Download PDF
Ultraschall Med 2022; 43(02): e1-e10
DOI: 10.1055/a-1376-6734
Original Article

Usefulness of New Shear Wave Elastography Technique for Noninvasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B: A Prospective Multicenter Study

Der Nutzen der neuen Scherwellen-Elastografie für die nichtinvasive Beurteilung der Leberfibrose bei Patienten mit chronischer Hepatitis B: Eine prospektive multizentrische Studie
Jinfen Wang‡
1   Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
,
Manli Wu‡
1   Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
,
Runze Linghu‡
2   Ultrasound Department of Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
,
Jiandong Chang
3   Department of Ultrasound, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
,
Min Wu
4   Department of Ultrasound, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
,
Cheng Feng
5   Department of Ultrasound, National Clinical Research Center for Infectious Disease, Department of Ultrasound, Shenzhen Third People’s Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
,
Xinping Ren
6   Department of ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
,
Changzhu Liu
7   Department of Ultrasound, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
,
Jie Lin
8   Department of Ultrasound, Mianyang Center Hospital, Mianyang, China
,
Tao Song
9   Department of abdominal ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Jionghui Gu
10   Department of Ultrasound, First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, China
,
Yao Zhang
11   Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing, China
,
Ye Fang
12   Department of Ultrasound, Ningbo Yinzhou No 2 Hospital, Ningbo, China
,
Sumei Ma
13   Department of Ultrasound, The First Hospital of Lanzhou University, Lanzhou, China
,
Pingxiang Hu
14   Ultrasound Imaging Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
,
Linsong Wu
15   Department of Ultrasound, Fuyang People's Hospital, Fuyang, China
,
Xue Han
16   Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
,
Kaixuan Chen
17   Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
,
Qiusheng Shi
18   Department of Medical Ultrasonography, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Ruifang Zhang
19   Department of Ultrasound, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
,
Qi Zhou
20   Department of Ultrasound, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
,
Ruiqing Du
21   Ultrasonography, Shijiazhuang Fifth Hospital, Shijiazhuang, China
,
Yongyan Gao
22   Ultrasound Department, Third Medical Center of PLA General Hospital, Beijing, China
,
Xiang Jing
23   Department of Ultrasound, The Third Central Hospital of Tianjin, China
,
Shunshi Yang
24   Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Chang Zhou
25   Department of Ultrasound, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
,
Jian Zheng
26   Department of Medical Ultrasound, Third Hospital of Longgang, Shenzhen, China
,
Ping Liang
2   Ultrasound Department of Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
,
Rong-Qin Zheng
1   Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
› Author AffiliationsSupported by: National Natural Science Foundation of China No. 81827802
› Further Information
Also available at
    Permissions and Reprints

Abstract

Purpose To explore the usefulness of liver stiffness measurements (LSMs) by sound touch elastography (STE) and sound touch quantification (STQ) in chronic hepatitis B (CHB) patients for staging fibrosis.

Methods This prospective multicenter study recruited normal volunteers and CHB patients between May 2018 and October 2019. The volunteers underwent LSM by STE and supersonic shear imaging (SSI) or by STQ and acoustic radiation force impulse imaging (ARFI). CHB patients underwent liver biopsy and LSM by both STE/STQ. The areas under the receiver operating characteristic curves (AUCs) for staging fibrosis were calculated.

Results Overall, 97 volunteers and 524 CHB patients were finally eligible for the study. The successful STE and STQ measurement rates were both 100 % in volunteers and 99.4 % in CHB patients. The intraclass correlation coefficients (ICCs) for the intra-observer stability of STE and STQ (0.94; 0.90) were similar to those of SSI and ARFI (0.95; 0.87), respectively. STE and STQ showed better accuracy than the aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) (AUC: 0.87 vs 0.86 vs 0.73 vs 0.77) in staging cirrhosis. However, both STE and STQ were not superior to APRI and FIB-4 in staging significant fibrosis (AUC: 0.76 vs 0.73 vs 0.70 vs 0.71, all P-values > 0.05).

