confirmed by histology (84%) or by clinical data and HVPG >= 10 mm Hg. Diagnostic accuracy was evaluated by positive and negative likelihood ratios (+LR and -LR). Results: Cirrhosis was diagnosed in 44 patients. There were 14 technical failures with TE and 1 with LLS (p = 0.001). TE and LLS had similar diagnostic accuracy but gave complementary information: TE was mildly more accurate than LLS to rule out LC (-LR: 0.08 vs. 0.10), while it was less accurate to rule it in (+LR 5.05 vs. 11.15). Their combination offered the best diagnostic performance (+LR 9.15; -LR 0.06). Conclusions: LLS is more technically applicable than TE. In patients with clinical suspicion of cirrhosis, LLS is the best non-invasive method to diagnose cirrhosis, while TE is preferable to rule it out. The combination of both holds the best diagnostic accuracy. (c) 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.