Shear wave elastography (SWE) may be more sensitive and more precise than transient elastography (TE) in predicting significant fibrosis in CHB patients：A prospective comparative study

Abstract Background Noninvasive measurements including transient elastography (TE) and the two-dimensional shear wave elastography (SWE) have been clinical used instead of liver biopsy for the regular assessment of liver fibrosis in patients during following-up. We aimed to investigate independent factors of SWE compared with TE and find the optimal cutoff values of these two non-invasive evaluation assessments based on our cohort of treatment-naive CHB patients. Methods Fifty-four treatment-naive CHB patients were enrolled and studied. All of them were performed SWE, TE, serum tests and liver biopsy. Potential factors of SWE and TE values were analysed by linear regression and orthogonal partial least squares (OPLS) discriminant analysis. The agreement, the association, the comparison of the two different methods were implemented based on the results of liver biopsy by using Bland–Altman analysis, spearman’s correlation and areas under the receive operating characteristic curves (AUROCs). Results There were 27 cases (50%) of mild fibrosis (F0-F2) and 27 (50%) cases of significant fibrosis (F3-F6), fibrosis was assessed with the Ishak scoring system. Multivariate linear regression analyses revealed that fibrosis stage was the only factor affecting the values of SWE (P<0.001), whereas total bilirubin levels (P=0.013) and fibrosis stage (P=0.037) were independent factors affecting TE values. OPLS showed the numbers independent factors (VIP>1) were more in TE than SWE. Bland-Altman analysis showed satisfied agreement between LSMs of SWE and TE. Both of SWE and TE could significantly evaluate significant fibrosis (P<0.001). Spearman’s correlation analysis revealed a correlation between liver fibrosis and LSMs of SWE and TE (r=0.65 and 0.50, P<0.001). Areas under receiver operating characteristics curves (AUROCs) of SWE and TE for significant fibrosis (F>2) were 0.786 and 0.714, respectively. The optimal cutoff values of LSMs of SWE and TE were 9.05kPa and 8.15kPa, respectively. Conclusions According to the AUROCs in comparative data, SWE may be more sensitive and more precise than TE in predicting significant fibrosis (>F2) in CHB patients. Compare to TE, the value of SWE is less affected by factors and will be more promising application prospects.

Download Full-text

Diagnostic Performance of TE, 2D-SWE And MRE For Liver Fibrosis In Treatment-Naive People With HBV: A Systematic Review And Meta-Analysis

10.21203/rs.3.rs-714753/v1 ◽

2021 ◽

Author(s):

Mingkai Li ◽

Sizhe Wan ◽

Xiaoying Wu ◽

Bin Wu

Keyword(s):

Diagnostic Accuracy ◽

Linear Models ◽

Transient Elastography ◽

Meta Analysis ◽

Previous Treatment ◽

Shear Wave Elastography ◽

Threshold Effect ◽

Cochrane Library ◽

Significant Fibrosis ◽

Treatment Naïve

Abstract Background/aims: To assess the performance of transient elastography (TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B (CHB) patients. Methods: Pubmed, Embase, Web of Science and Cochrane Library were searched for terms involving CHB, TE, SWE, and MRE. Other etiologies of chronic liver disease (CLD), previous treatment in patients or articles not published in SCI journals were excluded. Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE, 2D-SWE and MRE. Heterogeneity was explored via analysis of threshold effect and meta-regression. Results: Twenty-eight articles with a total of 4540 untreated CHB patients were included. The summary AUROC using TE, 2D-SWE and MRE for predicting significant fibrosis (SF) were 0.84, 0.89, and 0.99, respectively. MRE is more accurate than both TE (P＜0.01) and 2D-SWE (P＜0.01) in staging SF. 2D-SWE is superior to TE in detecting SF (P＜0.01). The summary AUROC employing TE, 2D-SWE and MRE for detecting cirrhosis were 0.9, 0.94, and 0.99, respectively. TE displayed a similar diagnostic accuracy with 2D-SWE in staging cirrhosis (P=0.14). MRE and 2D-SWE are comparable for staging cirrhosis (P=0.08). MRE is superior than TE (P＜0.01) in staging cirrhosis.Conclusion: TE, 2D-SWE, and MRE express acceptable diagnostic accuracies in staging staging significant fibrosis and cirrhosis in untreated CHB patients. Both MRE and 2D-SWE are better choices while the TE can be regarded as a secondary option.

