Study of detection times for liver stiffness evaluation by shear wave elastography

AIM: To investigate enough valid measurements (VMs) to assess liver fibrosis in chronic hepatitis B patients (CHB).METHODS: One hundred and twelve CHB patients (25 women, 87 men) with a mean age of 38.43 years received liver stiffness evaluations using real-time shear wave elastography for 10 VMs. All patients underwent liver biopsy. Based on the biopsy pathology, the liver stiffness data obtained from different VMs (1, 2, 3, 5 and 10 times) were compared for the evaluation of liver fibrosis. The correlation between the elastic modulus means of the liver obtained from different VMs of detection at each pathological stage was analysed. The receiver operating characteristic (ROC) curve was employed to determine the diagnostic performance of different VMs of detection, and the areas under the ROC curve of different groups were compared.RESULTS: The liver stiffness values obtained from 1 VM, 2 VMs, 3 VMs, 5 VMs and all 10 VMs for stage F0 were 6.95 ± 2.01 kPa, 6.87 ± 1.83 kPa, 6.90 ± 1.88 kPa, 6.95 ± 1.93 kPa and 7.15 ± 1.89 kPa, respectively (F = 0.043, P = 0.996). For stage F1, these values were 7.12 ± 1.72 kPa, 7.24 ± 1.72 kPa, 7.21 ± 1.74 kPa, 7.10 ± 1.78 kPa and 7.04 ± 1.70 kPa, respectively (F = 0.075, P = 0.990). For stage F2, they were 9.37 ± 3.87 kPa, 9.18 ± 3.68 kPa, 9.19 ± 3.81 kPa, 9.18 ± 3.81 kPa and 9.19 ± 3.53 kPa, respectively (F = 0.012, P = 1.000). For stage F3, these were 11.91 ± 3.88 kPa, 11.78 ± 4.04 kPa, 11.83 ± 4.07 kPa, 11.94 ± 4.17 kPa and 12.00 ± 4.02 kPa, respectively (F = 0.010, P = 1.000). For stage F4, the readings were 19.30 ± 7.63 kPa, 19.40 ± 7.36 kPa, 19.54 ± 7.43 kPa, 19.73 ± 7.21 kPa and 20.25 ± 7.22 kPa, respectively (F = 0.054, P = 0.995). There were no significant differences between these groups. Intraclass correlation coefficients among different pathological stages (F0-F4) with different detection VMs were 0.995, 0.993, 0.996, 0.994 and 0.996, respectively. The mean elasticity values from 1 VM, 2 VMs, 3 VMs, 5 VMs and 10 VMs can accurately distinguish fibrosis stages (F0 vs F1234, F01 vs F234, F012 vs F34 and F0123 vs F4) with no significant differences in the five groups (P > 0.05 for all).CONCLUSION: One VM may be sufficient to assess liver fibrosis by using SWE without any significant loss of accuracy in patients with CHB. However, future studies of larger patient samples are necessary for the validation of this method.     

Assessment of biopsy proven liver fibrosis by two-dimensional shear wave elastography in patients with primary biliary cholangitis

BackgroundTwo-dimensional shear-wave elastography (2D-SWE) is an ultrasound-based technique used to stage liver fibrosis by measuring liver stiffness (LS). The diagnostic performance of 2D-SWE for assessing liver fibrosis in patients with primary biliary cholangitis (PBC) has not been reported before.AimsTo investigate the diagnostic performance of 2D-SWE for staging liver fibrosis in patients with PBC by using histologic analysis as a reference standard.MethodsPatients with PBC who underwent liver biopsy and 2D-SWE were retrospectively collected. Liver fibrosis was staged according to the Scheuer scoring system. Areas under receiver operating characteristic curve (AUROC) was constructed to assess the accuracy of 2D-SWE and serum fibrosis models for staging liver fibrosis.ResultsThe diagnostic performance characteristics were determined for 157 patients with PBC. The AUROCs of LS measured by 2D-SWE for significant fibrosis, severe fibrosis, and cirrhosis were 0.88, 0.97 and 0.99, respectively. The cutoff values of LS measured by 2D-SWE in discriminating significant fibrosis, severe fibrosis, and cirrhosis were 10.7 kPa, 12.2 kPa and 14.1 kPa, respectively. The diagnostic accuracy of 2D-SWE for staging liver fibrosis was 73.9%.Conclusions2D-SWE is an efficient noninvasive method for the assessment of liver fibrosis in patients with PBC.     

Feasibility of liver transient elastography with FibroScan® using a new probe for obese patients

Background & Aims: Liver stiffness measurement (LSM) failure when using transient elastography occurs in 2–10% of patients, and is generally related to obesity. The aim of this prospective study was to assess the feasibility of LSM when using a new XL probe on patients with a body mass index (BMI)≥30 kg/m². Methods: For each patient, LSM was performed using both M probe (currently available and dedicated to patients with standard morphology) and XL probe (dedicated to overweighed patients). A blood sample was taken to assess usual biological variables and simple readily available fibrosis blood tests. Results: Ninety‐nine patients were included (27 men, mean age 52 years, mean BMI 40.5 kg/m²). LSM was successful (10 valid measurements) in 45% of the cases with the M probe, vs 76% of the cases with the XL probe (P<0.001). Fifty‐nine percent of those who could not be measured (<10 valid measurements) using the M probe could successfully be measured using the XL probe. In the 44 patients successfully measured with both probes, LSM was correlated with the platelet count, prothrombin time, γ‐glutamyltransferase, aspartate aminotransferase, fasting glucose, AST platelet ratio index, Forns score and FIB‐4. Conclusion: The new XL probe allows providing a higher rate of LSM than the M probe in patients with an increased BMI and shows promising results for the evaluation of liver fibrosis.     

两种超声弹性成像技术诊断慢性乙型肝炎患者肝纤维化价值比较*

目的 探讨瞬时弹性成像和二维剪切波弹性成像用于CHB患者肝纤维化诊断的临床价值。方法 2016年3月～2018年12月我院收治的CHB患者164例,均行瞬时弹性成像和二维剪切波弹性成像检查及肝穿刺活检,采用受试者工作特性(ROC)曲线下面积比较两种超声弹性成像检查诊断不同肝纤维化分期的效能。结果 经肝穿刺活检,在164例CHB患者中,诊断肝组织S₁期50例,S₂期42例,S₃期39例,S₄期33例;瞬时弹性成像检查S₁～S₄期肝纤维化分期的弹性值分别为(6.5±1.1)kPa、(8.6±1.4)kPa、(11.7±1.8)kPa和(16.3±1.8)kPa,二维剪切波弹性成像检查弹性值分别为(5.9±0.8) kPa、(8.1±1.2)kPa、(10.9±1.5)kPa和(16.7±1.9) kPa,两种超声弹性成像检查不同肝纤维化分期弹性值差异无统计学意义(P >0.05);二维剪切波弹性成像检查诊断肝纤维化S₂、S₃和S₄期的ROC曲线下面积(AUC)分别为0.971、0.979和0.973,显著高于瞬时弹性成像检查的0.902、0.906和0.904(P <0.05),其诊断的敏感性分别为90.3%、90.6%和100.0%,特异性分别为95.8%、90.6%和84.5%,而瞬时弹性成像检查诊断则分别为78. 5%、81.3%和73.1%,和93.3%、87.9%和91.0%。结论 二维剪切波弹性成像和瞬时弹性成像检查均可用于慢性乙型肝炎患者的肝纤维化诊断,其临床价值均需要进一步探讨。