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. 2021 Apr;40(2):217-227.
doi: 10.14366/usg.20036. Epub 2020 May 16.

Ultrasound-guided transient elastography and two-dimensional shear wave elastography for assessment of liver fibrosis: emphasis on technical success and reliable measurements

Jihyuk Lee  1   2 , Hyo-Jin Kang  1   2 , Jeong Hee Yoon  1   2 , Jeong Min Lee  1   2   3
Affiliations

Ultrasound-guided transient elastography and two-dimensional shear wave elastography for assessment of liver fibrosis: emphasis on technical success and reliable measurements

Jihyuk Lee et al. Ultrasonography. 2021 Apr.

Abstract

Purpose: This study investigated whether the use of ultrasound (US) guidance in transient elastography (TE) improved the technical success and reliability of liver stiffness (LS) measurements and whether 2-dimensional (2D) shear wave elastography (SWE) provided reliable LS measurements if TE measurements failed.

Methods: In this prospective study, 292 participants (male:female, 189:103; median age, 60 years) with chronic liver disease (CLD) were enrolled. LS was measured via the consecutive use of conventional TE, 2D-SWE, and US-guided TE. The technical success rates and reliable LS measurement rates of the three elastography techniques were compared. The risk factors for TE failure were assessed through univariate and multivariate logistic regression models.

Results: US-guided TE was associated with a higher technical success rate (281 of 292, 96.2%) and a higher reliable measurement rate (266 of 292, 91.1%) than conventional TE (technical success: 256 of 292, 87.7%; reliable measurements: 231 of 292, 79.1%; P<0.001 for both). In participants for whom conventional TE failed, 2D-SWE provided high rates of technical success (36 of 36, 100%) and reliable measurements (30 of 36, 83.3%). TE failure was associated with female sex (odds ratio [OR], 5.85; 95% confidence interval [CI], 1.30 to 26.40), severe reverberation artifacts (OR, 8.79; 95% CI, 3.93 to 19.69), and high skin-to-liver capsule depth (OR, 1.23; 95% CI, 1.09 to 1.39).

Conclusion: US guidance in TE improved the technical success and reliable measurement rates in the assessment of LS in patients with CLD. In participants for whom TE failed, subsequent 2D-SWE successfully delivered reliable LS measurements.

Keywords: Chronic liver disease; Shear wave elastography; Transient elastography; Ultrasonography.

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Conflict of interest statement

This study was funded by GE Healthcare (Milwaukee, WI, USA).

Figures

Fig. 1.
Fig. 1.. LS measurement with conventional TE (A), US-guided TE (B), and 2D-SWE (C).
LS measurement was obtained with TE in two sessions, first in conventional TE (A), and then in US-guided TE (B). In 2D-SWE, LS measurement was obtained from measurement box defined by the operator (C). All LS measurement was obtained using the LOGIQ S8 ultrasound scanner. LS, liver stiffness; TE, transient elastography; US, ultrasound; 2D-SWE, two-dimensional shear wave elastography.
Fig. 2.
Fig. 2.. Bar graphs showing outcome of US-guided TE and 2D-SWE in participants with technical failure (A) and unreliable measurement (B) with conventional TE.
US, ultrasound; TE, transient elastography; 2D-SWE, two-dimensional shear wave elastography.
Fig. 3.
Fig. 3.. Median LS values obtained with conventional TE, US-guided TE, and 2D-SWE.
LS, liver stiffness; TE, transient elastography; US, ultrasound; 2D-SWE, two-dimensional shear wave elastography.
Fig. 4.
Fig. 4.. Correlation of LS values between conventional TE, US-guided TE, and 2D-SWE.
Linear correlation analysis of LS values (A, conventional TE vs. US-guided TE; B, conventional TE vs. 2D-SWE; C, US-guided TE vs. 2D-SWE) indicates significant correlations in all combinations of the three techniques used in this study. LS, liver stiffness; TE, transient elastography; US, ultrasound; 2D-SWE, two-dimensional shear wave elastography.
See this image and copyright information in PMC

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