Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3730-3742
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3730
Shear wave elastography may be sensitive and more precise than transient elastography in predicting significant fibrosis
Tian-Tian Yao, Jing Pan, Jian-Dan Qian, Hao Cheng, Yan Wang, Gui-Qiang Wang
Tian-Tian Yao, Jing Pan, Jian-Dan Qian, Hao Cheng, Yan Wang, Gui-Qiang Wang, Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
Gui-Qiang Wang, Peking University International Hospital, Beijing 102206, China
Gui-Qiang Wang, the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
Author contributions: Yao TT collected, analyzed and interpreted the data and contributed to writing the manuscript; Pan J collected and analyzed data; Qian JD and Cheng H contributed to the statistical analysis; Wang Y contributed to discussion and manuscript revision; Wang Y and Wang GQ designed, drafted and substantively revised the manuscript, and contributed to this work equally; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81870417; Sub-Subject of the Major Projects of National Science and Technology, No. 2018ZX10302206, No. 2017ZX10203202 and No. 2017ZX10302201.
Institutional review board statement: The study was approved by the Ethics Committee of Peking University First Hospital and conformed to the guidelines set forth by the 1964 Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Gui-Qiang Wang, MD, PhD, Doctor, Professor, Department of Infectious Diseases, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China. john131212@sina.com
Received: January 8, 2020
Peer-review started: January 8, 2020
First decision: February 26, 2020
Revised: March 27, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: September 6, 2020
Processing time: 239 Days and 16.8 Hours
Abstract
BACKGROUND

Noninvasive measurements including transient elastography (TE) and two-dimensional shear wave elastography (SWE) have been used clinically instead of liver biopsy for regular assessment of liver fibrosis in chronic hepatitis B (CHB) patients.

AIM

To investigate the diagnostic efficiency of SWE compared to TE by assessing independent influencing factors and performance for diagnosing significant fibrosis based on our cohort of treatment-naive CHB patients.

METHODS

Fifty-four treatment-naive CHB patients who underwent liver biopsy to determine whether to initiate antiviral therapy were enrolled. SWE, TE, serum tests and liver biopsy were performed for all participants. The fibrosis-4 and aspartate aminotransferase to platelet ratio index scores were also calculated. Potential independent influencing factors on SWE and TE values were analyzed. Based on liver pathology results, the agreement and correlation were determined, and a comparison of the two methods was performed.

RESULTS

There were 27 cases (50%) of mild fibrosis (F0-F2) and 27 (50%) cases of significant fibrosis (F3-F6); fibrosis was assessed with the Ishak scoring system. Multivariate linear regression analyses revealed that the fibrosis stage was the only factor that affected the SWE values (P < 0.001), whereas the total bilirubin level (P = 0.013) and fibrosis stage (P = 0.037) were independent factors that affected TE values. Orthogonal partial least squares discriminant analysis showed that the number of independent factors (VIP > 1) was higher for TE than SWE. Bland-Altman analysis showed satisfactory agreement between liver stiffness measurements (LSMs) of SWE and TE. Both SWE and TE could significantly discriminate significant fibrosis from mild fibrosis (P < 0.001). SWE exhibited a higher correlation with LSMs of liver fibrosis than TE (r = 0.65 and 0.50, P < 0.001). The diagnostic performance of SWE was better than that of TE for significant fibrosis (F > 2). The areas under the receiver operating characteristic curves of SWE and TE were 0.786 and 0.714, respectively. The optimal LSM cutoff values of SWE and TE were 9.05 kPa and 8.15 kPa, respectively.

CONCLUSION

Compared to the TE value, the SWE value was less affected by other factors. SWE may be more sensitive and precise than TE in predicting significant fibrosis (> F2) in CHB patients.

Keywords: Liver stiffness measurements; Liver fibrosis; Shear wave elastography; Transient elastography; Chronic hepatitis B; Diagnostic efficiency

Core tip: Our study revealed that shear wave elastography (SWE) was less affected by influencing factors than transient elastography (TE). SWE may be more sensitive and more precise than TE in discriminating significant fibrosis (> F2). This modality might help identify chronic hepatitis B patients who may benefit from treatment. SWE may have broader clinical application prospects in routine standard examinations in hepatitis B virus patients.