Download Full-text

Quantitative Elastography of Liver Fibrosis and Spleen Stiffness in Chronic Hepatitis B Carriers: Comparison of Shear-Wave Elastography and Transient Elastography with Liver Biopsy Correlation

Radiology ◽

10.1148/radiol.13130128 ◽

2013 ◽

Vol 269 (3) ◽

pp. 910-918 ◽

Cited By ~ 169

Author(s):

Vivian Yee-fong Leung ◽

Jiayun Shen ◽

Vincent Wai-sun Wong ◽

Jill Abrigo ◽

Grace Lai-hung Wong ◽

...

Keyword(s):

Chronic Hepatitis ◽

Liver Fibrosis ◽

Hepatitis B ◽

Liver Biopsy ◽

Shear Wave ◽

Chronic Hepatitis B ◽

Transient Elastography ◽

Shear Wave Elastography ◽

Spleen Stiffness

Download Full-text

The Diagnostic Accuracy of LOGIQ S8 and E9 Shear Wave Elastography for Staging Hepatic Fibrosis, in Comparison with Transient Elastography

Diagnostics ◽

10.3390/diagnostics11101817 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1817

Author(s):

Jeong-Ju Yoo ◽

Sang Gyune Kim ◽

Young Seok Kim

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Shear Wave ◽

Transient Elastography ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Chronic Liver ◽

Significant Fibrosis

Background: The aim of this study was to evaluate the usefulness of two different types of 2-dimensional shear wave elastography (2D-SWE) for predicting liver fibrosis stages in comparison to transient elastography (TE), using a histologic METAVIR scoring system as the reference method. Methods: A total of 203 patients with chronic liver disease were prospectively enrolled in the study. Two different 2D-SWEs (LOGIQ S8 and E9 systems, GE Healthcare, Chalfont St Giles, UK) were assessed for liver stiffness in patients with chronic liver diseases. Patients received 2D-SWE examinations with the S8 and E9 systems, and also underwent TE (FibroScan®, Echosens, France) tests and liver biopsies on the same day. Results: The most common etiology of chronic liver disease was non-alcoholic fatty liver disease (28.7%), followed by chronic hepatitis B (25.1%). Liver fibrosis stages consisted of F0 (22.6%), F1 (29.7%), F2 (16.9%), F3 (12.8%) and F4 (17.9%). Overall, S8 and E9 were well correlated with the histologic fibrosis stages. The optimal cut-off values for S8 and E9 to differentiate significant fibrosis (≥F2) were 6.70 kPa and 6.42 kPa, respectively, while the cut-off values for S8 and E9 in distinguishing liver cirrhosis were 9.15 kPa and 8.88 kPa, respectively. Among the 195 patients who had successful measurements in both S8 and E9, liver stiffness showed good inter-equipment correlation (ICC: 0.900, p < 0.001). Regarding diagnostic ability, upon comparison (FibroScan®), there were no significant differences between 2D-SWEs and TE for detecting every stage of liver fibrosis. Conclusion: In comparison to TE, 2D-SWE with LOGIQ S8 and E9 (GE Healthcare) are useful non-invasive tools for predicting significant fibrosis and liver cirrhosis.

Download Full-text

Real time ultrasound tissue Elastography in post-hepatitis chronic liver disease; role, limitations and pitfalls

QJM ◽

10.1093/qjmed/hcab106.071 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Noha M Diaa ◽

Merhan A Nasr ◽

Mohamed M Mohamed ◽

Shimaa M Radwan

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Biopsy ◽

Real Time ◽

Transient Elastography ◽

Chronic Liver ◽

P Value ◽

Hcv Rna ◽

Significant Fibrosis ◽

Non Invasive

Abstract Assessment of liver fibrosis stage is important in determining the prognosis and treatment strategy in chronic liver diseases. To overcome the limitations of liver biopsy, great efforts have been made to develop and validate non-invasive methods for detecting liver fibrosis, including serological indicators and imaging methods. Among these noninvasive methods, ultrasound-based elastography techniques are increasingly employed to assess parenchymal stiffness. Real-time transient elastography is most accurate one of them and rapidly evolving technique that can reveal the elastic properties of tissues, and display it as real time images. This technique can avoid unnecessary invasive liver biopsy. Patients and methods This descriptive study was done on 20 chronic HCV patients as diagnosed by seropositivity for HCV antibodies and HCV RNA by PCR, Patients were recruited from police hospitals outpatient clinics to find an alternative method to assess liver fibrosis. Results showed highly significant agreement between fibroscan scores and biopsy results (p value was < 0.001), the identification of patients with significant fibrosis (F ≥ 2) “F2, 3, 4” We reported that the cut off level of significant fibrosis (F ≥ 2) assessed by the METAVIR scoring system was 10.2 kpa, with sensitivity 86.7 % and specificity 80 %. However, cut-off level of 13.8 kpa for the detection of cirrhosis (F4) with an area under the ROC of 0.913, and a very high sensitivity and specificity (sensitivity 90.1% and specificity 85.7%). Conclusion Transient Elastography is an easy and quick clinical non-invasive method to perform. Results are available immediately, and this technique is accurate in predicting significant fibrosis ≥f2. Hence, Transient Elastography could be useful not only to evaluate liver fibrosis as to monitor liver disease progression, but also to monitor anti-viral or antifibrotic therapy effects and to help taking decisions in daily clinical practice.

