Clinical relevance of shear wave elastography compared with transient elastography and other markers of liver fibrosis

Abstract

Background: Early and accurate non-invasive diagnosis of liver fibrosis is important for reducing the burden of cirrhosis and related complications.Aim: This cross-sectional study compares shear wave elastography (SWE), transient elastography (TE) and clinical markers of chronic liver disease in patients with various liver disorders.Methods: Liver ultrasound with SWE was performed on 421 adult patients, 227 of whom also had TE. Patient age, gender, body mass index (BMI), liver disease aetiology and laboratory results were recorded. Associations between SWE, TE and other tests for liver fibrosis and chronic liver disease severity were sought. Advanced liver fibrosis was defined as liver stiffness measurement (LSM) equivalent to ≥F3 using Metavir staging.Results: Patients were predominantly male (68%), with mean (standard deviation) age 54 (13) years, BMI 28 (6) kg/m 2 and serum alanine aminotransferase (ALT) 39 ( 27) U/L. Liver disorders were predominantly non-alcoholic fatty liver disease (NAFLD), chronic hepatitis B (CHB), chronic hepatitis C (CHC) and alcohol-related liver disease. The median (interquartile range) LSM was 10 (6-20) kPa with SWE and 9.2 (6-21) kPa with TE. Advanced liver fibrosis was associated with older age, higher BMI, model for end-stage liver disease score, aspartate aminotransferase (AST), AST/ALT ratio, AST to platelet ratio index, fibrosis-4 index and Hepascore. SWE and TE LSM were positively correlated, particularly for NAFLD and CHC. SWE LSM predicted ultrasound and endoscopy-diagnosed portal hypertension and oesophageal varices.Conclusions: Across various liver diseases, SWE is at least comparable with TE and other non-invasive tests of liver fibrosis. SWE is accurate for predicting liver-related portal hypertension.

Application and Diagnostic Performance of Two-Dimensional Shear Wave Elastography and Liver Fibrosis Scores in Adults with Class 3 Obesity

“…We found moderate-to-weak positive correlations between 2D-SWE-derived EQI Median and several established non-invasive liver fibrosis scoring systems, most notably the FIB-4 index. This is in line with the findings of a prior Australian study, in which 2D-SWE-measured liver stiffness measurements were found to be positively correlated with the FIB-4 index and APRI [41]. Similar to the findings of this study, a prior study conducted in Korea also reported that liver stiffness measured using 2D-SWE showed a moderate and weak positive correlation with the FIB-4 index (r = 0.493) and APRI (r = 0.392), respectively [55].…”

“…However, the applicability of 2D-SWE for the assessment of liver fibrosis among those with class 3 obesity is not well established [ 39 ]. Moreover, there are no ideal non-invasive tests to assess the severity of liver fibrosis in the class 3 obese population, in whom body habitus often makes imaging technically challenging [ 40 , 41 ]…”

Comparison between Two-Dimensional and Point Shear Wave Elastography Techniques in Evaluating Liver Fibrosis Using Histological Staging as the Reference Standard: A Prospective Pilot Study

“…Here, both 2D-SWE and p-SWE showed much higher diagnostic performance for the detection of significant fibrosis and cirrhosis than biomarkers (APRI and FIB-4). In contrast, other studies reported no statistical difference in the diagnostic performance of transient elastography for cirrhosis among SWE, APRI, and FIB-4 [32]. A meta-analysis comparing p-SWE, APRI, and FIB-4 reported that, similar to our results, p-SWE showed better diagnostic performance than biomarkers [33].…”

Elastography of the Liver in Wilson’s Disease

“…Strain elastography measures tissue deformation caused by pressing the body surface or by internally occurring physiologic motion. In chronic liver disease, transient elastography and AFRI are applicable which use shear-wave imaging (SWI) [30]. ARFI is also called shear-wave elastography (SWE) and is divided into two types: p-SWE and 2D-SWE.…”