Utility of real‐time shear wave elastography for assessing liver fibrosis in patients with chronic hepatitis C infection without cirrhosis: Comparison of liver fibrosis indices

Abstract

Aim:To clarify the diagnostic impact of liver fibrosis except for cirrhosis identified using shear wave elastography (SWE) in chronic hepatitis C (CHC) patients, and to compare the performance in diagnosing liver fibrosis among SWE and liver fibrosis indices.Methods: A total of 55 CHC patients who underwent liver biopsy were analyzed. The diagnostic performance for identifying significant liver fibrosis (F2-F3) for SWE, FIB-4 index, aspartate aminotransferase-to-platelet ratio index (APRI) and Forns' index was assessed using receiver-operator curve (ROC) analysis. Results:The median SWE elasticity value, FIB-4 index, APRI and Forns' index in the F0-F1 and F2-F3 groups were 6.3 kPa and 13.1 kPa; 1.52 and 4.45; 0.41 and 1.43; and 7.69 and 8.85, respectively (P < 0.001 for all four methods). Multivariate analysis showed that SWE was independently associated with the presence of significant liver fibrosis (odds ratio, 2.52; 95% confidence interval, 1.49-4.28; P < 0.001). The area under the ROC curve for SWE in diagnosing significant liver fibrosis was 0.94, indicating high diagnostic value, compared with 0.86, 0.88 and 0.83, for the FIB-4 index, APRI and Forns' index, respectively, which corresponds to moderate diagnostic value. The accuracy of SWE, FIB-4 index, APRI and Forns' index for diagnosing significant liver fibrosis was 90.9%, 76.4%, 74.5% and 67.2%, respectively.Conclusion: SWE has excellent ability for diagnosing significant liver fibrosis in CHC even when patients with cirrhosis are excluded. The diagnostic performance of SWE is superior to that of three liver fibrosis indices.

Comparison of Two-Dimensional Shear Wave Elastography and Real-Time Tissue Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B

“…In this study, the liver stiffness values of SWE and RTE increased in parallel with the degree of liver fibrosis and the grade of inflammation, which is consistent with the previous literatures [28,39,40]. However, the diagnostic efficacy of 2D SWE for significant fibrosis and cirrhosis was significantly higher than that of RTE, which may be due to the following reasons.…”

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.…”

Untitled

“…Diagnostic accuracy was high for the detection of significant and advanced fibrosis and cirrhosis (AUC> 0.90). In these studies the diagnostic performance for 2D-SWE was better than for TE [139,159] and serum fibrosis markers (FIB-4 index, APRI and Forns' index) [159]. In one study including 102 obese CHC patients, 2D-SWE had excellent diagnostic accuracy for the detection of severe fibrosis and cirrhosis (AUROC > 0.90 for both) [91].…”

“…2D-SWE as demonstrated with SSI can be used as a first-line assessment for the severity of liver fibrosis in patients with chronic viral hepatitis C. It performs best with regard to the ruling out of cirrhosis (LoE 1b, GoR A) [139,158,159]. Broad consensus (17/0/1, 94 %)…”