Download Full-text

Reliability of Transient Elastography as a non-Invasive Technique for Detection of Fibrosis in Budd Chiari Syndrome Patients after Endovascular Intervention

QJM ◽

10.1093/qjmed/hcab107 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed F Montasser ◽

Eman M Barakat ◽

Mohamed S Ghazy ◽

Sara M Abdelhakam ◽

Hend E Ebada ◽

...

Keyword(s):

Liver Fibrosis ◽

Liver Biopsy ◽

Transient Elastography ◽

Liver Stiffness ◽

Endovascular Intervention ◽

Invasive Technique ◽

Budd Chiari Syndrome ◽

Metavir Score ◽

Before And After ◽

Chiari Syndrome

Abstract Aim of the work To test the reliability of fibroscan in detection of fibrosis in patients with Budd Chiari syndrome before and after endovascular intervention (after elimination of hepatic congestion). Background transient elastography (TE) is a noninvasive methodology that has been used to monitor liver stiffness in patients with chronic viral hepatitis. One of the limitations for accurate assessment of liver fibrosis by TE is the liver congestion. Liver congestion can result from Budd Chiari syndrome (BCS).The treatment of BCS is through restoring the flow of the blood between the portal vein to the inferior vena cava, which will lead to decongestion of the liver.TE, will be tested after liver decongestion for proper detection of liver fibrosis. Patients and methods This was a prospective cohort study conducted on 25 Egyptian patients with confirmed diagnosis of primary Budd-Chiari Syndrome (BCS) in the period from June 2017 to September 2019. TE was performed three days before endovascular intervention and three months after it. Liver biopsy was taken during the intervention for assessment of METAVIR score. Comparison was done between TE assessments before and after intervention in detection of the degree of liver fibrosis in comparison to METAVIR score measured in liver biopsy. Results FVLM was the most common hypercoagulable cause in the involved patients. There was significant drop in Liver Stiffness Measurements (LSM) measured three months post-intervention indicating improvement of liver fibrosis after relieving liver congestion but still not correlated to the METAVIR scores measured in the liver biopsy. Conclusion Liver congestion has high impact on Liver stiffness measurement giving overestimation which improves significantly after decongestion of the liver by the endovascular intervention.

Download Full-text

Liver stiffness in chronic hepatitis C virus infection

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2018-0034 ◽

2019 ◽

Vol 57 (2) ◽

pp. 85-98

Author(s):

Romeo-Gabriel Mihăilă

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Fibrosis ◽

Chronic Hepatitis C ◽

Esophageal Varices ◽

Transient Elastography ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Stiffness Measurement ◽

A Value

Abstract Introduction. The severity of liver fibrosis can be assessed noninvasively today by liver stiffness measurements. Vibration-controlled transient elastography, shear wave elastography or magnetic resonance elastography are techniques increasingly used for this purpose. Methods. This article presents the recent advances in the use of new techniques for liver fibrosis assessment in chronic hepatitis C: the correlation between liver stiffness values and liver fibrosis estimated by liver biopsies, the prognosis role of liver stiffness values, their usefulness in monitoring the treatment response, in assessing the severity of portal hypertension and in estimating the presence of esophageal varices. Scientific articles from January 2017 to January 2018 were searched in PubMed and PubMed Central databases, using the terms “liver stiffness” and “hepatitis C”. Results. The median liver stiffness values measured with different techniques are not identical, so that FibroScan thresholds cannot be used on any other elastographic machine. The higher the liver’s stiffness measurement, the higher the liver-related events in patients with chronic hepatitis C. A liver stiffness measurement over 17 kPa could be an independent predictor for the presence of esophageal varices as well as a spleen with a longitudinal span ≥ 15 cm for patients with a value of liver stiffness < 17 kPa. A progressive and persistent decrease in liver stiffness is dependent on sustained virological response achievement. The lack of liver stiffness decrease has been associated with relapsers and a low value of liver stiffness at baseline. Conclusion. Liver stiffness provides clues about the severity and evolution of liver disease.

