Repeating measurements by transient elastography in non-alcoholic fatty liver disease patients with high liver stiffness
Abstract
BACKGROUND AND AIM: The Baveno VI Consensus recommends repeating examination in patients with high liver stiffness measurement (LSM) by transient elastography to reduce false-positive diagnosis of advanced liver disease. We tested whether repeating transient elastography can increase the overall diagnostic accuracy. METHODS: Ninety-seven patients with non-alcoholic fatty liver disease who underwent two FibroScan examinations within 6 months prior to liver biopsy were evaluated. An LSM cut-off of 7.9 kPa was used to exclude F3-4 fibrosis. RESULTS: Seventy-eight patients had high LSM at baseline, among whom 27 had low LSM on repeated testing; only four had F3 and none had cirrhosis. In contrast, 31 of 51 patients with high LSM at both examinations had F3-4. Nineteen patients had low LSM at baseline; none of them had F3-4 regardless of the second LSM results. If we took LSM <7.9 kPa at either examination as sufficient to exclude F3-4, the negative predictive value remained high at 91%. The positive predictive value for F3-4 increased from 45% in patients with high LSM at baseline to 61% in those with high LSM at both examinations. Sensitivity analysis using different cut-offs yielded similar results, with 76% of patients with LSM >12 kPa at both examinations having F3-4. CONCLUSIONS: Transient elastography is a highly sensitive screening test to exclude F3-4 fibrosis in non-alcoholic fatty liver disease patients. One-third of patients with high LSM may have normal results on repeated examination. By repeating examination in cases with high LSM, one may spare patients from unnecessary liver biopsy.
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High VCTE measurements > 7.9 kPa may not be reproducible at subsequent measurements in about one-third of individuals.
“high VCTE measurements > 7.9 kPa may not be reproducible at subsequent measurements in about one-third of individuals. 190”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [190]
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Self-citation
- Authors
- Chow, J. C., Wong, G. L., Chan, A. W., Shu, S. S., Chan, C. K., Leung, J. K., Choi, P. C., Chim, A. M., Chan, H. L., & Wong, V. W.
- Affiliations
- Chinese University of Hong Kong (HK)
- Corresponding author
- Wong, Vincent Wai‐Sun
- Venue
- Journal of Gastroenterology and Hepatology
- Publisher
- Wiley
- Published
- 2018-06-27
- Volume
- 34
- Issue
- 1
- Pages
- 241-248
- ISSN
- 0815-9319 (ISSN-L)
- 1440-1746
- OpenAlex
- W2808017849
- Cited by
- 46
- References
- 38
- Citations by year
- 2026: 10 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 8 · 2019: 8 · 2018: 2
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Research Grants Council of the Hong Kong SAR Government (CUHK 14108916)
- 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, non-alcoholic fatty liver disease, liver stiffness measurement, FibroScan, liver fibrosis, advanced fibrosis, liver cirrhosis, diagnostic accuracy, false positives, liver biopsy avoidance, negative predictive value
- MeSH terms
- Aged, Elasticity, False Positive Reactions, Female, Humans, Liver Cirrhosis, Male, Middle Aged, Predictive Value of Tests, Reproducibility of Results, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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