A pilot study estimating liver fibrosis with ultrasound shear-wave elastography: does the cause of liver disease or location of measurement affect performance?

• Published in: American journal of roentgenology (1976) Vol. 203; no. 3; pp. W267 - W273
• Main Authors: Beland, Michael D, Brown, Sanford F, Machan, Jason T, Taliano, Ross J, Promrat, Kittichai, Cronan, John J
• Format: Journal Article
• Language: English
• Published: United States 01.09.2014
• Subjects: Adult; Aged; Elastic Modulus; Elasticity Imaging Techniques - methods; Female; Hepatitis C - complications; Hepatitis C - diagnostic imaging; Hepatitis C - physiopathology; Humans; Image Interpretation, Computer-Assisted - methods; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - etiology; Liver Cirrhosis - physiopathology; Male; Observer Variation; Patient Positioning - methods; Pilot Projects; Reproducibility of Results; Sensitivity and Specificity; elastography; liver biopsy; hepatitis C; cirrhosis; ultrasound
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.13.11718

The purpose of this study was to evaluate the diagnostic accuracy of real-time shear-wave elastography for assessment of liver fibrosis in an unselected patient population, comparing shear-wave elastography measurements obtained at and remote from the site of random liver biopsy. In a prospective study of 50 patients (21 with and 29 without hepatitis C) referred for clinically indicated random liver biopsy for diffuse liver disease, shear-wave elastography measurements were taken from four locations before biopsy: one at the left lobe, two at the right lobe, and one at the biopsy location. The mean, minimum, maximum, and SD of shear-wave elastography were compared with pathologic grading. Steatosis and serum markers were analyzed using multiple logistic regression. Optimized shear-wave elastography thresholds were calculated using AUC analysis. The AUC (95% CI) at the biopsy site, ipsilateral lobe, and contralateral lobe were 0.82 (0.63-1.0), 0.84 (0.67-1.0), and 0.59 (0.19-0.99) in hepatitis C patients; 0.89 (0.75-1.0), 0.88 (0.73-1.0), and 0.93 (0.80-1.0) in nonhepatitis C patients; and 0.85 (0.74-0.96), 0.89 (0.79-0.99), and 0.80 (0.67-0.93) in all patients, respectively. Optimized biopsy site shear-wave elastography values for detecting Metavir score F2 or greater were 1.87 m/s (75% sensitivity and specificity), 2.00 m/s (80% sensitivity and specificity), and 1.89 m/s (76% sensitivity and specificity) in hepatitis C, nonhepatitis C, and all patients, respectively. Steatosis and serum markers were not significant. Real-time shear-wave elastography accurately predicted significant fibrosis (stage ≥ 2) in an unselected patient population with diffuse disease, including patients with and without hepatitis C. Shear-wave elastography best predicts pathologic grading when taken at the biopsy site or ipsilateral lobe in hepatitis C patients. Percentage steatosis was not predictive of shear-wave elastography results.