Real time shear wave elastography in chronic liver diseases: Accuracy for predicting liver fibrosis, in comparison with serum markers

doi:10.3748/wjg.v20.i38.13920

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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. Oct 14, 2014; 20(38): 13920-13929
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13920

Table 1 Baseline characteristics of patients

Characteristics	n = 70
Age, yr (SD, range)	45.9	(15.7, 12.0-82.0)
Sex, male (%)	45	(64.3)
HBV/HCV/Alcohol/NAFLD/Other (%)	23 (32.9)/18 (25.7)/12 (17.1)/4 (5.7)/13 (18.6)
Body mass index, kg/m²(SD, range)	23.8	(2.9, 16.9-29.7)
Hemoglobin, g/dL (SD, range)	12.9	(2.2, 6.7-17.8)
Platelet count, 10³/mm³ (SD, range)	174.7	(55.3, 76.0-285.0)
Albumin, g/dL (SD, range)	3.9	(0.7, 1.6-5.3)
AST, U/L (IQR, range)	55	(31-111, 13-369)
ALT, U/L (IQR, range)	47	(24-99, 6-473)
Total bilirubin, mg/dL (IQR, range)	0.7	(0.5-1.1, 0.2-4.9)
GGT, U/L (IQR, range)	57	(31-157, 13-1569)
Prothrombin time, INR (IQR, range)	0.93	(0.87-1.00, 0.76-1.48)
APRI (IQR, range)	0.91	(0.51-1.35, 0.55-5.88)
Hyaluronic acid¹, ng/mL (IQR, range)	62	(23-176, 10-2796)
Type IV collagen¹, ng/mL (IQR, range)	182	(117-310, 66-2790)
Liver stiffness by SWE, kPa (IQR, range)	11.1	(7.3-18.4, 4.73-48.61)
Fibrosis stage (%)
F0-1	15	(21.4)
F2	20	(28.6)
F3	13	(18.6)
F4	22	(31.4)

¹n = 61. HBV: Hepatitis B virus; HCV: Hepatitis C virus; NAFLD: Nonalcoholic fatty liver disease; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma glutamyltranspeptidase; INR: International normalized ratio; SWE: Shear wave elastography; kPa: Kilopascals; SD:Standard deviation; IQR: Interquartile range.

Table 2 Liver stiffness cut-off values for the diagnosis of significant (≥ F2) and advanced (≥ F3) fibrosis and cirrhosis (F4) (n = 70)

Value	≥F2	≥F3	= F4
Number of patients, n (%)	55 (78.6)	35 (50.0)	22 (31.4)
Optimal cut-off¹ (kPa)	8.60	10.46	14.00
Sensitivity (%)	78.20	88.60	77.30
Specificity (%)	93.30	80.00	85.40
Negative likelihood ratio	11.73	4.43	5.30
Positive likelihood ratio	0.23	0.14	0.27

¹Cut-off value was calculated to maximize the sum of sensitivity and specificity. kPa: Kilopascals.

Table 3 Correlation between noninvasive serum markersand histologic fibrosis in chronic liver disease (n =70)

Fibrosis stage	r	P value
Age	0.344	0.004
Hemoglobin	-0.281	0.018
Platelet	-0.514	< 0.001
Albumin	-0.505	< 0.001
AST	0.215	0.074
ALT	-0.087	0.475
Total bilirubin	0.302	0.011
GGT	0.236	0.049
Prothrombin time (INR)	0.479	< 0.001
APRI	0.390	0.001
Hyaluronic acid¹	0.708	< 0.001
Type IV collagen¹	0.691	< 0.001
Liver stiffness by SWE	0.774	< 0.001

¹n = 61. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma glutamyltranspeptidase; INR: International normalized ratio; APRI: Aspartate aminotransferase to platelet ratio index; SWE: Shear wave elastography.

Table 4 Comparison of diagnostic performance between noninvasive serum marker for discriminating F0-1 vs F2-4 (significant fibrosis), F0-2 vs F3-4 (advanced fibrosis) and F0-3 vs F4 (cirrhosis) (n =61)

