Comparative analysis of vibration-controlled transient elastography and EUS-shear wave elastography for liver stiffness measurement in cirrhosis

Abstract

Background and objectives: Chronic liver inflammation leads to fibrosis and cirrhosis. To avoid portal hypertension-related complications, fibrosis' early detection is imperative. Biopsy remains the gold standard, but magnetic resonance elastography (MRE) and EUS-guided elastography are noninvasive procedures currently used for liver stiffness measurement (LSM). Two-dimensional EUS-guided shear-wave elastography (EUS-SWE) represents a more-every-day used technique.The aim of this study is to correlate LSM determined by vibration-controlled transient elastography (VCTE) and EUS-SWE and determine the measurements' accuracy in diagnosing cirrhosis.

Methods: A single-center, nested case-control study was performed between March 2020 and November 2021. Patients were classified into 2 study groups: the cirrhosis group and the control group. Patients from both groups underwent VCTE and EUS-SWE for LSM. A P value < 0.05 was considered statistically significant.

Results: Of the 59 participants included (mean age 63.5 years; 71.1% female), 29 had cirrhosis (49.15%) and 30 were controls (50.84%). In cirrhosis patients, liver fibrosis (F) was staged as F3-4 by VCTE in 82.8%, with a median LSM of 17.8 kPa; through EUS-SWE, 27 kPa in the right hepatic lobe (RHL) and 25 kPa in the left hepatic lobe (LHL). Controls fibrosis was staged as F0-2 by VCTE in 30/30 (100%), with a median LSM of 4.6 kPa (P < 0.001); through EUS-SWE, 5.6 kPa in the RHL (P < 0.001) and 6.5 kPa in the LHL (P < 0.001). The observed agreement was 91.5% for VCTE, 93.2% for RHL-EUS-SWE, and 96.6% for LHL-EUS-SWE. The AUROCs for EUS-SWE and VCTE were over 0.95.

Conclusions: VCTE and EUS-SWE are comparable techniques for diagnosing cirrhosis; however, EUS-SWE had a higher agreement than VCTE, especially in LHL assessment.

Keywords: EUS; Elastography; Fibrosis; Liver cirrhosis.

Figure 1

Vibration-controlled transient elastography evaluation. A, Case no. 55. A 63-year-old female with chronic dyspepsia and abdominal pain, a past medical history of rheumatoid arthritis, current methotrexate therapy, and a family history of pancreatic cancer. This participant underwent vibration-controlled transient elastography (VCTE) to rule out hepatotoxicity, and the calculated VCTE was 3.3 kPa. B, Case no. 27. An 82-year-old male with a 36-month history of cirrhosis and previous alcohol consumption of 150 g/w underwent VCTE to rule out complications such as esophageal varices and hepatocellular carcinoma, and the calculated VCTE was 19.6 kPa.

Figure 2

EUS–guided 2-dimensional shear wave elastography (EUS-SWE) evaluation. A, Case no. 37. A 63-year-old female with chronic abdominal bloating, previous US results of a normal liver and a gallbladder polyp, and a previous EUS result of minimal inflammatory pancreatic changes. She underwent EUS-SWE, which revealed an LSM of 6.27 kPa in the RHL and 8.37 kPa in the LHL. B, Case no. 09. A 49-year-old female with a 10-day history of jaundice and epigastric pain radiating throughout the abdomen and recent weight loss of 24 lb. She has a past medical history of cirrhosis and diabetes. EUS-SWE revealed an LSM of 31.1 kPa in the RHL and 31.6 kPa in the LHL. LHL, left hepatic lobe; SWE, shear wave elastography; LSM, liver stiffness measurement.

Figure 3

Area under the receiver operating characteristic curve (AUROC) for diagnosing cirrhosis. A, Vibration-controlled transient elastography (VCTE). B, EUS–guided 2-dimensional shear wave elastography (EUS-SWE) stiffness measurement of the right hepatic lobe (RHL). C, EUS-SWE stiffness measurement of the left hepatic lobe (LHL).