Determination of reliability criteria for liver stiffness evaluation by transient elastography
Open accessAbstract
Liver stiffness evaluation (LSE) is usually considered as reliable when it fulfills all the following criteria: ≥10 valid measurements, ≥60% success rate, and interquartile range / median ratio (IQR/M) ≤0.30. However, such reliable LSE have never been shown to be more accurate than unreliable LSE. Thus, we aimed to evaluate the relevance of the usual definition for LSE reliability, and to improve reliability by using diagnostic accuracy as a primary outcome in a large population. 1,165 patients with chronic liver disease from 19 French centers were included. All patients had liver biopsy and LSE. 75.7% of LSE were reliable according to the usual definition. However, these reliable LSE were not significantly more accurate than unreliable LSE with, respectively: 85.8% versus 81.5% well-classified patients for the diagnosis of cirrhosis ( P = 0.082). In multivariate analyses with different diagnostic targets, LSE median and IQR/M were independent predictors of fibrosis staging, with no significant influence of ≥10 valid measurements or LSE success rate. These two reliability criteria determined three LSE groups: “very reliable” (IQR/M ≤0.10), “reliable” (0.10< IQR/M ≤0.30, or IQR/M >0.30 with LSE median <7.1 kPa), and “poorly reliable” (IQR/M >0.30 with LSE median ≥7.1 kPa). The rates of well-classified patients for the diagnosis of cirrhosis were, respectively: 90.4%, 85.8%, and 69.5% ( P < 10−3). According to these new reliability criteria, 9.1% of LSE were poorly reliable (versus 24.3% unreliable LSE with the usual definition, P < 10−3), 74.3% were reliable, and 16.6% were very reliable. Conclusion : The usual definition for LSE reliability is not relevant. LSE reliability depends on IQR/M according to liver stiffness median level, defining thus three reliability categories: very reliable, reliable, and poorly reliable LSE. (Hepatology 2013)
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One large collaborative study showed LSM and IQR/median as two independent criteria of VCTE reliability.
“One large collaborative study showed LSM and IQR/median as the two independent criteria of VCTE reliability [92]”
From EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. (2017) · cites this paper as [92]
One large collaborative study showed LSM and IQR/median as the two independent criteria of VCTE reliability.
“One large collaborative study showed LSM and IQR/median as the two independent criteria of VCTE reliability221”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [221]
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- Authors
- Boursier, J., Zarski, J.-P., de Ledinghen, V., Rousselet, M.-C., Sturm, N., Lebail, B., Fouchard-Hubert, I., Gallois, Y., Oberti, F., Bertrais, S., & Calès, P.
- Affiliations
- Université Nantes Angers Le Mans (FR)
- Inserm (FR)
- Centre Hospitalier Universitaire d'Angers (FR)
- Corresponding author
- Boursier, Jérôme
- ORCID
- Venue
- Hepatology
- Published
- 2013-03
- Volume
- 57
- Issue
- 3
- Pages
- 1182-1191
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W2093904708
- Semantic Scholar
- 766ce7c850a060d7e4bb2890a0e44443c293f9e7
- Cited by
- 662
- References
- 35
- Citations by year
- 2026: 50 · 2025: 59 · 2024: 68 · 2023: 49 · 2022: 47 · 2021: 54 · 2020: 54 · 2019: 52 · 2018: 51 · 2017: 56 · 2016: 48 · 2015: 32 · 2014: 27 · 2013: 13
- FWCI
- 17.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- ANRS (French National Agency for AIDS and Viral Hepatitis) for HC/EP23 Fibrostar
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Ultrasound Imaging and Elastography
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- transient elastography, measurement reliability, liver fibrosis staging, cirrhosis diagnosis, chronic liver disease, diagnostic accuracy, liver biopsy
- MeSH terms
- Adult, Biopsy, Fatty Liver, Female, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Predictive Value of Tests, Severity of Illness Index, Reproducibility of Results, Hepatitis B, Chronic, Hepatitis C, Chronic, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
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