	AUROC	95%CI	Pairwise comparison of ROC curves
	AUROC	95%CI	Factor	Difference between areas (95%CI)	P value
Significant fibrosis
SWE	0.908	0.806-0.967	HA	0.097 (-0.012-0.205)	0.081
			Type IV	0.067 (-0.003-0.167)	0.189
			APRI	0.217 (0.074-0.359)	0.003
HA	0.812	0.691-0.900	Type IV	0.030 (-0.092-0.152)	0.634
			APRI	0.120 (-0.041-0.281)	0.145
Type IV	0.841	0.725-0.922	APRI	0.150 (-0.006-0.305)	0.059
APRI	0.691	0.560-0.803
Advanced fibrosis
SWE	0.893	0.787-0.957	HA	0.004 (-0.093-0.101)	0.939
			Type IV	0.017 (-0.080-0.113)	0.735
			APRI	0.150 (0.013-0.287)	0.032
HA	0.897	0.792-0.960	Type IV	0.020 (-0.074-0.115)	0.671
			APRI	0.154 (0.014-0.293)	0.031
Type IV	0.876	0.767-0.947	APRI	0.133 (-0.010-0.277)	0.069
APRI	0.743	0.615-0.846
Cirrhosis
SWE	0.877	0.768-0.947	HA	0.002 (-0.114-0.118)	0.974
			Type IV	0.027 (-0.084-0.138)	0.631
			APRI	0.194 (0.031-0.358)	0.002
HA	0.879	0.770-0.948	Type IV	0.029 (-0.072-0.130)	0.571
			APRI	0.196 (0.022-0.371)	0.027
Type IV	0.850	0.736-0.928	APRI	0.167 (-0.003-0.338)	0.055
APRI	0.683	0.551-0.796

ROC: Receiver-operating characteristic curves; AUROC: Area under the ROC curve; SWE: Shear wave elastography; HA: Hyaluronic acid; Type IV: Type IV collagen; APRI: Aspartate aminotransferase to platelet ratio index.

Table 5 Comparison of diagnostic performance between shear wave elastography and noninvasive serum markers for discriminating F0-1 vs F2-4 (significant fibrosis) and F0-2 vs F3-4 (advanced fibrosis) in patients with chronic viral hepatitis (n =36)

	AUROC	95%CI	Pairwise comparison of ROC curves
			Factor	Difference between areas (95%CI)	P value
Significant fibrosis
SWE	0.935	0.800-0.989	HA	0.277 (0.070-0.485)	0.009
			Type IV	0.158 (-0.009-0.325)	0.063
			APRI	0.077 (-0.066-0.220)	0.289
HA	0.658	0.482-0.807	Type IV	0.119 (-0.084-0.326)	0.257
			APRI	0.200 (-0.029-0.429)	0.086
Type IV	0.777	0.608-0.898	APRI	0.081 (-0.126-0.288)	0.445
APRI	0.858	0.701-0.951
Advanced fibrosis
SWE	0.914	0.771-0.980	HA	0.094 (-0.054-0.243)	0.214
			Type IV	0.120 (-0.030-0.271)	0.118
			APRI	0.086 (-0.061-0.234)	0.250
HA	0.819	0.656-0.927	Type IV	0.026 (-0.120-0.172)	0.725
			APRI	0.008 (-0.168-0.183)	0.931
Type IV	0.793	0.626-0.909	APRI	0.034 (-0.153-0.221)	0.722
APRI	0.827	0.665-0.932

Table 6 Comparison of diagnostic performance between shear wave elastography and noninvasive serum markers for discriminating F0-1 vs F2-4 (significant fibrosis) and F0-2 vs F3-4 (advanced fibrosis) with non-viral chronic liver diseases (n = 25)

	AUROC	95%CI	Pairwise comparison of ROC curves
			Factor	Difference between areas (95%CI)	P value
Significant fibrosis
SWE	0.979	0.826-0.988	HA	0.035 (-0.058-0.128)	0.465
			Type IV	0.035 (-0.051-0.121)	0.429
			APRI	0.389 (0.163-0.615)	0.001
HA	0.944	0.773-0.993	Type IV	0.000 (-0.103-0.103)	1.000
			APRI	0.354 (0.137-0.572)	0.001
Type IV	0.944	0.773-0.993	APRI	0.354 (0.130-0.578)	0.002
APRI	0.590	0.378-0.781
Advanced fibrosis
SWE	0.910	0.726-0.985	HA	0.077 (-0.042-0.196)	0.206
			Type IV	0.090 (-0.034-0.214)	0.156
			APRI	0.295 (0.060-0.530)	0.014
HA	0.987	0.839-1.000	Type IV	0.013 (-0.034-0.060)	0.593
			APRI	0.372 (0.155-0.589)	0.001
Type IV	1.000	0.862-1.000	APRI	0.385 (0.160-0.609)	0.001
APRI	0.615	0.401-0.801

Citation: Jeong JY, Kim TY, Sohn JH, Kim Y, Jeong WK, Oh YH, Yoo KS. Real time shear wave elastography in chronic liver diseases: Accuracy for predicting liver fibrosis, in comparison with serum markers. World J Gastroenterol 2014; 20(38): 13920-13929
URL: https://www.wjgnet.com/1007-9327/full/v20/i38/13920.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i38.13920