Understanding confounding factors allows for accurate interpretation of liver stiffness measurements by ElastQ, a novel 2D shear wave elastography technique

Abstract

Purpose

Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) or two-dimensional shear wave elastography (2D-SWE) is recommended to assess the risk of liver fibrosis and advanced chronic liver disease. Even though both techniques measure liver stiffness, their numerical results often diverge. Confounders and reliability criteria for 2D-SWE have not been systematically investigated.

Materials and Methods

We prospectively recruited participants with paired LSM by VCTE and the novel 2D-SWE technique ElastQ (Philips) in three European tertiary centers. The following parameters were recorded: sex, age, body mass index (BMI), etiology, laboratory markers of liver damage and function, as well as cholestasis, LSM by VCTE and controlled attenuation parameter (CAP), interquartile range (IQR)/median for VCTE-LSM and ElastQ-LSM, and the skin-to-liver capsule distance.

Results

We included 840 participants: 447 (53.2%) males; median age 57.0 [IQR:19.0] years; median BMI 25.4 [6.0] kg/m²; median VCTE-LSM 7.25 [9.2] kPa; median ElastQ-LSM 6.7 [5.4] kPa. On uni- and multivariable modeling (adjusted for LSM), we found that the discrepancy increased with liver stiffness and markers of disease severity. Skin-to-liver capsule distance and BMI affected VCTE-LSM more compared to ElastQ-LSM and significantly increased the discordance between the two measurements.

Conclusion

The discrepancy of ElastQ-LSM to VCTE-LSM increases with liver stiffness and disease severity. BMI and skin-to-liver capsule distance increase the discrepancy between VCTE- and ElastQ-LSM but affect ElastQ-LSM less. The quality criterion IQR/median ≤ 30% indicates reliable ElastQ-LSM.

Zusammenfassung

Hintergrund

Trotz gleicher Messgröße (Lebersteifigkeit) zeigen VCTE und die neue 2D-SWE-Technik ElastQ oft divergente Ergebnisse. Die verzerrenden Faktoren und Zuverlässigkeitskriterien für 2D-SWE wurden bislang nicht systematisch untersucht.

Materialen und Methoden

Wir rekrutierten prospektiv Teilnehmer mit gepaarten LSM-Messungen mittels VCTE und der neuen 2D-SWE-Technik ElastQ (Philips) in 3 europäischen Tertiärzentren. Die folgenden Parameter wurden erfasst: Geschlecht, Alter, Body-Mass-Index (BMI), Ätiologie, Labormarker für Leberschäden und -funktion sowie Cholestase, LSM durch VCTE und der kontrollierte Dämpfungsparameter (CAP), Interquartilsabstand (IQR)/Median für VCTE-LSM und ElastQ-LSM, sowie der Abstand von der Haut zur Leberkapsel.

Ergebnisse

Wir schlossen 840 Teilnehmer ein: 447 (53,2%) Männer; mittleres Alter 57,0 [IQR: 19,0] Jahre; mittlerer BMI 25,4 [1] 99] kg/m²; mittlere VCTE-LSM 7,25 [9,2] kPa; mittlere ElastQ-LSM 6,7 [5,4] kPa. In univariater und multivariater Modellierung (angepasst an LSM) stellten wir fest, dass die Diskrepanz mit der Lebersteifigkeit und den Markern für die Schwere der Erkrankung zunimmt. Der Abstand von der Haut zur Leberkapsel und der BMI beeinflussten VCTE-LSM stärker als ElastQ-LSM und erhöhten die Diskrepanz zwischen den beiden Messungen signifikant.

Schlussfolgerung

Die Diskrepanz von ElastQ-LSM zu VCTE-LSM nimmt mit der Lebersteifigkeit und der Schwere der Erkrankung zu. BMI und der Abstand von der Haut zur Leberkapsel erhöhen die Diskrepanz zwischen VCTE- und ElastQ-LSM, beeinflussen jedoch ElastQ-LSM weniger. Das Qualitätskriterium IQR/Median ≤30% zeigt eine zuverlässige ElastQ-LSM an.

Keywords

2D-SWE - ElastQ - liver stiffness measurement - liver elastography - two-dimensional shear wave elastography

Publication History

Received: 18 July 2023

Accepted after revision: 14 May 2024

Article published online:
08 August 2024

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