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Assessment of liver fibrosis in chronic hepatitis: comparison of shear wave elastography and transient elastography

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Abstract

Purpose

To evaluate the diagnostic accuracy of shear wave elastography (SWE) and transient elastography (TE) in the evaluation of liver fibrosis in chronic hepatitis B (CHB) and C (CHC) patients taking liver biopsy as gold standard.

Methods

Ethics committee approved this prospective cross-sectional study. Between October 2012 and December 2014, consecutive CHB/CHC patients fulfilling the inclusion criteria were included—age more than 18 years, informed written consent, willing and suitable for liver biopsy. SWE, TE, and biopsy were performed the same day. Liver stiffness measurement (LSM) cut-offs for various stages of fibrosis were generated for SWE and TE. AUC, sensitivity, specificity, and positive/negative predictive values were estimated individually or in combination.

Results

CH patients (n = 240, CHB 172, CHC 68), 176 males, 64 females, mean age 32.6 ± 11.6 years were enrolled. Mean LSM of patients with no histological fibrosis (F0) was 5.0 ± 0.7 and 5.1+1.4 kPa on SWE and TE, respectively. For differentiating F2 and F3–4 fibrosis on SWE, at 7.0 kPa cut-off, the sensitivity was 81.3% and specificity 77.6%. For TE, at 8.3 kPa cut-off, sensitivity was 81.8% and specificity 83.1%. For F3 vs. F4, SWE sensitivity was 83.3% and specificity 90.7%. At 14.8 kPa cut-off, TE showed similar sensitivity (83.3%) but specificity increased to 96.5%. Significant correlation between SWE and TE was observed (r = 0.33, p < 0.001). On combining SWE and TE, a drop in sensitivity with increased specificity for all stages of liver fibrosis occured.

Conclusion

SWE is an accurate technique for evaluating liver fibrosis. SWE compares favorably with TE especially for predicting advanced fibrosis/cirrhosis. Combining SWE and TE further improves specificity.

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Acknowledgments

Authors want to acknowledge Mr. Sanjeev Negi and Mr. Dilshad Ali, the research staff, for handling the data.

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Authors and Affiliations

  1. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India

    Shashi B. Paul & Shivanand R. Gamanagatti

  2. Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Prasenjit Das, Maneesh Vijayvargiya, Shouriyo Ghosh & Siddhartha Dutta Gupta

  3. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Mousumi Mahanta, Saurabh Kedia, Nancy Kalra, Harpreet Kaur,  Shalimar & Subrat K. Acharya

  4. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Vishnubhatla Sreenivas

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  1. Shashi B. Paul
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Correspondence to Shashi B. Paul.

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Funding

No funding was received for this study.

Conflict of interest

The authors have no conflict of interest.

Ethical approval

The study was performed after approval from the Ethics committee of our institute and all procedures performed on human participants were in accordance with the ethical standards.

Informed consent

A written informed consent was obtained from all individual participants included in the study.

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Paul, S.B., Das, P., Mahanta, M. et al. Assessment of liver fibrosis in chronic hepatitis: comparison of shear wave elastography and transient elastography. Abdom Radiol 42, 2864–2873 (2017). https://doi.org/10.1007/s00261-017-1213-5

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  • DOI: https://doi.org/10.1007/s00261-017-1213-5

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