Liver Fibrosis with Two-dimensional US Shear-Wave Elastography in Participants with Chronic Hepatitis B: A Prospective Multicenter Study

Abstract

Purpose To investigate the diagnostic performance of two-dimensional (2D) shear-wave elastography (SWE) in chronic hepatitis B. Materials and Methods This prospective multicenter study from January 2015 to January 2016 was conducted at 12 hospitals and included 654 participants with chronic hepatitis B who had undergone liver biopsy and 2D SWE examination. Participants were divided into chronic infection and chronic hepatitis groups. The diagnostic performance of 2D SWE was compared with the aspartate amino transferase-to-platelet ratio index (APRI), the Fibrosis-4 index (FIB-4), and transient elastography (TE) by using a DeLong test and was also compared between two subgroups. Dual cutoff values for cirrhosis were determined with multilevel likelihood ratio analysis. Results Overall, 402 participants with chronic hepatitis B were enrolled (154 with chronic infection and 248 with chronic hepatitis). The areas under the receiver operating characteristic curve of 2D SWE (0.87; 95% confidence interval [CI]: 0.83, 0.90) were higher than those of TE (0.80; 95% CI: 0.68, 0.88), APRI (0.70; 95% CI: 0.65, 0.74), and FIB-4 (0.73; 95% CI: 0.69, 0.78) in cirrhosis. The high area under the receiver operating characteristic curve (0.92; 95% CI: 0.87, 0.96) was achieved in the chronic infection group and was significantly higher than that of the chronic hepatitis group (0.84; 95% CI: 0.78, 0.88; P = .017). Dual cutoff values with the likelihood ratios below 0.1 and above 10 (8.4 kPa and 11.0 kPa to rule out and rule in a diagnosis of cirrhosis, respectively) were effectively determined in chronic infection; a total of 81.2% (125 of 154) participants with cirrhosis were definitively diagnosed. Conclusion The performance of two-dimensional (2D) shear-wave elastography (SWE) was higher than that of other noninvasive methods. 2D SWE was most effective in ruling in and ruling out cirrhosis in participants with chronic infection, which may prompt antiviral treatment. © RSNA, 2018 Online supplemental material is available for this article.

Quantification of Steatosis and Fibrosis using a new system implemented in an ultrasound machine

“…Published papers evaluating 2D-SWE systems have shown good correlations with liver histology or TE [18,[32][33][34][35]. In a previous study performed by Hermann et al [33], which included 1134 patients with mixed chronic liver disease and where liver biopsy was used as a reference method, 2D-SWE demonstrated excellent diagnostic accuracies for all fibrosis stages in patients with hepatitis C, hepatitis B and NAFLD (AUROC 0.86, 0.90, 0.85 for diagnosing significant fibrosis and AUROC 0.92, 0.95, 0.91 for diagnosing cirrhosis, respectively).…”

Two-dimensional shear wave elastography for significant liver fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

“…After excluding non-original researches, studies not in the field of interest, non-English studies, etc., 27 full-text articles were downloaded for careful screening. Finally, eleven eligible studies with 2623 patients were included for narrative synthesis [27][28][29][30][31][32][33][34][35][36][37] and 9 studies including 1977 patients were selected for meta-analysis [28][29][30][31][32][34][35][36][37]. Table 1 summarizes the basic characteristics of the included studies.…”

“…Table 1 summarizes the basic characteristics of the included studies. Most studies were from China [27][28][29][30][31][33][34][35][36][37], while only 1 study came from Korea [32]. There were six prospective studies [27,30,33,[35][36][37] and 5 retrospective studies [28,29,31,32,34].…”

“…Most studies were from China [27][28][29][30][31][33][34][35][36][37], while only 1 study came from Korea [32]. There were six prospective studies [27,30,33,[35][36][37] and 5 retrospective studies [28,29,31,32,34]. Six studies recruited consecutive patients [27,29,30,34,36,37], while inconsecutive enrollments were found in 5 studies [28,[31][32][33]35].…”

“…There were six prospective studies [27,30,33,[35][36][37] and 5 retrospective studies [28,29,31,32,34]. Six studies recruited consecutive patients [27,29,30,34,36,37], while inconsecutive enrollments were found in 5 studies [28,[31][32][33]35]. The mean age of the patients was 43.6 years (range: 35.8-56.8 years).…”