Accuracy of the ElastPQ® Technique for the Assessment of Liver Fibrosis in Patients with Chronic Hepatitis C: a “Real Life” Single Center Study

Abstract

Background & Aims: Noninvasive assessment of liver stiffness has been increasingly used to evaluate fibrosis instead of liver biopsy, especially in patients with chronic viral hepatitis. The aim of this study was to assess the performance in staging liver fibrosis of the updated ElastPQ® technique (EPIQ7 ultrasound system, Philips Healthcare, Bothell, WA, USA) in the “real life” setting by using the FibroScan as the reference standard and to understand whether the use of the quality criteria improves the performance of the technique.
 Methods: This was a cross-sectional study: 278 patients affected by chronic hepatitis C referred for liver stiffness measurement with the FibroScan® 502 Touch device (Echosens, Paris, France) underwent measurements also with the ElastPQ® technique. For the assessment of significant fibrosis (F≥2), advanced fibrosis (F≥3) and cirrhosis (F=4), respectively, we used the cutoffs of 7.0, 9.5 and 12.0 kPa. The diagnostic performance of ElastPQ® was assessed using the area under the ROC (AUROC) curve analysis and was evaluated overall and for cases with (a) 10 measurements and IQR/M≤30%, (b) 5 measurements and IQR/M ≤30%, (c) 10 measurements and IQR/M>30%, (d) 5 measurements and IQR/M>30%.
 Results: The optimal cutoffs of ElastPQ® for significant fibrosis, advanced fibrosis and cirrhosis were 6.43, 9.54 and 11.34 kPa, respectively. For measurements with an IQR/M≤30%, there was no statistically significant decrease in sensitivity between 10 and 5 measurements (p=0.26, p=0.09, p=0.71, for F≥2, F≥3, and F=4, respectively).
 Conclusion: The ElastPQ® technique is reliable and accurate for staging liver fibrosis. The number of measurements does not affect the performance.
 Abbreviations: ALP: alkaline phosphatase; ALT: alanine aminotransferase; AST: aspartate aminotransferase; AUROC: area under the ROC curve; BMI: body mass index; GGT: gamma-glutamyl transferase; LR: likelihood ratio; LSM: liver stiffness measurement; pSWE: point shear wave elastography; ROC: receiver operating characteristic; VCTE: vibration controlled transient elastography; VTQ®: virtual touch quantification.

The Importance of Transaminases Flare in Liver Elastography: Characterization of the Probability of Liver Fibrosis Overestimation by Hepatitis C Virus-Induced Cytolysis

“…Their acquisition methods and reliability characteristics are described elsewhere [18]. We used the following cut-off values: mild/no fibrosis (F0-1), 4.1-5.5 kPa; significant fibrosis (F2), 5.51-7.5 kPa; advanced fibrosis (F3), 7.51-11.00 kPa; liver cirrhosis (F4) >11.01 kPa [19,20].…”

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version)

“…In univariate and multivariate analysis, an IQR/M ≥ 30 % was associated with a discordance of at least 2 stages of fibrosis between SWS and histological fibrosis. Using ElastPQ ® , a recent study has suggested that an IQR/ M ≤ 30 % is the most important quality criterion, whereas the number of measurements seems not to affect the performance, provided that they are at least five [73]. Thus, the compliance with quality criteria may increase the diagnostic accuracy of pSWE [68,72].…”

Comparative study between four ultrasound Shear Waves Elastographic methods for liver fibrosis assessment

“…Ten valid measurements were performed and the median value was calculated and expressed in kPa. Reliable measurements were considered the median value of 10 valid LS measurements with an interquartile range/median <30% (IQR/Median <30%) recommended by The Society of Radiologists in Ultrasound [17] and proven by the Ferraioli at al study [18]. For fibrosis estimation we used the cutoffs proposed by Mare et al [19] (Table I).…”