Adaptation of Liver Stiffness Cutoff Values to Inflammation, Cholestasis, and Congestion

BACKGROUND: Two-dimensional shear-wave elastography (2D-SWE) has been used for years for liver assessment of patients with chronic hepatitis B (CHB), but its effectiveness remains unclear in different populations and using different ultrasound systems. OBJECTIVE: This study investigated the effectiveness of 2D-SWE in evaluating liver fibrosis in patients with CHB. METHODS: A prospective investigation was conducted after approval by the institutional ethics committee, with 116 out of 133 patients with CHB referred for liver biopsy included and 50 patients with healthy livers selected as controls. Assessment with 2D-SWE of liver stiffness measurement (LSM) was compared with histopathological results. Cutoff values for LSM were set to determine the degree of fibrosis, and area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity were calculated. RESULTS: The optimal LSM cutoff for differentiating healthy livers from livers with CHB and any liver fibrosis was 6.485 kPa, with an AUROC of 0.927, sensitivity of 94%, and specificity of 19.8%. The optimal LSM cutoff values for F1, F2, F3, and F4 were 6.19 kPa, 6.485 kPa, 7.46 kPa, and 9.62 kPa, respectively, with corresponding AUROCs of 0.516, 0.625, 0.779, and 0.881, respectively. Comparisons of AUROCs between F1 and F3, F1 and F4, F2 and F3, and F2 and F4 were all significantly different (P = 0.0001, P < 0.0001, P = 0.0139, and P = 0.0003, respectively); comparisons of AUROCs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.1232 and P = 0.2462, respectively). Comparisons of LSMs between healthy livers and F0 and between healthy livers and a combination of F0 and F1 were significantly different (P = 0.002 and P = 0.001, respectively). Comparisons of LSMs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.233 and P = 0.072, respectively). Other comparisons between fibrosis score groups were significantly different (F1 and F3, P = 0.003; F1 and F4, P = 0.007; F2 and F3, P = 0.013; F2 and F4, P = 0.015). CONCLUSION: 2D-SWE using a specific diagnostic ultrasound system is effective for the assessment of severe liver fibrosis and cirrhosis, but is limited in diagnosing mild liver fibrosis.

Download Full-text

Is That Measure Really One-Dimensional?

Methodology ◽

10.1027/1614-2241/a000158 ◽

2018 ◽

Vol 14 (4) ◽

pp. 188-196 ◽

Cited By ~ 5

Author(s):

Esther T. Beierl ◽

Markus Bühner ◽

Moritz Heene

Keyword(s):

Model Fit ◽

Nuisance Parameters ◽

Factorial Validity ◽

Fit Indices ◽

Analysis Model ◽

Factor Analysis Model ◽

One Dimensional ◽

Confirmatory Factor Analysis Model ◽

Cutoff Values ◽

Confirmatory Factor

Abstract. Factorial validity is often assessed using confirmatory factor analysis. Model fit is commonly evaluated using the cutoff values for the fit indices proposed by Hu and Bentler (1999) . There is a body of research showing that those cutoff values cannot be generalized. Model fit does not only depend on the severity of misspecification, but also on nuisance parameters, which are independent of the misspecification. Using a simulation study, we demonstrate their influence on measures of model fit. We specified a severe misspecification, omitting a second factor, which signifies factorial invalidity. Measures of model fit showed only small misfit because nuisance parameters, magnitude of factor loadings and a balanced/imbalanced number of indicators per factor, also influenced the degree of misfit. Drawing from our results, we discuss challenges in the assessment of factorial validity.

Download Full-text

Liver Elastography in Healthy Children Using Three Different Systems – How Many Measurements Are Necessary?

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1283-5906 ◽

2020 ◽

Author(s):

Anders Batman Mjelle ◽

Anesa Mulabecirovic ◽

Roald Flesland Havre ◽

Edda Jonina Olafsdottir ◽

Odd Helge Gilja ◽

...

Keyword(s):

Shear Wave ◽

Transient Elastography ◽

Intraclass Correlation ◽

Age Groups ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Healthy Children ◽

Significant Difference ◽

Pediatric Liver Disease ◽

Liver Elastography

Abstract Purpose Liver elastography is increasingly being applied in screening for and follow-up of pediatric liver disease, and has been shown to correlate well with fibrosis staging through liver biopsy. Because time is of the essence when examining children, we wanted to evaluate if a reliable result can be achieved with fewer acquisitions. Materials and Methods 243 healthy children aged 4–17 years were examined after three hours of fasting. Participants were divided into four age groups: 4–7 years; 8–11 years; 12–14 years and 15–17 years. Both two-dimensional shear wave elastography (2D-SWE; GE Logiq E9) and point shear wave elastography (pSWE; Samsung RS80A with Prestige) were performed in all participants, while transient elastography (TE, Fibroscan) was performed in a subset of 87 children aged 8–17 years. Median liver stiffness measurement (LSM) values of 3, 4, 5, 6, 7, and 8 acquisitions were compared with the median value of 10 acquisitions (reference standard). Comparison was performed for all participants together as well as within every specific age group. We investigated both the intraclass correlation coefficient (ICC) with absolute agreement and all outliers more than 10 %, 20 % or ≥ 0.5 or 1.0 kPa from the median of 10 acquisitions. Results For all three systems there was no significant difference between three and ten acquisitions, with ICCs ≥ 0.97. All systems needed 4 acquisitions to achieve no LSM deviating ≥ 1.0 kPa of a median of ten. To achieve no LSM deviating ≥ 20 % of a median of ten acquisitions, pSWE and TE needed 4 acquisitions, while 2D-SWE required 6 acquisitions. Conclusion Our results contradict recommendations of 10 acquisitions for pSWE and TE and only 3 for 2D-SWE.

Download Full-text