Conclusion STE and STQ are convenient techniques with a reliable LSM value. They have a similar diagnostic performance and are superior to serum biomarkers in staging cirrhosis in CHB patients.

Zusammenfassung

Ziel Untersuchung des Nutzens von Lebersteifigkeitsmessungen (LSMs) mittels Sound-Touch-Elastografie (STE) und Sound-Touch-Quantifizierung (STQ) für das Fibrosestaging von Patienten mit chronischer Hepatitis B (CHB).

Methoden In diese prospektive multizentrische Studie an 26 Zentren wurden normale Freiwillige und CHB-Patienten zwischen Mai 2018 und Oktober 2019 eingeschlossen. Die Normalprobanden unterzogen sich einer LSM mittels STE und Supersonic Shear Imaging (SSI) oder mittels STQ und Acoustic Radiation Force Impulse Imaging (ARFI). Bei den CHB-Patienten wurden eine Leberbiopsie und eine LSM sowohl mit STE als auch STQ durchgeführt. Die Flächen unter den Receiver Operating Characteristic Curves (AUCs) wurden für das Fibrosestaging berechnet.

Ergebnisse An dieser Studie nahmen 97 Freiwillige und 524 CHB-Patienten teil. Die Quoten der erfolgreichen STE- und STQ-Messungen betrugen jeweils 100 % bei den Normalprobanden und 99,4 % bei den CHB-Patienten. Die Intraklasse-Korrelationskoeffizienten (ICCs) für die Intraobserver-Stabilität von STE und STQ (0,94; 0,90) waren ähnlich denen von SSI und ARFI (0,95; 0,87). STE und STQ zeigten eine bessere Genauigkeit als der APRI-Test („aspartate aminotransferase to platelet ratio index“) und der Fibosis-4-Index (FIB-4) (AUC: 0,87 vs. 0,86 vs. 0,73 vs. 0,77) beim Staging der Zirrhose. Allerdings waren sowohl STE als auch STQ dem APRI-Test und dem FIB-4 beim Staging einer höhergradigen Fibrose nicht überlegen (AUC: 0,76 vs. 0,73 vs. 0,70 vs. 0,71; alle p-Werte > 0,05).

Schlussfolgerung STE und STQ sind praktische Techniken mit verlässlichem LSM-Wert; sie haben eine ähnliche diagnostische Leistung und sind den Serum-Biomarkern beim Staging der Zirrhose bei CHB-Patienten überlegen.

Key words

sound touch elastography - sound touch quantification - chronic hepatitis B - liver fibrosis

