Ultrasonographic scoring system score versus liver stiffness measurement in prediction of cirrhosis

Abstract

Background/aims: We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis.

Methods: Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4±9.5 y, mean±SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0-F4) were evaluated.

Results: The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0-F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS ≥6: LSM ≥17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4.

Conclusions: The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis.

Keywords: Biopsy; Cirrhosis; Elastography; Ultrasonography.

Figure 1

Ultrasonography images showing representative cases of ultrasonographic scoring system (USSS) parameters. (A) smooth and sharp surface and edge, score 0; (B) mildly irregular and mildly blunted surface and edge, score 1; (C) irregular and blunted surface and edge, score 2; (D) fine parenchyma, score 0; (E) mildly coarse parenchyma, score 1; (F) coarse parenchyma, score 2; (G) absence of right lobe atrophy (right lobe maximal oblique diameter >7 cm with no subphrenic ascites), score 0; (H) presence of right-lobe atrophy (right-lobe maximal oblique diameter <10 cm with subphrenic ascites), score 2; (I) spleen size <10 cm, score 0; (J) spleen size 10-14 cm, score 1; (K) spleen size >14 cm, score 2; (L) splenic vein diameter <0.7 cm, score 0; (M) splenic vein diameter 0.7-0.9 cm, score 1; (N) splenic vein diameter >0.9 cm, score 2; (O) triphasic hepatic vein waveform, score 0; (P) biphasic hepatic vein waveform, score 1; (Q) monophasic hepatic vein waveform, score 1.

Figure 2

(A) USSS score for each fibrosis stage. The top and bottom edges of the boxes indicate the first and third quartiles, respectively, while the lines through the middle of the boxes indicate median values. The median USSS scores were 2.0 (range, 1-4), 3.5 (range, 0-4), 5.0 (range, 2-7), 6.0 (range, 4-9), and 7.0 (range, 5-11) in fibrosis stages F0-F4, respectively. (B) Liver stiffness measurement (LSM) values for each fibrosis stage. The median LSM values were 6.8 (range, 4.4-15.3), 16.6 (range, 8.2-17.3), 9.9 (range, 6.6-16.6), 25.1 (range, 11.8-48.0), and 42.2 (range, 15.5-75.0) kPa in F0-F4, respectively.

Figure 3

Receiver operating characteristic (ROC) Curves Of The Usss Score And Lsm For The Prediction Of Overt Fibrosis (F4). The Areas Under The Roc Curves Of The Usss Score And Lsm Were 0.849 (Standard Error, 0.001; 95% Confidence Interval, 0.782-0.916) And 0.729 (Standard Error, 0.001; 95% Confidence Interval, 0.637-0.820), respectively.

Figure 4

ROC curves of the USSS score and LSM for the prediction of advanced fibrosis (F3 or F4). The areas under the ROC curves of the USSS score and LSM were 0.885 (standard error, 0.001; 95% confidence interval, 0.826-0.945) and 0.884 (standard error, 0.001; 95% confidence interval 0.827-0.940), respectively.