Accuracy of ultrasound to identify chronic liver disease

AIM:To identify and assess studies reporting the diagnostic performance of ultrasound imaging for identifying chronic liver disease(CLD)in a high risk population. METHODS:A search was performed to identify studies investigating the diagnostic accuracy of ultrasound imaging for CLD.Two authors independently used the quality assessment of diagnostic accuracy studies(QUADAS)checklist to assess the methodological quality of the selected studies.Inter-observer reliability of the QUADAS tool was assessed by measuring the degree of agreement(percent agreement,κstatistic)between the reviewers for each assessment prior to a consensusmeeting.The characteristics of each study population, sensitivity and specificity results for the index tests, and results of any testing for observer agreement were extracted from the reports.Receiver Operator Characteristic plots were generated using Microsoft Excel 2003 software and used to graphically display the diagnostic performance data and to explore the relationships between the reported ultrasound techniques and study characteristics,and methodology quality. RESULTS:Twenty-one studies published between 1991 and 2009 were retained for data extraction,analysis and assessment for methodological quality.Assessment of methodology quality was performed on the 21 selected studies by two independent reviewers(RA&KT) using the QUADAS assessment tool.Across all studies the mean number of responses within the QUADAS assessment tool was 10(range 7-13)for"Yes",1(range 0-3)for"No"and 3(range 0-6)for"unclear".Interrater agreement for assessment of methodology quality was significantly greater than chance when assessing for representative spectrum,clear selection criteria, appropriate delay between reference and index tests, adequate descriptions of the index and reference tests, reference and index test blinding,and if relevant clinical information was provided.Seven studies reported moderate to high observer agreement for ultrasound techniques.Studies which clearly reported blinding performed better than the other studies for diagnostic accuracy,and lower diagnostic accuracy was evident for populations with lower prevalence of disease.Assessment of the liver surface using ultrasound consistently had moderate diagnostic accuracy across studies which demonstrated good research methodology.Other techniques demonstrated variable or poor to fair diagnostic accuracy. CONCLUSION:Ultrasound of the liver surface is a useful diagnostic tool in patients at risk of CLD when assessing whether they should undergo a liver biopsy.

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension(CHESS1802):An International Multicenter Study

Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI(CHESS-DIS score)for detecting portal hy-pertension in cirrhosis.Methods:In this international multicenter,diagnostic study(ClinicalTrials.gov,NCT03766880),patients with cirrhosis who had hepatic venous pressure gradient(HVPG)measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China(n=4)and Turkey(n=1)between December 2018 and April 2019.A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017.After segmentation of the liver on fat-suppressed T1-weighted MRI maps,CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity.Results:A total of 149 patients were included,of which 124 were from four Chinese hospitals(training cohort)and 25 were from two international hospitals(validation cohort).A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36(p<0.0001)and 0.55(p<0.01)for the training and validation cohorts,respectively.The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension(CSPH)was 0.81 and 0.9 in the training and validation cohorts,respectively.The intra-class correlation coefficients for assessing the inter-and intra-observer agreement were 0.846 and 0.841,respectively.Conclusions:A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG.Besides,this score could be used to detect CSPH in patients with cirrhosis.