2D shear wave elastography (SWE) performance versus vibration-controlled transient elastography (VCTE/fibroscan) in the assessment of liver stiffness in chronic hepatitis

Abstract

Background: The assessment of liver stiffness and the degree of fibrosis are important factors affecting the management strategy. Multiple non-invasive tools are now available to offer an adequate alternative to biopsy. In this study, we tried to compare the performance of 2D shear wave elastography (SWE) to the transient elastography/fibroscan as a non-invasive tool in the prediction of liver stiffness. This is a prospective study of 215 patients confirmed by serology to have positive virus C or B infection. 2D SWE was done followed by vibration-controlled transient elastography (VCTE) known as fibroscan at the same session. Biopsy results were collected.

Results: The mean age was 51.07 years ± 6.07 SD. Five cases were excluded due to insufficient data. Fibroscan failed in 30 cases out of 210 cases (failure rate of 14.3%) compared with only 12 patients (6.7% failure rate) while using SWE. Only 180 patients completed the study to the result analysis. SWE results showed significant agreement to the fibroscan results with 86.7% agreement with a tendency for overestimation of the degree of fibrosis (11.7%). The efficacy of SWE was the highest during the assessment of patients with F0 (98.9%), F1 (97.8%), and F4 (93.3%) respectively and relatively low in F2 (92.8%) and F3 (90.6%).

Conclusion: 2D SWE is a relatively recent non-invasive tool in the assessment of liver fibrosis grading which can be used as an alternative to the fibroscan with almost similar diagnostic performance especially when fibroscan is not capable to obtain adequate results such as in obesity and ascites.

Keywords: Chronic liver disease; Fibroscan; Liver stiffness; Shear wave elastography; Transient elastography.

Fig. 1

The interpretation of TE or fibroscan results by kilopascal and the liver fibrosis staging (quoted from GE healthcare documents, 2017)

Fig. 2

The degree of agreement and the mismatch incidence between the SWE fibrosis score compared to the fibroscan fibrosis score

Fig. 3

The diagnostic accuracy of SWE compared to the TE fibroscan when using the TE fibroscan results as a reference

Fig. 4

A male patient 52 years old with chronic hepatitis C infection on follow-up. a SWE revealed median velocity = 2.62 m/s and V median/IQR = 14.6% consistent with F4 according to Metavir score. b Fibroscan was done for the same patient and revealed kPa = 64 and IQR/median = 16% consistent with F4

Fig. 5

A female patient 48 years old with chronic hepatitis B infection on follow-up. a SWE revealed median velocity = 1.54 m/s and V median/IQR = 23% consistent with F2 according to Metavir score. b Fibroscan was done for the same patient and revealed kPa = 2.9 and IQR/median = 4% consistent with F0