Intra- and Inter-Observer Reproducibility of a 2-D Shear Wave Elastography Technique and the Impact of Ultrasound Experience in Achieving Reliable Data

Moga, Tudor; Stepan, Ana Maria; Pienar, Corina; Bende, Felix; Popescu, Alina; Şirli, Roxana; Dănilă, Mirela; Sporea, Ioan

doi:10.1016/j.ultrasmedbio.2018.03.029

Cited by 29 publications

(25 citation statements)

References 22 publications

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“…Several other studies using SWE have demonstrated good to excellent interobserver and intraobserver agreement 10,28 . In contrast, our study showed poor‐to‐moderate interobserver agreement on the ICC, with a mean liver stiffness difference of between 0.66 and 0.9 kPa on the Bland–Altman analysis.…”

Section: Discussioncontrasting

confidence: 83%

“…Several other studies using SWE have demonstrated good to excellent interobserver and intraobserver agreement. 10,28 In contrast, our study showed poor-tomoderate interobserver agreement on the ICC, with a mean liver stiffness difference of between 0.66 and 0.9 kPa on the Bland-Altman analysis. The interobserver agreement improved in later sessions, perhaps suggestive of a learning curve in SWE, which is supported by findings of other studies.…”

Section: Discussioncontrasting

confidence: 80%

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Interobserver and Intraobserver Reliability of Hepatic Shear Wave Elastography and the Influence of Fasted Versus Nonfasted States in Healthy Volunteers

Lim

Whitaker²,

DeColle³

et al. 2020

J of Ultrasound Medicine

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Objectives The primary objective of this study was to assess the effect of fasting versus ingestion of food and water on hepatic measurements by shear wave elastography (SWE) in healthy participants. The secondary objective was to assess inter‐ and intra‐reader reliability of hepatic elastography in healthy participants. Methods Twenty healthy participants were enrolled in this prospective study and underwent quantitative SWE under fasting conditions and after the ingestion of water and food and water. Two blinded sonographers each independently performed a total of 6 sessions of hepatic SWE in each participant. Sessions 1 to 3 were performed on day 0 and sessions 4 to 6 on day 7. Statistical tests used included the Wilcoxon signed ranks test, the intraclass correlation coefficient, and Bland–Altman plots. Results There were no significant differences in hepatic SWE measurements after the ingestion of water versus the fasting state. Statistical significance was assessed as P < 0.05. The postprandial status had a statistically significant effect on hepatic SWE measurements at 1 hour (P = .04) but not at 3 hours (P = .08). By the intraclass correlation coefficient, there was poor‐to‐moderate inter‐reader agreement and minimal‐to‐moderate intra‐reader agreement. The median inter‐reader difference in SWE measurements ranged from 0.66 to 0.96 kPa. The median intra‐reader difference ranged from 0.43 to 0.55 kPa. Conclusions Our study shows that the ingestion of water has no effect on hepatic SWE measurements in healthy participants. The postprandial state had a significant effect on SWE measurements at 1 hour after ingestion but not at 3 hours. The inter‐reader and intra‐reader agreements were variable and moderate at best.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussioncontrasting

confidence: 80%

Interobserver and Intraobserver Reliability of Hepatic Shear Wave Elastography and the Influence of Fasted Versus Nonfasted States in Healthy Volunteers

Lim

Whitaker²,

DeColle³

et al. 2020

J of Ultrasound Medicine

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“…However, when talking about the intra-observer reproducibility, LSM performed by the experienced examiner were more homogeneous (higher ICCs) meaning that experience may play a role in acquiring reliable LSM by THE system. This observation was also made in another study [ 25 ] that evaluated the reproducibility of a 2D-SWE system, with similar results as ours in what regards the operator experience in performing the elastographic technique.…”

Section: Discussionsupporting

confidence: 88%

Performance of a Noninvasive Time-Harmonic Elastography Technique for Liver Fibrosis Evaluation Using Vibration Controlled Transient Elastography as Reference Method