Supplement



Publication History

Received: 11 April 2020

Accepted: 18 January 2021

Article published online:
28 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Seto WK, Lo YR, Pawlotsky JM. et al Chronic hepatitis B virus infection. Lancet 2018; 392: 2313-2324
    CrossrefPubMedSearch in Google Scholar
  • 2 European Association for Study of Liver. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. Journal of hepatology 2015; 63: 237-264
    CrossrefPubMedSearch in Google Scholar
  • 3 Younossi ZM, Stepanova M, Rafiq N. et al Pathologic criteria for nonalcoholic steatohepatitis: interprotocol agreement and ability to predict liver-related mortality. Hepatology 2011; 53: 1874-1882
    CrossrefPubMedSearch in Google Scholar
  • 4 European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Journal of hepatology 2017; 67: 370-398
    CrossrefPubMedSearch in Google Scholar
  • 5 Ferraioli G, Wong VW, Castera L. et al Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol 2018; 44: 2419-2440
    CrossrefPubMedSearch in Google Scholar
  • 6 Shiina T, Nightingale KR, Palmeri ML. et al WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound in medicine & biology 2015; 41: 1126-1147
    CrossrefPubMedSearch in Google Scholar
  • 7 Dietrich CF, Bamber J, Berzigotti A. et al EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall in Med (Stuttgart, Germany: 1980) 2017; 38: e16-e47
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Zeng J, Liu GJ, Huang ZP. et al Diagnostic accuracy of two-dimensional shear wave elastography for the non-invasive staging of hepatic fibrosis in chronic hepatitis B: a cohort study with internal validation. European radiology 2014; 24: 2572-2581
    CrossrefPubMedSearch in Google Scholar
  • 9 Colombo S, Buonocore M, Del Poggio A. et al Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis. J Gastroenterol 2012; 47: 461-469
    CrossrefPubMedSearch in Google Scholar
  • 10 Silva Jr RG, Fakhouri R, Nascimento TV. et al Aspartate aminotransferase-to-platelet ratio index for fibrosis and cirrhosis prediction in chronic hepatitis C patients. Braz J Infect Dis 2008; 12: 15-19
    CrossrefPubMedSearch in Google Scholar
  • 11 Vallet-Pichard A, Mallet V, Nalpas B. et al FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology 2007; 46: 32-36
    CrossrefPubMedSearch in Google Scholar
  • 12 Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. Hepatology 1996; 24: 289-293
    CrossrefPubMedSearch in Google Scholar
  • 13 Poynard T, Halfon P, Castera L. et al Standardization of ROC curve areas for diagnostic evaluation of liver fibrosis markers based on prevalences of fibrosis stages. Clinical chemistry 2007; 53: 1615-1622
    CrossrefPubMedSearch in Google Scholar
  • 14 Ahn SJ, Lee JM, Chang W. et al Prospective Validation of Intra- and Interobserver Reproducibility of a New Point Shear Wave Elastographic Technique for Assessing Liver Stiffness in Patients with Chronic Liver Disease. Korean J Radiol 2017; 18: 926-935
    CrossrefPubMedSearch in Google Scholar
  • 15 Kishimoto R, Kikuchi K, Koyama A. et al Intra- and inter-operator reproducibility of US point shear-wave elastography in various organs: evaluation in phantoms and healthy volunteers. European radiology 2019; 29: 5999-6008
    CrossrefPubMedSearch in Google Scholar
  • 16 Zhuang Y, Ding H, Zhang Y. et al Two-dimensional Shear-Wave Elastography Performance in the Noninvasive Evaluation of Liver Fibrosis in Patients with Chronic Hepatitis B: Comparison with Serum Fibrosis Indexes. Radiology 2017; 283: 873-882
    CrossrefPubMedSearch in Google Scholar
  • 17 Gao Y, Zheng J, Liang P. et al Liver Fibrosis with Two-dimensional US Shear-Wave Elastography in Participants with Chronic Hepatitis B: A Prospective Multicenter Study. Radiology 2018; 289: 407-415
    CrossrefPubMedSearch in Google Scholar
  • 18 Zeng J, Huang Z, Jin J. et al Diagnostic Accuracy of 2-D Shear Wave Elastography for the Non-Invasive Staging of Liver Fibrosis in Patients with Elevated Alanine Aminotransferase Levels. Ultrasound Med Biol 2018; 44: 85-93
    CrossrefPubMedSearch in Google Scholar
  • 19 Chon YE, Choi EH, Song KJ. et al Performance of Transient Elastography for the Staging of Liver Fibrosis in Patients with Chronic Hepatitis B: A Meta-Analysis. Plos One 2012; 7 (09)
    CrossrefPubMedSearch in Google Scholar
  • 20 Sporea I, Bota S, Peck-Radosavljevic M. et al Acoustic Radiation Force Impulse elastography for fibrosis evaluation in patients with chronic hepatitis C: an international multicenter study. Eur J Radiol 2012; 81: 4112-4118
    CrossrefPubMedSearch in Google Scholar
  • 21 Bota S, Herkner H, Sporea I. et al Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver international : official journal of the International Association for the Study of the Liver 2013; 33: 1138-1147
    CrossrefPubMedSearch in Google Scholar
  • 22 Xu X, Su Y, Song R. et al Performance of transient elastography assessing fibrosis of single hepatitis B virus infection: a systematic review and meta-analysis of a diagnostic test. Hepatol Int 2015; 9: 558-566
    CrossrefPubMedSearch in Google Scholar