Published online Jan 8, 2017. doi: 10.4254/wjh.v9.i1.38
Peer-review started: April 6, 2016
First decision: May 17, 2016
Revised: June 24, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: January 8, 2017
To assess the accuracy of shear wave elastography (SWE) alone and in combination with aminotransferase platelet ratio index (APRI) score in the staging of liver fibrosis.
A multicenter prospective study was conducted to assess the accuracy of SWE (medians) and APRI to predict biopsy results. The analysis focused on distinguishing the different stages of liver disease, namely, F0 from F1-4, F0-1 from F2-4, F0-2 from F3-4 and F0-3 from F4; F0-F1 from F2-F4 being of primary interest. The area under the receiver operating characteristic (AUROC) curve was computed using logistic regression model. The role of age, gender and steatosis was also assessed.
SWE alone accurately distinguished F0-1 from F2-4 with a high probability. The AUROC using SWE alone was 0.91 compared to 0.78 for using the APRI score alone. The APRI score, when used in conjunction with SWE, did not make a significant contribution to the AUROC. SWE and steatosis were the only significant predictors that differentiated F0-1 from F2-4 with an AUROC of 0.944.
Our study validates the use of SWE in the diagnosis and staging of liver fibrosis. Furthermore, the probability of a correct diagnosis is significantly enhanced with the addition of steatosis as a prognostic factor.
Core tip: The gold standard in the diagnosis and staging of liver fibrosis is an invasive liver biopsy. The accuracy of non-invasive tools such as ultrasound shear wave elastography either alone or in combination with the use of the aspartate transaminase platelet ratio index score compared to histology to guide management of liver fibrosis is not known. We addressed this question in a multicenter trial in patients with chronic progressive liver disease in a low to middle income country.