Agreement and accuracy of shear-wave techniques (point shear-wave elastography and 2D-shear-wave elastography) using transient elastography as reference

Abstract

Objective We aimed to evaluate the agreement/accuracy of point shear-wave elastography (p-SWE) and 2D-shear-wave elastography (2D-SWE) for liver fibrosis staging using transient elastography (TE) as the reference. Methods This retrospective study analyzed data from people with chronic liver diseases submitted to TE, p-SWE, and 2D-SWE. Liver fibrosis stages were defined using the TE’s ‘rule of five’: normal (<5 kPa); suggestive of compensated-advanced chronic liver disease (cACLD) (10–15 kPa); highly suggestive of cACLD (15–20 kPa); suggestive of clinically significant portal hypertension (>20 kPa). Agreement and accuracy of p-SWE and 2D-SWE were assessed. Optimal cutoffs for p-SWE and 2D-SWE were identified using the point nearest to the upper left corner of the ROC curves. Results A total of 289 participants were included. The correlation between TE and 2D-SWE (rho = 0.59; P < 0.001) or p-SWE (rho = 0.69; P < 0.001) was satisfactory. The AUROCs (95% CI) of 2D-SWE and p-SWE for TE ≥ 5 kPa; TE ≥ 10 kPa; TE ≥ 15 kPa and TE ≥ 20 kPa were 0.757 (0.685–0.829) and 0.741 (0.676–0.806); 0.819 (0.770–0.868) and 0.870 (0.825–0.915); 0.848 (0.803–0.893) and 0.952 (0.927–0.978); 0.851 (0.806–0.896) and 0.951 (0.920–0.982), respectively. AUROCs of 2D-SWE were significantly lower compared with p-SWE for detecting cACLD. Optimal thresholds of 2D-SWE and p-SWE for TE ≥ 15 kPa were 8.82 kPa (sensitivity = 86% and specificity = 79%) and 8.86 kPa (sensitivity = 90% and specificity = 92%), respectively. Conclusion LSM by p-SWE and 2D-SWE techniques were correlated with TE. LSM by p-SWE seems to be more accurate than 2D-SWE to identify patients with more advanced fibrosis.

Validation of the Baveno VI criteria to rule out high-risk varices using hepatic shear-wave elastography

“…We acknowledge that the limited sample size ( n = 79) and the presence of a high proportion of people with HCV-SVR (51%) could have influenced these findings when compared with other studies that used the same 2D-SWE system [19,20]. In contrast, our proposed optimal cutoff for predicting HRV was similar to the threshold proposed in a recent Brazilian study for predicting CSHP using transient elastography as the reference (>20 kPa) in people with HCV-SVR using 2D-SWE GE LOGIQ S8 system: 9.56 kPa (AUROC = 0.85, sensitivity = 87%) [14]. These data might suggest that 2D-SWE-LSM by GE System might be lower in people with non-active liver disease; however, this finding might not impact the accuracy of this method when associated with platelet count to predict HRV in that sub-sample of patients.…”

“…The ROI measuring 20 mm 2 was positioned at least 15-20 mm from the liver capsule. LSMs were performed in a fixed depth area without large vessels in a neutral breath to avoid artifacts [14]. 2D-SWE-LSM was considered reliable as the median of 10 measurements with a dispersion rate (interquartile range/LSM) lower than 30%.…”

“…LSM using transient elastography by Fibroscan (EchoSens) were performed by experienced operators (>1000 exams) as a regular part of medical follow-up. Briefly, exams were performed after 4 h of fasting in patients in the supine position with maximal abduction of the right arm as described elsewhere [14]. The choice of M or XL transient elastography probe was performed by the operator during the exam.…”

“…The main advantages of SWE techniques compared to transient elastography remain the acquisition of images of the liver parenchyma (B-mode ultrasound), choice of size and location of ROI, and higher applicability in patients with obesity and ascites [10,12]. In addition, these devices are cheaper, do not need annual probe calibration, and have good accuracy for detecting c-ACLD [11,12]; however, thresholds to stage liver fibrosis and to detect CSPH from SWE methods seem to be different from those from transient elastography [13,14]. For this reason, the Baveno VII consensus reinforced that further studies are needed to determine the optimal cutoff points of SWE techniques to rule out HRV [2].…”

Accuracy and concordance of two-dimensional shear-wave elastography using transient elastography as the reference in chronic viral hepatitis and HIV infection in Rio de Janeiro, Brazil

“…The optimal thresholds for transient elastography ≥ 10 kPa and transient elastography ≥ 15 kPa were 7.84 kPa [sensitivity = 82% (95% CI, 73–89); specificity = 76% (95% CI, 69–82)] and 8.82 kPa [sensitivity = 86% (95% CI, 74–93); specificity = 79% (95% CI, 73–84)], respectively. The difference in the sample characteristics between these two Brazilian studies might explain the variability in optimal cut-offs proposed for 2D-SWE LOGIQ S8 [22].…”