The validity of two-dimensional shear wave ultrasound for assessing fibrosis stage in patients with chronic liver disease

Abstract

Background: Several real‐time two‐dimensional shear wave elastography (2D‐SWE) have been developed to assess liver fibrosis with readily use of combining elastography and traditional ultrasound imaging. However, compared with transient elastography (fibroscan), the diagnostic accuracy and clinical usefulness of these methods were not fully validated. In this study, newly developed 2D‐SWE (LOGIQ E9, GE healthcare, UK) was evaluated for predicting liver fibrosis stage and compared with fibroscan. Methods: Out of 1,395 patients who received 2D‐SWE during May 2015 to Apr 2016, seventy (5.0%) who failed to get available value of 2D‐SWE due to obesity and 131 (9.4%) with high value of AST or ALT were excluded in the analysis. Liver biopsy was performed in 177 patients. 2D‐SWE measurement was considered valid when homogenous color pattern in a region of interest of at least 10 mm was shown at 10 different sites. Diagnostic performance was calculated using area under the receiver operating characteristics curve (AUROC). Results: Patients were male predominant (60.8%), their mean age was 50.4±12.4 years old and most common etiology of liver disease was hepatitis B (40.3%) followed by alcohol (26.1%). Liver fibrosis stage consisted of F0 (14.1%), FI (12.4%), F2 (28.8%), F3 (18.1%) and F4 (26.6%). Overall, 2D‐SWE was well correlated with transient elastography (r=0.788, P<0.001). 2D‐SWE median values (kPa) increased with increasing stage of liver fibrosis [ F0 (5.0±1.5), FI (6.4±2.3), F2 (6.5±2.0), F3 (9.0±2.7), F4 (12.7±2.9)] (p for trend <0.001). For the diagnosis of liver cirrhosis, AUROCs and optimal cutoff of 2D‐SWE were 0.928 (95% confidence interval [CI], 0.890‐0.967) and 10.1 kPa. The sensitivity, specificity, positive predictive value and negative predictive value for predicting cirrhosis were 82.2%, 92.2%, 78.7% and 93.7% respectively. For diagnosing significant liver fibrosis (≥F2), AUROCs and optimal cutoff of 2D‐SWE were 0.913 (95% Cl, 0.870‐0.956) and 7.99 kPa. Conclusions: With good comparability to fibroscan and availability of a conventional ultrasound examination, Two‐dimensional SWE is an useful tool for stratifying liver fibrosis stage and diagnosing liver cirrhosis. Disclosures: The following people have nothing to disclose: Sang Gyune Kim, Jeong‐Ju Yoo, Young Seok Kim, Bora Lee, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Young Don Kim, Gab Jin Cheon, Boo Sung Kim