Download Full-text

REAL-TIME ELASTOGRAPHY AND ITS CLINICAL APPLICATION COMPARED WITH OTHER METHODS FOR EVALUATION OF THE LIVER FIBROSIS DEGREE IN PATIENTS WITH CHRONIC HEPATITIS C

Journal Infectology ◽

10.22625/2072-6732-2018-10-3-84-90 ◽

2018 ◽

Vol 10 (3) ◽

pp. 84-90

Author(s):

M. A. Belopolskaya ◽

V. Yu. Avrutin ◽

O. D. Denisova ◽

E. V. Lichnaya ◽

E. Yu. Yushina ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Fibrosis ◽

Liver Biopsy ◽

Liver Tissue ◽

Transient Elastography ◽

Alternative Methods ◽

Saint Petersburg ◽

The One ◽

Severe Fibrosis

In this work we investigated to which extent the evaluation results of the degree of hepatic fibrosis obtained by realtime elastography (RTE) method are compatible with the results of the transient elastography (TE) and with the APRI indexes. We also analyzed the factors which can influence the reliability of the fibrosis degree evaluation obtained by different methods.Materials and methods. The study included 99 patients (60 women and 39 men) with HCV, examined in the polyclinic department of the Saint-Petersburg Botkin clinical infectious hospital in 2017. In 83 patients, the fibrosis degree in the liver tissue has been evaluated by the RTE method using HI VISION Preirus (Hitachi, Japan) with a linear sensor. In 67 patients, the evaluation has been performed by the TE method using Fibroscan (Echosens, France). Both methods have been applied to 51 patients.Conclusions. The aplication results of the RTE and TE methods do not differ significantly for patients with a severe fibrosis. Usually, the degree of fibrosis in patients with CHC obtained by the RTE is higher than the one obtained by the TE in the same patient. Due to the possibility to visualize a larger area under study, the RTE method has clear advantages in evaluating the degree of fibrosis in liver tissue in patients with focal changes in the liver. If the results obtained by the RTE and TE methods differ significantly, alternative methods must be used, such as a liver biopsy and biochemical methods.

Download Full-text

Comparison between shear wave elastography and serological findings for the evaluation of fibrosis in chronic liver disease

Journal of Ultrasonography ◽

10.15557/jou.2021.0030 ◽

2021 ◽

Vol 21 (86) ◽

pp. e186-e193

Author(s):

Mahjabeen Liaqat ◽

◽

Kashif Siddique ◽

Imran Yousaf ◽

Raham Bacha ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Diagnostic Accuracy ◽

Chronic Liver Disease ◽

Shear Wave ◽

Shear Wave Elastography ◽

Chronic Liver ◽

Optimal Cutoff ◽

Cutoff Value ◽

Cutoff Values

Aim: In this study, we sought to examine the optimal cutoff values for predicting different stages of liver fibrosis, and to determine the level of agreement between shear wave elastography and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores in patients with chronic liver disease. Methodology: A descriptive, cross-sectional study was performed at the Radiology Department of Shaukat Khanum Memorial Hospital Lahore from 1 Jun 2019 until 1 June 2020. FIB-4 and APRI scores were determined by the following formula: FIB-4 = (age × AST) ÷ (platelet count × (√ (ALT)) and APRI = (AST÷AST upper limit of normal) ÷ platelet × 100. Data was analyzed with the help of SPSS version 24.0 and Microsoft Excel 2013. Results: Eighty individuals were conveniently selected, of which 62.5% were men and 37.5% were women. The mean age of the subjects was 43.47 SD ± 13.85 years. APRI and FIB-4 scores predicted F4 patients using the cutoff values of 0.47 (Sn. 72%, Sp. 70%) and 1.27 (Sn. 78%, Sp. 73%), respectively. The cutoff values of 0.46 for APRI and 1.27 for FIB-4 predicted F3–F4 patients (Sn. 74% and 77%; Sp. 76% and 76%), respectively. To predict F1–F4 compared to F0, the cutoff value was 0.34 (Sn. 68%, Sp. 75%) for APRI, while the cutoff value for FIB was 0.87 (Sn. 72%, Sp. 75%). The findings suggest that FIB-4 shows better diagnostic accuracy than APRI. Conclusion: This study provides optimal cutoff values for different groups of fibrosis patients for both serum markers. Also, the diagnostic accuracy of FIB-4 for predicting liver fibrosis was found to be superior to APRI in all disease stages.

Download Full-text