Comparison between Two-Dimensional and Point Shear Wave Elastography Techniques in Evaluating Liver Fibrosis Using Histological Staging as the Reference Standard: A Prospective Pilot Study

Abstract

Evaluation of hepatic fibrosis is essential to prevent liver-related morbidity and mortality. Although various types of ultrasound shear wave elastography (SWE) have been used and validated, there are limited studies on the relatively newer technique, two-dimensional SWE (2D-SWE). Therefore, this study aimed to compare the diagnostic performances of 2D-SWE and point SWE (p-SWE) for evaluating liver fibrosis using histology as the reference standard. To measure liver stiffness (LS) values, 87 patients underwent 2D-SWE and p-SWE using the same machine. Technical failures and unreliable measurements were also evaluated. The diagnostic performances of 2D-SWE and p-SWE were compared using area under the receiver operating characteristic (AUROC) curve analysis. No technical failures were observed in either method; however, unreliable measurements were less frequent in 2D-SWE (1/87 [1.1%]) than in p-SWE (8/87 [9.2%]) (p < 0.001). The AUROC of the LS values of 2D-SWE were significantly higher than those of p-SWE for diagnosing significant fibrosis (0.965 vs. 0.872, p = 0.022) and cirrhosis (0.994 vs. 0.886, p = 0.042). In conclusion, 2D-SWE is more reliable and accurate than p-SWE for diagnosing hepatic fibrosis.

Keywords: chronic liver disease; histology; liver fibrosis; point shear wave elastography; two-dimensional shear wave elastography.

Figure 1

Flow diagram of the study population. 2D-SWE, two-dimensional shear wave elastography; p-SWE, point shear wave elastography.

Figure 2

Liver stiffness value measurements using 2D-SWE (A) and p-SWE (B). 2D-SWE, two-dimensional shear wave elastography; p-SWE, point shear wave elastography.

Figure 3

Box-and-whisker plot of the liver stiffness (LS) values at each fibrosis staging. The boxes indicate the LS values between the 25th and 75th quartiles, and the lines at the center of the boxes represent the median. The whiskers represent the 9th and 91st percentiles. Small orange squares represent outlier LS values measured using p-SWE and red orange square represents outlier LS value measured using 2D-SWE. LS, liver stiffness; 2D-SWE, two-dimensional shear wave elastography; p-SWE, point shear wave elastography.

Figure 4

Area under the receiver operating curves of 2D-SWE and p-SWE in diagnosing significant fibrosis (≥F2) (A) and cirrhosis (F4) (B). 2D-SWE, two-dimensional shear wave elastography; p-SWE, point shear wave elastography.