Shear-Wave Elastography for the Estimation of Liver Fibrosis in Chronic Liver Disease: Determining Accuracy and Ideal Site for Measurement

Abstract

).q RSNA, 2014 Purpose:To evaluate the accuracy of shear-wave elastography (SWE) for staging liver fibrosis in patients with diffuse liver disease (including patients with hepatitis C virus [HCV]) and to determine the relative accuracy of SWE measurements obtained from different hepatic acquisition sites for staging liver fibrosis. Materials and Methods:The institutional review board approved this single-institution prospective study, which was performed between January 2010 and March 2013 in 136 consecutive patients who underwent SWE before their scheduled liver biopsy (age range, 18-76 years; mean age, 49 years; 70 men, 66 women). Informed consent was obtained from all patients. SWE measurements were obtained at four sites in the liver. Biopsy specimens were reviewed in a blinded manner by a pathologist using METAVIR criteria. SWE measurements and biopsy results were compared by using the Spearman correlation and receiver operating characteristic (ROC) curve analysis. Results:SWE values obtained at the upper right lobe showed the highest correlation with estimation of fibrosis (r = 0.41, P , .001). Inflammation and steatosis did not show any correlation with SWE values except for values from the left lobe, which showed correlation with steatosis (r = 0.24, P = .004). Abbreviations: AUC = area under the ROC curve CI = confidence interval CLD = chronic liver disease DANA = difference between the mean fibrosis stage of advanced fibrosis and the mean fibrosis stage of nonadvanced fibrosis HCV = hepatitis C virus ROC = receiver operating characteristic SWE = shear-wave elastography Author contributions:Guarantors of integrity of entire study, A.E.S., M.D.; study concepts/study design or data acquisition or data analysis/ interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, A.E.S., M.D., A.V., J.M.N., K.E.C.; clinical studies, A.E.S., A.V., A.K.B., J.M.N., K.E.C., R.T.C.; statistical analysis, M.D., E.F.H.; and manuscript editing, A.E.S., M.D., A.V., R.T.C. Funding:R.T.C. supported by the National Institutes of Health (grant DK078772).Conflicts of interest are listed at the end of this article. (1), with as many as 150 000 new cases diagnosed each year (2)-20% of which had cirrhosis at presentation. The multiple causes of CLD follow a common pathway of progressive liver fibrosis, ultimately culminating in cirrhosis. These include hepatitis C virus (HCV), hepatitis B virus, nonalcoholic fatty liver disease, and alcoholic liver disease (3). Although the prevalence of major causes of CLD remains stable, data from the National Health and Nutrition Examination Surveys show that nonalcoholic fatty liver disease will be a substantial burden on the prevalence of CLD in the United States (1). Advanced fibrosis, cirrhosis, and hepatocellular carcinoma develop in about 17%-55% of patients with HCV ...

Prediction of liver cirrhosis, using diagnostic imaging tools

“…This is expected to overcome the limitations of transient elastography, where liver stiffness cannot be measured accurately in patients with severe obesity, and ascites. Some articles have shown growing evidence for the accuracy of US elastography [33][34][35][36][37] (Table 1). Although the low reproducibility of measurements derived from operator-dependent performance remains a significant limitation of US elastography, this technique is a useful diagnostic tool for hepatic fibrosis and further validation is warranted.…”

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“…Obtaining an elastogram 2D-SWE evaluation should be performed in a well-visualized area of the right liver lobe, free of large vessels, liver capsule, ligaments and the gallbladder [30]. Since movement greatly influences results, the subject is asked to suspend breathing.…”

“…Measurements in the left liver lobe are significantly higher and show more variability than those in the right lobe [28,29]. 2D-SWE LSMs correlate best with the stage of liver fibrosis when obtained in the upper right lobe of the liver [30]. LSM in the left liver lobe should be avoided.…”

Non-Invasive Assessment of Liver Fibrosis in a Rat Model: Comparison of Shear Wave Elastography with Serologic Tests

“…The latest generation of the emerging elastographic technologies is the two-dimensional real-time shear wave elastography (SWE) implemented on the Aixplorer device (Supersonic Imagine, Aix-en-Provence, France), which also showed preliminary good diagnostic efficacy in the existing literatures (4,5).…”