Bi-Dimensional Shear Wave Elastography Produces Comparable Liver Stiffness Measurements to Conventional Method

Bi-dimensional shear wave elastography (2D-SWE) and conventional vibration-controlled transient elastography (VCTE) produced comparable measurements of liver stiffness, according to study data published in Clinical Gastroenterology and Hepatology. 2D-SWE was able to correctly identify patients with advanced chronic liver disease (cACLD) using VCTE cutoff values, supporting its viability for clinical practice.

Researchers conducted a retrospective review of medical records for patients with chronic liver disease who underwent liver stiffness evaluation with VCTE and 2D-SWE between 2011 and 2019 at participating imaging centers in France. Eligible patients underwent VCTE and 2D-SWE examination on the same day. A specialist was blinded to the result of the unused method performed. The researchers calculated liver stiffness as the median value of 3 (2D-SWE) or 10-20 (VCTE) measurements, expressed in kilopascals (kPa). They classified measurements as a failed result if little to no signal was observed for all acquisitions. Measurements were considered unreliable when the ratio of interquartile range (IQR) to median thickness was ≥0.30 in patients with a median thickness ≥7.1 kPa. The correlation between VCTE and 2D-SWE values was tested using the Pearson’s correlation coefficient and the Lin concordance coefficient. The researchers used the area under the receiving operating characteristic curve (AUC) to assess the ability of 2D-SWE to identify patients with cACLD based on VCTE cutoff values. VCTE values <10 kPa were considered to “rule out” cACLD, while VCTE ≥15 kPA “strongly suggested” cACLD.

A total of 1219 patients were included in analyses, of whom 712 (58.4%) were men. Mean age at evaluation was 53.3 ± 15 years. The most common chronic liver disease etiologies were alcohol use disorder (10.2%), non-alcoholic fatty liver disease (28.3%), hepatitis C (28.4%), and hepatitis B (13%). The percentage of failed or unreliable measurements was higher with VCTE than with 2D-SWE (11.3% vs 8.3%; P <.0001). Median liver stiffness was 6.7 kPa (interquartile range, 4.8-11.6 kPa) with VCTE and 7.1 kPa (IQR, 5.4-11.1 kPa) with 2D-SWE. Overall, VCTE and 2D-SWE values were significantly correlated (Pearson’s correlation coefficient, 0.882; Lin concordance coefficient, 0.846, P <.0001 for both). For patients with VCTE values <10, the AUC for 2D-SWE was 0.964, suggesting excellent ability to rule out cACLD. For patients with VCTE values above 15 kPa, the AUC value was 0.976, suggesting excellent ability to detect cACLD. A 2D-SWE cutoff value of 10 kPa detected VCTE values below 10 kPa with 92% sensitivity, 87% specificity, and 91% accuracy.

Use of 2D-SWE showed excellent diagnostic ability for detecting cACLD according to VCTE cutoff values. However, investigators noted that 2D-SWE and VCTE were administered by different providers. This may have contributed to some of the variation seen between measurements. Additionally, the 2D-SWE technique required only 3 measurements, while VCTE required 10-20. Even so, SD-SWE performed comparably to VCTE in liver stiffness evaluations. “These results should help the clinical implementation of the 2D-SWE technique, accelerate its integration in international guidelines and recommendations, and greatly help hepatologists in their clinical practice,” investigators wrote.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Cassinotto C, Lapuyade B, Guiu B, et al. Agreement between 2-dimensional shear wave and transient elastography values for diagnosis of advanced chronic liver disease [published online April 26, 2020]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.04.034