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Ruling in and ruling out with elastography in compensated advanced chronic liver disease
  1. Salvador Augustin1,2,
  2. Mónica Pons1,
  3. Joan Genesca1,2
  1. 1 Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
  2. 2 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Dr Salvador Augustin, Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain; salva.augustin{at}

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The recent letter by Jansen et al 1 presenting an algorithm to rule out clinically significant portal hypertension (CSPH) by combining shear-wave elastography of liver (L-SWE) and spleen (S-SWE) is an important contribution to the increasing knowledge regarding non-invasive assessment of patients with compensated advanced chronic liver disease (cACLD). Baveno VI recommendations focused on transient elastography as a tool to rule in CSPH in patients with the authors cACLD of viral etiology,2 ,3 but there is no doubt that other related elastography techniques should work similarly. Also, recent UK guidelines on variceal bleeding introduced elastography for variceal screening and diagnosis.4

In their study, the authors concluded that combining L-SWE <16 kPa with S-SWE <26.6 kPa showed a very high sensitivity (98.6%), with a remarkable negative predictive value for CSPH (96.3%). However, we have a few comments about the design and interpretation of results that we hope may enhance the transferability of these excellent results to …

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