et al. 2020

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Aim: This study aimed to evaluate the diagnosis performance of time-harmonic elastography (THE) technique in real life in assessing liver fibrosis, considering vibration-controlled transient elastography (VCTE) as a reference method. Material and Method: We prospectively evaluated outpatients from the gastroenterology department. Liver stiffness (LS) was measured by the THE system by dedicated operators, and by VCTE by experienced operators. The diagnostic accuracy of THE in staging liver fibrosis was assessed. We also performed an intra- and interobserver reproducibility sub-analysis on a sub-group of 27 subjects, where liver stiffness measurements (LSM) were performed by a novice, an elastography expert, and an ultrasound expert. Results: Of the 165 patients, using VCTE cut-off values, 49.6% were F0-F1, 15.7% were F2, 6.6% were F3, and 28.1% were F4. A direct, significant and strong correlation (r = 0.82) was observed between LSM assessed by VCTE and THE, p < 0.0001. The cut-off for ruling out liver cirrhosis (LC) by THE on our study group was <1.61 m/s (7.77 kPa)–AUROC = 0.90 [95% CI (0.82–0.93)], Se = 90.7%, Sp = 66.6%, PPV = 55.7%, NPV = 93.9%. The cut-off for ruling in LC by THE was >1.83 m/s (10 kPa)-AUROC = 0.90 [95% CI (0.82–0.93)], p < 0.0001, Se = 65.1%, Sp = 96.7%, PPV = 90.3%, NPV = 85.7%. The overall agreement between examiners was excellent: 0.94 (95% CI: 0.89–0.97); still, the ICCs were higher for the more experienced elastography examiner: 0.92 (95% CI: 0.82–0.96) vs. 0.94 (95% CI: 0.87–0.97) vs. 0.97 (95% CI: 0.95–0.99). Conclusions: THE is a feasible and reproducible elastography technique that can accurately rule in and rule out advanced liver disease.

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“…UGAP values are expressed in dB/cm/ MHz or in dB/m. LOGIQ E10 ultrasound machine can also perform liver stiffness measurements for fibrosis evaluation using an accurate 2D-Shear Wave Elastography (2D-SWE) technique [20][21][22][23], but this type of evaluation was not included in the present study.…”

Section: Subjectsmentioning

confidence: 99%

Ultrasound-Guided Attenuation Parameter (UGAP) for the quantification of liver steatosis using the Controlled Attenuation Parameter (CAP) as the reference method

et al. 2021

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Aim: Nonalcoholic Fatty Liver Disease (NAFLD) is increasing in frequency in daily practice and evaluation of liver steatosis, fibrosis and inflammation severity are essential for prognosis assessment. The aim was to evaluate the usefulness of a new liver steatosis quantification system - Ultrasound-Guided Attenuation Parameter (UGAP) from General Electric Healthcare, using Controlled Attenuation Parameter (CAP) as the reference method.Material and method: 179 consecutive subjects, in whom liver steatosis was assessed in the same session using UGAP, implemented on LOGIQ E10 system (GE Healthcare), and CAP (FibroScan, EchoSens). To discriminate between steatosis stages by CAP, we used the cut-offs recommended by the manufacturer: S1 (mild) – 230 dB/m, S2 (moderate) – 275 dB/m, S3 (severe) – 300 dB/m.Results: We classified our cohort by means of CAP into the following groups: S0 (no steatosis): 48/176 (27.2%), S1 (mild): 56/176 (31.6%), S2 (moderate): 14/176 (7.3%) and S3 (severe): 59/176 (33.9%). The mean UGAP values increased with the steatosis grade and for each group were the following: S0: 198.3±25.7 dB/m, S1: 216.86±26.3 dB/m, S2: 237.79±26.3 dB/m, and S3: 270.8±31.62 dB/m respectively (p<0.001). A very good positive correlation was found between UGAP and CAP values (r=0.73, p<0.0001). The best cut-off values for predicting different grades of liver steatosis using CAP as the reference were: S1 - 192.5 dB/m (AUC 0.83); S2 – 231 dB/m (AUC 0.90) and S3 – 248 dB/m (AUC 0.91).Conclusion: UGAP seems to be a good method for liver steatosis quantification and correlates strongly with CAP values.

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Intra- and Inter-Observer Reproducibility of a 2-D Shear Wave Elastography Technique and the Impact of Ultrasound Experience in Achieving Reliable Data

Cited by 29 publications

References 22 publications

Interobserver and Intraobserver Reliability of Hepatic Shear Wave Elastography and the Influence of Fasted Versus Nonfasted States in Healthy Volunteers

Interobserver and Intraobserver Reliability of Hepatic Shear Wave Elastography and the Influence of Fasted Versus Nonfasted States in Healthy Volunteers

Performance of a Noninvasive Time-Harmonic Elastography Technique for Liver Fibrosis Evaluation Using Vibration Controlled Transient Elastography as Reference Method

Ultrasound-Guided Attenuation Parameter (UGAP) for the quantification of liver steatosis using the Controlled Attenuation Parameter (CAP) as the reference method

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