Evaluation of Inter-System Variability in Liver Stiffness Measurements

Ferraioli, Giovanna; Silvestri, Annalisa De; Lissandrin, Raffaella; Maiocchi, Laura; Tinelli, Carmine; Fı̀lice, Carlo; Barr, Richard G.

doi:10.1055/s-0043-124184

Cited by 73 publications

(86 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ICC of 0.88, with the CI spanning the good to excellent range, further confirms the agreement. In a recent study assessing intersystem variability of liver stiffness measurement in 21 patients with varying degrees of fibrosis, the 2 scanners used in this study also showed high agreement . In patients with little or no fibrosis (<15 kPa), the mean difference in liver stiffness between the scanners was 0.55 kPa (95% LoA, ± 2.67 kPa) compared to 0.02 kPa in this study.…”

Section: Discussionsupporting

confidence: 63%

Reproducibility of 2 Liver 2‐Dimensional Shear Wave Elastographic Techniques in the Fasting and Postprandial States

Simkin¹,

Rattansingh²,

Liu

et al. 2018

J of Ultrasound Medicine

View full text Add to dashboard Cite

Objectives-The purpose of this study was to compare the reliability and agreement of 2 methods of 2-dimensional (2D) shear wave elastography (SWE) on liver stiffness in healthy volunteers. We also assessed effects of the prandial state and operator experience on measurements.Methods-Two operators, 1 experienced and 1 novice, independently examined 20 healthy volunteers with 2D SWE on 2 ultrasound machines (Aixplorer [SuperSonic Imagine, Aix-en-Provence, France] and Aplio 500 [Canon Medical Systems Corporation, Otawara, Japan]). Volunteers were scanned 8 times by the operators using both machines in fasting and postprandial states. Agreement was evaluated by a Bland-Altman analysis, and the correlation was assessed by the Pearson correlation and intraclass correlation coefficients (ICCs). An analysis of variance was conducted to determine the contribution of the machine, prandial state, and operator experience to the variability.Results-Agreement assessed by Bland-Altman plots showed no statistically significant difference in measured liver stiffness between the machines (mean difference, -0.8%; 95% confidence interval, -3.7%, 2.1%), with a critical difference of 1.36 kPa. The correlation was good to excellent for both the crude overall Pearson coefficient and the ICC, both measuring 0.88 (95% confidence interval, 0.82, 0.92). Subclass ICCs for the fasting state, postprandial state, novice operator, and experienced operator were 0.89, 0.88, 0.90, and 0.86, respectively. The 2-way mixed effect analysis of variance showed that the volunteers accounted for 86.3% of variation in median liver stiffness, with no statistically significant contribution from operator experience, the prandial state, or the machine (P = .108, .067, and .296, respectively).Conclusions-Our study showed that the 2D SWE techniques had a high degree of reliability and agreement in measurement of liver stiffness in a healthy population. Operator experience and the prandial state did not impart significant variability to stiffness measurements.

show abstract

Section: Discussionsupporting

confidence: 63%

Reproducibility of 2 Liver 2‐Dimensional Shear Wave Elastographic Techniques in the Fasting and Postprandial States

Simkin¹,

Rattansingh²,

Liu

et al. 2018

J of Ultrasound Medicine

View full text Add to dashboard Cite

show abstract

“…Interobserver variability is a general problem for US diagnostics. Only a few studies have addressed this issue using small numbers of probands or phantom models . To our knowledge, we addressed this issue for the first time for examiners with different expertise levels in a subgroup of 20 healthy individuals.…”

Section: Discussionmentioning

confidence: 99%

Liver Stiffness Measured by 2‐Dimensional Shear Wave Elastography: Prospective Evaluation of Healthy Volunteers and Patients With Liver Cirrhosis

