Nondiseased Liver Stiffness Measured by Shear Wave Elastography

Abstract

A Pilot Studyoninvasive diagnosis of hepatic fibrosis has been a challenge for many hepatologists. Although liver biopsy is the standard method for diagnosing hepatic fibrosis, it is invasive, has been associated with mortality, 1 and represents only a limited area of liver. 2 For these reasons, many studies have been performed to find other markers for diagnosing hepatic fibrosis. [3][4][5] Grayscale sonography and Doppler sonography are good candidates for noninvasive methods, but there are several limitations such as low interobserver and intraobserver agreement and variability according to the physiologic and pathologic status of the patient. [6][7][8][9] Seung Woo Cha, MD, Woo Kyoung Jeong, MD, Yongsoo Kim, MD, Min Yeong Kim, MD, Jinoo Kim, MD, Soo Yeon Kim, MD, Jeong Ah Ryu, MD, Tae Yeob Kim, MD, Joo Hyun Sohn, MD, Young Hwan Kim, MD Received January 18, 2013, Objectives-The purpose of this study was to investigate the value of liver stiffness in patients without liver disease using shear wave elastography and to determine the liver stiffness threshold value for identifying patients with chronic liver diseases.Methods-A total of 150 patients who underwent liver sonography coupled with shear wave elastography were enrolled. On the basis of clinical and pathologic criteria, they were assigned to 1 of 2 groups: nondiseased liver (n = 97) and noncirrhotic chronic liver disease (n = 53). Liver stiffness was measured in the right liver, and the median value of 10 measurements was calculated. Both mean and median values in the nondiseased liver group were compared with those in the noncirrhotic chronic liver disease group. To validate this comparison, liver stiffness of the patients who underwent liver biopsy revealing either no fibrosis (fibrosis score F0; n = 5) or substantial fibrosis (F2; n = 14) was also investigated and compared. To determine the optimal threshold value for determining chronic liver disease, a receiver operating characteristic curve analysis was performed.Results-The mean liver stiffness value in the nondiseased liver group was 5.4 kPa. In the noncirrhotic chronic liver disease group, the mean value was 8.1 kPa. Differences between the nondiseased liver and both noncirrhotic chronic liver disease groups were statistically significant (P < .001). The optimal liver stiffness threshold value for discriminating nondiseased liver from noncirrhotic chronic liver disease was 6.9 kPa. The sensitivity using this threshold was 94%. In the biopsy-proven patients, the mean liver stiffness values were 6.0 kPa in the F0 group and 9.9 kPa in the F2 group.Conclusions-The range of liver stiffness in patients with nondiseased liver and the optimal threshold value for discriminating these patients from those with chronic liver disease were identified.

Streamlining Screening to Treatment: The Hepatitis C Cascade of Care at Kaiser Permanente Mid-Atlantic States

“…Gastroenterologists interpret the F-score by comparing kilopascal (kPa) values to F-score ranges, using previously published tables (Figure 2) [29,30].…”

The Evaluation of Liver Fibrosis in the Real-Time Shear Wave Elastography Technique in Chronic Hepatitis B and C Patients: How Many Measurements Are Necessary to Assign Patients to METAVIR Score Properly?

“…It is necessary to evaluate the 2D SWE values of the liver in conjunction with clinical information. Different cut-off values are observed in patients with HCV and HBV (1,5). Furthermore, there are discrepancies in studies that attempt to evaluate the cut-off values for patients with HCV (5, 10).…”

“…Liver biopsy (LB) has been the "golden standard" for many years. Because of its invasive character and limitations, other markers of hepatic fibrosis are taken into consideration (1,2). The advancement in ultrasonic non-invasive techniques enables quick, repeatable, and reliable measurements (3(ARFI) is the first two-dimensional technique that uses high-intensity acoustic pulses to estimate tissue stiffness (6,7).…”

“…The study by Sporea et al on a population of 449 patients with and without liver disease revealed that 3 consecutive measurements of liver were sufficient to obtain an adequate average value in comparison with 5 measurements (14). There are several studies concerning the average 2D SWE value of the liver in healthy subjects (1,4,(15)(16)(17). The study conducted by Feraioli and Leung revealed that there are different cut-off values in patients with hepatitis C and B that allows assigning them to different liver fibrosis stages according to the METAVIR Scoring System (4,10,12).…”

Elastografía en tiempo real (supersonic): comportamiento de la prueba en sujetos sanos de Bogotá

“…Ferraioli (16) encontró un punto de corte de 7,1 kPa, con valor promedio 6,2 kPa para F0 y F1 con un RIQ entre 5,1-6,8 y más centrado en sus análisis en fibrosis significativa. Dentro de los estudios que buscan el valor normal, Cha (17), en un estudio retrospectivo con 97 pacientes sin enfermedad hepática, encontró un valor promedio de rigidez hepática de 5,4 kPa para definir normalidad; el punto de corte óptimo para discriminar el hígado no enfermo del enfermo crónico fue de 6,9 kPa, con una sensibilidad del 94%. Sirli (18) sin patología hepática conocida (70 con medidas confiables), con edades entre 18 y 76 años.…”