Technical Performance of Two-Dimensional Shear Wave Elastography for Measuring Liver Stiffness: A Systematic Review and Meta-Analysis

Abstract

Objective To assess the technical performance of two-dimensional shear wave elastography (2D-SWE) for measuring liver stiffness. Materials and Methods The Ovid-MEDLINE and EMBASE databases were searched for studies reporting the technical performance of 2D-SWE, including concerns with technical failures, unreliable measurements, interobserver reliability, and/or intraobserver reliability, published until June 30, 2018. The pooled proportion of technical failure and unreliable measurements was calculated using meta-analytic pooling via the random-effects model and inverse variance method for calculating weights. Subgroup analyses were performed to explore potential causes of heterogeneity. The pooled intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated using the Hedges-Olkin method with Fisher's Z transformation of the correlation coefficient. Results The search yielded 34 articles. From 20 2D-SWE studies including 6196 patients, the pooled proportion of technical failure was 2.3% (95% confidence interval [CI], 1.3–3.9%). The pooled proportion of unreliable measurements from 20 studies including 6961 patients was 7.5% (95% CI, 4.7–11.7%). In the subgroup analyses, studies conducting more than three measurements showed fewer unreliable measurements than did those with three measurements or less, but no intergroup difference was found in technical failure. The pooled ICCs for interobserver reliability (from 10 studies including 517 patients) and intraobserver reliability (from 7 studies including 679 patients) were 0.87 (95% CI, 0.82–0.90) and 0.93 (95% CI, 0.89–0.95), respectively, suggesting good to excellent reliability. Conclusion 2D-SWE shows good technical performance for assessing liver stiffness, with high technical success and reliability. Future studies should establish the quality criteria and optimal number of measurements.

Accuracy of real-time shear wave elastography in staging hepatic fibrosis: a meta-analysis

“…Although many studies, including meta-analysis [16], have shown that liver elasticity measured by SWE is related to the pathological stage of fibrosis, the accuracy and diagnostic thresholds based on SWE are still controversial and the quality criteria and optimal number of measurements need to be defined [17]. Therefore, we performed a meta-analysis to assess the overall performance of SWE in the diagnosis of liver fibrosis.…”

Added value of 2D shear wave imaging of the gallbladder bed of the liver for acute cholecystitis

“…Activation of shear wave propagation and data filling of the sample box were performed 3 times for each patient, and each set of shear wave propagation data included one or two ROIs: Therefore, we measured liver stiffness and the SWD 3 to 6 times for each patient. If a bizarre pattern of shear wave propagation was observed or the color layer was absent in the ROIs, SWI was considered as a technical failure [16][17][18]. For each patient, we calculated an interquartile range interval (IQR), and considered measurements with IQR values less than 30% as reliable [16].…”

Test-retest repeatability of ultrasonographic shear wave elastography in a rat liver fibrosis model: toward a quantitative biomarker for preclinical trials

“…Liver SWE has been increasingly used as a quantitative biomarker for evaluating new drugs or treatments, such as anti-viral agents and anti-fibrotic agents [4]. In the clinical field, the physics and manufacturing techniques, measurement variability, quality criteria, and procedures for performing elastography have been extensively investigated, and have now become standardized through the emergence of an international consensus [5][6][7]. As such, the World Federation for Ultrasound in Medicine and Biology (WFUMB) issued guidelines on the use of SWE for the assessment of liver diseases in 2015 and 2018 [8,9].…”