Applicability and variability of liver stiffness measurements according to probe position

doi:10.3748/wjg.15.3398

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jul 21, 2009; 15(27): 3398-3404
Published online Jul 21, 2009. doi: 10.3748/wjg.15.3398

Table 1 Characteristics of included and non-included patients n (%)

Characteristics	Included	Non-included
Number of patients	442	26
Mean age (SE)	49 (1)	50 (2)
Male	293 (66)	17 (65)
Ethnic origin
Caucasian	285 (65)	17 (65)
Asian	36 (8)	2 (8)
North African	43 (10)	1 (4)
Other African	78 (17)	6 (23)
Anthropometric data
Height (m)	1.71 (0.05)	1.70 (1.91)
Weight (kg)	71.7 (0.7)	69.7 (2.4)
BMI (kg/m²)	24.4 (0.2)	24.1 (0.8)
Abdominal fold mm	21.7 (0.5)	26.1 (3.2)
Thoracic fold mm	13.1 (0.3)	13.6 (1.1)
Waist circumference cm	84 (1)	83 (2)
Daily alcohol ≥ 30 g/d	18 (7)	2 (11)
Diagnosis
HCV	200 (45)	13 (50)
HBV	79 (18)	6 (23)
NAFLD	59 (13)	1 (4)
HIV coinfection	50 (11)	4 (15)
ALD	11 (3)	0 (0)
Other/unknown	93 (21)	2 (8)
Biochemistry
ALT (IU/L)	58 (3)	151 (100)
AST (IU/L)	48 (2)	45 (6)
	n = 416	n = 16
Cholesterol (mmol/L)	4.70 (0.05)	4.50 (0.34)
	n = 381	n = 14
Glucose (mmol/L)	5.34 (0.07)	5.28 (0.16)
	n = 404	n = 16
Triglycerides (mmol/L)	1.21 (0.06)	1.10 (0.19)
	n = 381	n = 14
FibroTest	0.40 (0.01)	0.51 (0.06)
	n = 442	n = 18
ActiTest	0.32 (0.01)	0.39 (0.07)
	n = 442	n = 18
SteatoTest	0.33 (0.01)	0.27 (0.06)
	n = 378	n = 12

Table 2 Liver stiffness measurements applicability

Position, operator and quality criteria	Applicability (%)	Presumed fibrosis stages among applicable patients F0F1/F2/F3/F4 n (%)^c
Reference position	306/442 (69)^a	167 (55)/59 (19)/51 (17)/29 (9)^d
Operator 1	208/329 (63)	117 (56)/40 (19)/32 (15)/19 (9)
Valid10	312/329 (95)
SR60	300/329 (91)
IQR30	220/329 (67)
Operator 2	98/113 (87)	50 (51)/19 (19)/19 (19)/10 (10)
Valid10	113/113 (100)
SR60	113/113 (100)
IQR30	98/113 (87)
Anterior position	357/442 (81)^a	223 (62)/52 (15)/49 (14)/33 (9)^d
Operator 1	255/329 (78)	166 (65)/34 (13)/31 (12)/24 (9)
Valid10	300/329 (91)
SR60	296/329 (90)
IQR30	271/329 (82)^b
Operator 2	102/113 (90)	57 (56)/18 (18)/18 (18)/9 (9)
Valid10	111/113 (98)
SR60	111/113 (98)
IQR30	103/113 (91)^b
Lower position	302/442 (68)^a	170 (56)/49 (16)/47 (16)/36 (12)
Operator 1	224/329 (68)	126 (56)/36 (16)/36 (16)/26 (12)
Valid10	299/329 (91)
SR60	291/329 (88)
IQR30	240/329 (73)^b
Operator 2	78/113 (69)	44 (56)/13 (17)/11 (14)/10 (13)
Valid10	96/113 (85)
SR60	94/113 (83)
IQR30	86/113 (76)^b

^aApplicability of the anterior position was significantly higher than that of the reference and the lower positions (both P = 0.0001);

^bIQR30 was obtained more frequently with the anterior position than with the reference and lower positions for operator 1 (82% vs 67% P < 0.0001; 82% vs 73% P = 0.004) and for operator 2 (91% vs 87% P = 0.40; 91% vs 76% P = 0.004);

^cPresumed fibrosis stage (METAVIR scoring system) using 7.7 kPa for F2, 8.8 kPa for F3 and 14.5 kPa for F4;

^dPresumed prevalence of non-advanced fibrosis was lower using the reference position than the anterior position (P = 0.04).

Table 3 Strength of concordance between stiffness measurements assessed in three positions in the biopsy area

Position (No. of patients)	Method assessing concordance
Quantitative concordance	Spearman mean (95% CI)	Intra class coefficient mean (95% CI)
Reference vs anterior (196)	0.81 (0.75-0.85)	0.90 (0.86-0.94)
Reference vs lower (196)	0.77 (0.70-0.82)	0.86 (0.79-0.93)
Anterior vs lower (196)	0.77 (0.70-0.82)	0.87 (0.80-0.94)
Two classes concordance	Discordance rate (%)	Kappa mean (SE)
Advanced vs non advanced fibrosis	Discordance rate (%)	Kappa mean (SE)
7.1 cutoff
Reference vs anterior (196)	35 (17.9)^a	0.63 (0.07)
Reference vs lower (196)	33 (16.8)^b	0.66 (0.07)
Anterior vs lower (196)	34 (17.3)^c	0.64 (0.07)
8.8 cutoff
Reference vs anterior (196)	22 (11.2)	0.71 (0.07)
Reference vs lower (196)	28 (14.3)	0.65 (0.07)
Anterior vs lower (196)	20 (10.2)	0.74 (0.07)

^aP = 0.06 vs 8.8 kPa cutoff;

^bP = 0.50 vs 8.8 kPa cutoff;

^cP = 0.04 vs 7.1 kPa cutoff.

