Basic Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 8, 2017; 9(1): 38-47
Published online Jan 8, 2017. doi: 10.4254/wjh.v9.i1.38
Ultrasound shear wave elastography and liver fibrosis: A Prospective Multicenter Study
Joyce Anyona Sande, Suleman Verjee, Sudhir Vinayak, Farin Amersi, Munir Ghesani
Joyce Anyona Sande, Sudhir Vinayak, Department of Radiology, Aga Khan University Hospital, Nairobi 30270-00100, Kenya
Suleman Verjee, Department of Statistical, Versante International LLC, Oakland, CA 94606, United States
Farin Amersi, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Munir Ghesani, Department of Radiology, NYU Langone Medical Center, New York, NY 10016, United States
Author contributions: Sande JA performed the research; Sande JA and Verjee S designed the research and analyzed the data; Sande JA, Verjee S, Vinayak S, Amersi F and Ghesani M contributed equally to this work; Vinayak S contributed new reagents/analytic tools; all the authors wrote the paper.
Institutional review board statement: Aga Khan University Faculty of Health Sciences Research and Ethics Committee reviewed the proposal and related documentation submitted and approved the study based on core scientific and ethical standards which were fully instituted in the protocol.
Informed consent statement: Informed voluntary consent was acquired from all the study participants.
Conflict-of-interest statement: All authors declare no conflicting interests (including but not limited to commercial, personal, political, intellectual or religious interests).
Data sharing statement: Technical appendix, statistical code and data set available from the corresponding author at Presented data are anonymised and risk of identification is nil.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Joyce Anyona Sande, MBCHB, Department of Radiology, Aga Khan University Hospital, Stadium Road, Nairobi 30270-00100, Kenya.
Telephone: +254-20-87706015
Received: April 5, 2016
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.

Keywords: Shear wave elastography, Aminotransferase platelet ration, Liver fibrosis, Liver biopsy

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.