Quantitative Elastography of Liver Fibrosis and Spleen Stiffness in Chronic Hepatitis B Carriers: Comparison of Shear-Wave Elastography and Transient Elastography with Liver Biopsy Correlation

Abstract

SW elastography provides more accurate correlation of liver elasticity with liver fibrosis stage compared with transient elastography, especially in identification of stage F2 or greater.

Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection

“…2D-SWE was compared to TE in 226 HBV patients and 171 healthy controls, with the highest AUROC values achieved by 2D-SWE across all fibrosis grades (AUROC 0.86 for fibrosis (≥ F1 stage); 0.88 for moderate fibrosis (≥ F2 stage); 0.93 for severe fibrosis (≥ F3 stage); and 0.98 for cirrhosis. In this study, 2D-SWE also had higher successful acquisition rate than TE (98.9% vs. 89.6%) (113). In a study of 123 HCV and HBV patients, 2D-SWE accurately differentiated fibrosis stages, with cut-off values of 8.1 (AUC =0.99) for F ≥ 3, 10.8 kPa (AUC =0.95) for cirrhosis, and 27 kPa (AUC =0.96) for decompensated cirrhosis (114).…”

Shear wave elastography (SWE) of the spleen in patients with hepatitis B and C but without significant liver fibrosis

“…Some authors prefer suspended breathing; others prefer examining after deep inhalation. 6 In our experience, deep inhalation allows better visualization of the spleen and gives fewer artefacts. The operator chose the best static shear wave elastographic display images onto which a rectangular electronic ROI and a circular ROI (placed within the centre of the rectangular ROI) for analysis were positioned within 1-3 and 0.5-2 cm, respectively, from the capsular surface of the liver and spleen (Figures 1 and 2).…”

“…2 The cut-off value for significant liver fibrosis in the SWE technique was set at 7.1 kPa. 6,7 Much less is known about spleen elastography, which was not included in the guidelines, and no standard examination procedure exists. 6,12 In the present study, spleen stiffness was measured through an intercostal approach after deep inhalation.…”

“…6,7 An unsatisfactory spleen elastography was performed on 37 subjects, who were therefore not included in the study, giving successful spleen measurements in about 72% of patients with non-enlarged spleens. Liver elastography was successful in all subjects.…”

“…3-5 Although Leung et al 6 reported a strong positive correlation between spleen stiffness and the severity of liver fibrosis, this association was less accurate for lower stages of fibrosis because of the overlapping of SWE between study groups and healthy controls. The authors of the present study wanted to shed more light on the accuracy of SWE of the spleen in patients with hepatitis who had not developed liver fibrosis.…”