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

Abstract

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.

Dynamic Changes in Liver Stiffness in Patients with Chronic Hepatitis B Undergoing Antiviral Therapy

“…TE is one of the first and the most used and validated elastographic techniques for assessing liver stiffness as a marker of liver fibrosis in CLD. It was followed by the development of point share wave elastography (pSWE) and two-dimensional share wave elastography (2D-SWE) [ 6 , 7 , 8 , 9 , 10 , 11 ].…”

The Place of Liver Elastography in Diagnosis of Alcohol-Related Liver Disease

“…TE is followed by other ultrasound-based methods, such as point Share Wave Elastography (pSWE), Two-Dimensional Share Wave Elastography (2D-SWE), or Time-Harmonic Elastography embedded in ultrasound systems [47][48][49][50][51][52][53]. There are few studies that show data on the performance of pSWE or 2D-SWE in ALD (Table 4), with a small number of included patients, and in some studies, data show a wide range of values.…”

The Prevalence of Liver Fibrosis Stages on More than 23,000 Liver Stiffness Measurements by Vibration-Controlled Transient Elastography: A Single Center Study

“…Following its introduction, a multitude of ultrasound-based methodologies have been explored. Presently, manufacturers of ultrasonographic equipment are progressively advancing techniques specifically tailored to quantify hepatic stiffness as a non-invasive marker of fibrosis [2][3][4].…”