Real time shear wave elastography in chronic liver diseases: accuracy for predicting liver fibrosis, in comparison with serum markers

Abstract

Aim: To evaluate the correlation between liver stiffness measurement (LSM) by real-time shear wave elastography (SWE) and liver fibrosis stage and the accuracy of LSM for predicting significant and advanced fibrosis, in comparison with serum markers.

Methods: We consecutively analyzed 70 patients with various chronic liver diseases. Liver fibrosis was staged from F0 to F4 according to the Batts and Ludwig scoring system. Significant and advanced fibrosis was defined as stage F ≥ 2 and F ≥ 3, respectively. The accuracy of prediction for fibrosis was analyzed using receiver operating characteristic curves.

Results: Seventy patients, 15 were belonged to F0-F1 stage, 20 F2, 13 F3 and 22 F4. LSM was increased with progression of fibrosis stage (F0-F1: 6.77 ± 1.72, F2: 9.98 ± 3.99, F3: 15.80 ± 7.73, and F4: 22.09 ± 10.09, P < 0.001). Diagnostic accuracies of LSM for prediction of F ≥ 2 and F ≥ 3 were 0.915 (95%CI: 0.824-0.968, P < 0.001) and 0.913 (95%CI: 0.821-0.967, P < 0.001), respectively. The cut-off values of LSM for prediction of F ≥ 2 and F ≥ 3 were 8.6 kPa with 78.2% sensitivity and 93.3% specificity and 10.46 kPa with 88.6% sensitivity and 80.0% specificity, respectively. However, there were no significant differences between LSM and serum hyaluronic acid and type IV collagen in diagnostic accuracy.

Conclusion: SWE showed a significant correlation with the severity of liver fibrosis and was useful and accurate to predict significant and advanced fibrosis, comparable with serum markers.

Keywords: Elastography; Liver biopsy; Liver fibrosis; Liver stiffness; Serum markers.

Figure 1

Score values of liver stiffness by according to fibrosis stage (n = 70). Boxplots summarize the liver stiffness by shear wave elastography (SWE) for each fibrosis classification. For each box, the box gives the interquartile range, that is, the 25^th to 75^th percentiles of liver stiffness by SWE, with line inside the box denoting the median, the 50^th percentile of data. Statistical significant test was done by Tukey test using ranks.

Figure 2

Receiver-operating characteristic curves of liver stiffness determined by shear wave elastography for diagnosis of significant fibrosis (F0-1 vs F2-4, A), advanced fibrosis (F0-2 vs F3-4, B) and cirrhosis (F0-3 vs F4, C) (n = 70).

Figure 3

Receiver operating characteristic curves of noninvasive serum markers for discriminating F0-1 vs F2-4 (significant fibrosis, A), F0-2 vs F3-4 (advanced fibrosis, B) and F0-3 vs F4 (cirrhosis, C) (n = 61). SWE: Shear wave elastography; APRI: Aspartate aminotransferase to platelet ratio index.

Figure 4

Comparison of receiver-operating characteristiccurves of noninvasive serum markers for discriminating F0F1 vs F2-4 (significant fibrosis, A) and F0-2 vs F3F4 (advanced fibrosis, B) in 36 patients with chronic viral hepatitis. ROC: Receiver-operating characteristic curves; SWE: Shear wave elastography; APRI: Aspartate aminotransferase to platelet ratio index.

Figure 5

Comparison of receiver-operating characteristic curves of noninvasive marker for discriminating F0F1 vs F2-4 (significant fibrosis, A) and F0-2 vs F3F4 (advanced fibrosis, B) in 25 patients with non-viral chronic liver diseases. ROC: Receiver-operating characteristic curves; SWE: Shear wave elastography; APRI: Aspartate aminotransferase to platelet ratio index.