Diagnosis of Fibrosis and Activity by a Combined Use of Strain and Shear Wave Imaging in Patients with Liver Disease

Abstract

Objective: Performing shear wave imaging is simple, but can be difficult when inflammation, jaundice, and congestion are present. Therefore, the correct diagnosis of liver fibrosis using shear wave imaging alone might be difficult in mild-to-moderate fibrosis cases. Strain imaging can diagnose liver fibrosis without the influence of inflammation. Therefore, the combined use of strain and shear wave imaging (combinational elastography) for cases without jaundice and congestion might be useful for evaluating fibrosis and inflammation. Methods: We enrolled consecutive patients with liver disease, without jaundice or liver congestion. Strain and shear wave imaging, blood tests, and liver biopsy were performed on the same day. The liver fibrosis index (LF index) was calculated by strain imaging; real-time tissue elastography, and the shear wave velocity (V_s) was calculated by shear wave imaging. Fibrosis index (F index) and activity index (A index) were calculated as a multiple regression equation for determining hepatic fibrosis and inflammation using histopathological diagnosis as the gold standard. The diagnostic ability of F index for fibrosis and A index for inflammation were compared using LF index and V_s. Results: The total number of enrolled cases was 388. The area under the receiver operating characteristic (AUROC) was 0.87, 0.80, 0.83, and 0.80, at diagnosis of fibrosis stage with an F index of F1 or higher, F2 or higher, F3 or higher, and F4, respectively. The AUROC was 0.94, 0.74, and 0.76 at diagnosis of activity grade with an A index of A1 or higher, A2 or higher, and A3, respectively. The diagnostic ability of F index for liver fibrosis and A index for inflammation was higher than for other conventional diagnostic values. Conclusions: The combined use of strain and shear wave imaging (combinational elastography) might increase the positive diagnosis of liver fibrosis and inflammation.

Novel quantitative assessment system of liver steatosis using a newly developed attenuation measurement method

“…Furthermore, it has been reported that liver fibrosis correlates with the prognosis of chronic hepatitis including NAFLD; thus, assessment of liver fibrosis is also essential . In the present study, we used an ultrasonic system that diagnoses liver fibrosis using a combination of strain and shear wave imaging, and reported the utility of its diagnostic capability for liver fibrosis . Moreover, it is possible to undertake simultaneous diagnosis of B‐mode imaging, liver steatosis, and fibrosis using the same device, which is considered to be a unique advantage not established in other equipment.…”

Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study

“…The SWM device has a unique reliability index, the VsN, which is used to determine whether the Vs value is reliable. Yada reported that a VsN ≥ 50% could be a good indicator of accurate SWM in the liver [10, 11]. Using this index, data can be collected with high reliability.…”

“…1). Using the reliability index, the percentage of the net amount of effective shear-wave velocity (VsN: %) was calculated to determine whether shear-wave propagation was detected correctly and whether unnecessary components other than those generated by shear-wave propagation existed in the ROI according to predefined rejection conditions, and the value was displayed on the monitor [10, 11]. EUS-SWMs of the pancreatic body and tail were performed through the stomach, and measurements of the pancreatic head were performed through the duodenum.…”

“…By measuring shear-wave velocity (Vs), tissue elasticity can be quantified in terms of the elasticity modulus. Studies have shown that shear-wave EG can be used to noninvasively detect fibrosis in the liver and in other gastrointestinal organs via transabdominal ultrasound [10, 11]. More recently, studies have demonstrated the use of shear-wave EG to detect pancreatic fibrosis and chronic pancreatitis [12–14].…”

Liver Fibrosis Assessment by Point Shear-Wave Elastography Techniques

“…pSWE was combined with strain elastography on a Hitachi system. A study evaluated 388 patients with this combined technique, considering liver biopsy as reference method [76]. The AUROCs to predict fibrosis stage were 0.87, 0.80, 0.83, and 0.80 for F1, F2, F3, and F4, respectively, while the AUROCs for activity grade were 0.94, 0.74, and 0.76 for A1, A2, and A3, respectively.…”