Petzold¹,

Hofer²,

Ellenrieder³

et al. 2018

J of Ultrasound Medicine

View full text Add to dashboard Cite

Objectives-We aimed to establish normal values for liver stiffness measurement, performed by 2-dimensional shear wave elastography (LOGIQ E9; GE Healthcare, Wauwatosa, WI), in healthy volunteers, patients with nonhepatic morbidities, and patients with histologically confirmed liver cirrhosis.Methods-A total of 175 participants were included between July 2016 and February 2018. Three cohorts were analyzed: healthy volunteers (n = 68), patients with healthy livers but nonhepatic morbidities (n = 57), and patients with liver cirrhosis (n = 50). Liver stiffness measurement was performed by 2 observers with different levels of experience to determine interobserver agreement.Results-Of the 175 participants included, 91 were male, and the mean age ± SD was 44.4 ± 19.4 years. The success rate for 175 liver stiffness measurements was 95.4%. The number of unsuccessful measurements was significantly higher in the liver cirrhosis cohort (P = .04). The interobserver agreement was excellent (intraclass correlation coefficient, 0.87). Liver stiffness in the healthy-liver patient cohort (4.93 ± 0.83 kPa) was not significantly different from that in the healthy-volunteer cohort (5.19 ± 1.03 kPa; P = .13). Apart from male sex in the healthy-volunteer cohort, age, body mass index, mild steatosis, and nonhepatic morbidities had no significant impact on liver stiffness. Liver stiffness values in participants without liver disease (healthy volunteers and healthy-liver patients; n = 125) ranged from 3.62 to 7.02 kPa (2.5th-97.5th percentiles). Notably, there was no overlap of liver stiffness measurements between the patients without liver disease and the cirrhosis cohort ).Conclusions-Liver stiffness values in healthy individuals vary widely and are not dependent on age, body mass index, or specific nonhepatic comorbidities. Liver stiffness values within the normal range can noninvasively rule out cirrhosis, as liver stiffness is significantly higher in cirrhotic patients (P < .001). Twodimensional shear wave elastography has excellent interobserver agreement.

show abstract

“…Moreover, as has been shown with other pSWE products, median values obtained with an IQR/M ≤ 30% improve the diagnostic performance of the method [15,16]. This study has some limitations.…”

Section: Discussionmentioning

confidence: 76%

Ruling-in and Ruling-out Significant Fibrosis and Cirrhosis in Patients with Chronic Hepatitis C Using a Shear Wave Measurement Method

Ferraioli

Maiocchi

Lissandrin

et al. 2017

JGLD

Self Cite

View full text Add to dashboard Cite

Aims: To prospectively assess the cutoff values of a point shear wave measurement (SWM) method for ruling-in and ruling-out significant fibrosis and cirrhosis using transient elastography (TE) as the reference standard.Method: Consecutive patients with chronic hepatitis C were enrolled. Liver stiffness was assessed with the SWM method implemented on the HI VISION Ascendus ultrasound system (Hitachi Ltd, Japan) and with the TE method of the FibroScan® device (Echosens, France). For staging significant fibrosis (F≥2) and cirrhosis (F=4) we used the TE cutoffs of 7.0 and 12.0 kiloPascal (kPa), respectively. The diagnostic performance of SWM was assessed by calculating the area under the receiver operating characteristic (AUROC) curve. Cutoffs with specificity or sensitivity > 90% were chosen to rule-in or rule-out F≥2 and F=4.Results: 445 individuals [235 males, 210 females; mean age, 61.1 (13.3) years] were studied: 190 (42.7%) individuals had F0-F1 fibrosis stage, 82 (18.4%) F2, 46 (10.3%) F3, and 127 (28.6%) F4 fibrosis stage. For ruling-in F≥2 the SWM cutoff was 6.78 kPa [sensitivity, 76.9%(70.6-82.4); specificity, 90.3% (85.0-94.3)] and for ruling-out it was 5.55 kPa [sensitivity, 90.6% (85.8-94.1); specificity, 72.2% (64.9-78.6)]. For ruling-in F=4 the SWM cutoff was 9.15 kPa [sensitivity, 83.3% (74.4-90.2); specificity, 90.1% (86.0-93.2)] and for ruling-out it was 8.41 kPa [sensitivity, 90.6% (82.9-95.6); specificity, 82.2% (77.3-86.4)]. AUROCs were 0.92 (0.89-0.94) for F≥2 and 0.94 (0.91-0.96) for F=4.Conclusions. In clinical practice, the use of a dual cutoff of SWM may increase the confidence in staging liver fibrosis with a non-invasive shear wave elastography technique.Abbreviations: ARFI: acoustic radiation force impulse; AUROC: area under the ROC curve; CCC: concordance correlation coefficient; IQR/M: interquartile range/median; LSM: liver stiffness measurement; ROC: receiver operating characteristic; pSWE: point shear wave elastography; SWM: shear wave measurement; TE: transient elastography; US: ultrasound.

show abstract

Evaluation of Inter-System Variability in Liver Stiffness Measurements

Abstract: The results of this study show that the agreement between LSMs performed with different US systems is good to excellent and the overall inter-observer agreement in "ideal conditions" is above 0.90 in expert hands.

Cited by 73 publications

References 21 publications

Reproducibility of 2 Liver 2‐Dimensional Shear Wave Elastographic Techniques in the Fasting and Postprandial States

Reproducibility of 2 Liver 2‐Dimensional Shear Wave Elastographic Techniques in the Fasting and Postprandial States

Liver Stiffness Measured by 2‐Dimensional Shear Wave Elastography: Prospective Evaluation of Healthy Volunteers and Patients With Liver Cirrhosis

Ruling-in and Ruling-out Significant Fibrosis and Cirrhosis in Patients with Chronic Hepatitis C Using a Shear Wave Measurement Method

Contact Info

Product

Resources

About