Table 4 Factors associated with discordance between reference and anterior positions n (%)

Characteristics	Concordant	Discordant	P
Number of patients	221	47
Mean age (SE)	47 (1)	49 (2)	0.16
Male	151 (68)	34 (72)	0.59
Ethnic origin
Caucasian	134 (61)	30 (64)	0.69
Asian	16 (7)	4 (8)	0.68
North African	27 (12)	6 (13)	0.87
Other African	44 (20)	7 (15)	0.38
Anthropometric data
Height (m)	1.71 (0.01)	1.71 (0.10)	0.96
Weight (kg)	69.8 (0.9)	73.6 (2.2)	0.12
BMI (kg/m²)	23.7 (0.2)	25.0 (0.5)	0.02
Abdominal fold (mm)	19.2 (0.6)	23.0 (1.6)	0.03
Thoracic fold (mm)	11.4 (0.4)	14.5 (0.9)	0.001
Waist circumference (cm)	82 (1)	86 (2)	0.047
Daily alcohol ≥ 30 g/d	18/137 (13)	2/23 (9)	0.55
Diagnosis
HCV	102 (46)	18 (38)	0.29
HBV	44 (20)	9 (19)	0.88
NAFLD	21 (10)	11 (23)	0.002
HIV coinfection	29 (13)	5 (11)	0.63
ALD	8 (4)	0 (0)	0.16
Other	46 (20)	9 (19)	0.88
Biochemistry
ALT (IU/L)	55 (3)	81 (19)	0.56
	n = 221	n = 47
AST (IU/L)	47 (2)	57 (6)	0.54
	n = 221	n = 47
Cholesterol (mmol/L)	4.63 (0.08)	4.85 (0.13)	0.06
	n = 186	n = 42
Glucose (mmol/L)	5.26 (0.09)	5.42 (0.17)	0.15
	n = 197	n = 46
Triglycerides (mmol/L)	1.15 (0.06)	1.37 (0.19)	0.10
	n = 186	n = 42
FibroTest	0.40 (0.01)	0.41 (0.06)	0.76
	n = 221	n = 47
ActiTest	0.32 (0.02)	0.34 (0.04)	0.59
	n = 221	n = 18
SteatoTest	0.30 (0.01)	0.38 (0.04)	0.04
	n = 183	n = 42

Table 5 Strength of concordance between LSM and FibroTest (FT) according to positions

Position (No. of patients)	Method assessing	Kappa
Position (No. of patients)	Discordance rate (%)	Kappa
Quantitative concordance	Spearman mean (95% CI)	Intra class coefficient mean (95% CI)
All positions applicable
Reference (196)	0.46 (0.34-0.56)	0.55 (0.33-0.67)
Anterior (196)	0.46 (0.34-0.56)	0.56 (0.34-0.68)
Lower (196)	0.40 (0.27-0.51)	0.50 (0.38-0.62)
Mean of positions (196)	0.47 (0.35-0.57)	0.56 (0.34-0.68)
At least one position applicable
Reference (306)	0.44 (0.35-0.53)	0.51 (0.39-0.63)
Anterior (357)	0.46 (0.38-0.54)	0.54 (0.32-0.66)
Lower (302)	0.39 (0.29-0.49)	0.50 (0.38-0.62)
Two classes concordance	Discordance rate n (%)	Kappa mean (SE)
Cutoff 7.1 kPa
All positions applicable
Reference (196)	66 (33.6)^a	0.30 (0.07)
Anterior (196)	61 (31.1)	0.32 (0.07)
Lower (196)	71 (36.2)	0.24 (0.07)
Mean of positions (196)	67 (34.2)	0.28 (0.07)
At least one position applicable
Reference (306)	107 (34.9)^b	0.28 (0.06)
Anterior (357)	112 (31.6)	0.33 (0.05)
Lower (302)	109 (36.1)^c	0.24 (0.06)
Cutoff 8.8 kPa
All positions applicable
Reference (196)	46 (23.5)^a	0.45 (0.07)
Anterior (196)	54 (27.6)	0.33 (0.07)
Lower (196)	56 (28.6)	0.34 (0.07)
Mean of positions (196)	52 (26.5)	0.37 (0.07)
At least one position applicable
Reference (306)	82 (26.8)^b	0.38 (0.06)
Anterior (357)	108 (30.2)	0.30 (0.05)
Lower (302)	84 (27.8)^c	0.34 (0.06)

^a,b,cP = 0.03 between 7.1 and 8.8 kPa.

Citation: Ingiliz P, Chhay KP, Munteanu M, Lebray P, Ngo Y, Roulot D, Benhamou Y, Thabut D, Ratziu V, Poynard T. Applicability and variability of liver stiffness measurements according to probe position. World J Gastroenterol 2009; 15(27): 3398-3404
URL: https://www.wjgnet.com/1007-9327/full/v15/i27/3398.htm
DOI: https://dx.doi.org/10.3748/wjg.15.3398