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Magnitude dependent discordance in liver stiffness measurements using elastography point quantification with transient elastography as the reference test

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To investigate diagnostic performance of point shear wave elastography by elastography point quantification (ElastPQ) for non-invasive assessment of liver fibrosis in patients with chronic liver diseases (CLD).

Methods

Liver stiffness measurement (LSM) by transient elastography (TE) and ElastPQ was performed in patients with CLD and healthy volunteers. The stage of liver fibrosis was defined by TE which served as the reference. We compared two methods by using correlation, area under the receiver operating characteristics curve (AUC) analysis, Bland and Altman plot and Passing-Bablok regression.

Results

A total of 185 subjects (20 healthy volunteers and 165 patients with CLD (128 non-alcoholic fatty liver disease), 83 (44.9%) females, median age 53 years, BMI 27.3 kg/m2) were evaluated. There were 24.3%, 13.5% and 11.4% patients in ≥ F2, ≥ F3 and F4 stage, respectively. The best performing cutoff LSM values by ElastPQ were 5.5 kPa for F ≥ 2 (AUC = 0.96), 8.1 kPa for F ≥ 3 (AUC = 0.98) and 9.9 kPa for F4 (AUC = 0.98). Mean (SD) difference between TE and ElastPQ measurements was 0.98 (3.27) kPa (95% CI 0.51–1.45, range 4.99–21.60 kPa). Two methods correlated significantly (r = 0.86; p < 0.001), yet Bland and Altman plot demonstrated difference between measurements, especially with TE values > 10 kPa. Passing and Bablok regression analysis yielded significant constant and proportional difference between ElastPQ and TE.

Conclusion

ElastPQ is reliable method for assessment of liver fibrosis but LSM values are not interchangeable with TE, especially above 10 kPa. Diagnostic performance of ElastPQ for sub-classification of patients with compensated advanced chronic liver disease should therefore be furtherly investigated.

Key Points

• ElastPQ appears to be reliable method for assessment of liver fibrosis, with data presented here mostly applicable to NAFLD.

• LSM values produced by TE and ElastPQ are NOT interchangeable—in values < 10 kPa, they are similar, but in values > 10 kPa, they appear to be increasingly and significantly different.

• Diagnostic performance of ElastPQ for sub-classification of patients with compensated advanced chronic liver disease should be furtherly investigated.

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Abbreviations

AUC:

Area under the receiver operating characteristics curve

CLD:

Chronic liver diseases

ElastPQ:

Elastography point quantification

IQR:

Interquartile range

LSM:

Liver stiffness measurement

NAFLD:

Non-alcoholic fatty liver disease

NPV:

Negative predictive value

PPV:

Positive predictive value

pSWE:

Point shear wave elastography

SD:

Standard deviation

TE:

Transient elastography

US:

Ultrasound

References

  1. Ferraioli G, Filice C, Castera L et al (2015) WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 3: liver. Ultrasound Med Biol 41:1161–1179

    Article  PubMed  Google Scholar 

  2. European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado (2015) EASL-ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 63:237–264

  3. Bedossa P, Dargère D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1457

    Article  PubMed  Google Scholar 

  4. Piccinino F, Sagnelli E, Pasquale G, Giusti G (1986) Complications following percutaneous liver biopsy: a multicentre retrospective study on 68 276 biopsies. J Hepatol 2:165–173

    Article  CAS  PubMed  Google Scholar 

  5. Sandrin L, Fourquet B, Hasquenoph JM et al (2003) Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 29:1705–1713

    Article  PubMed  Google Scholar 

  6. Bamber J, Cosgrove D, Dietrich C et al (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med 34:169–184

    Article  CAS  PubMed  Google Scholar 

  7. Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK (2011) Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J Hepatol 54:650–659

  8. Castera L (2015) Noninvasive assessment of liver fibrosis. Dig Dis 33:498–503

    Article  PubMed  Google Scholar 

  9. de Lédinghen V, Vergniol J, Barthe C et al (2013) Non-invasive tests for fibrosis and liver stiffness predict 5-year survival of patients chronically infected with hepatitis B virus. Aliment Pharmacol Ther 37:979–988

  10. Cosgrove D, Piscaglia F, Bamber J et al (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: clinical applications. Ultraschall Med 34:238–253

    Article  CAS  PubMed  Google Scholar 

  11. Şirli R, Sporea I, Deleanu A et al (2014) Comparison between the M and XL probes for liver fibrosis assessment by transient elastography. Med Ultrason 16:119–122

  12. Yoo H, Lee JM, Yoon JH, Lee DH, Chang W, Han JK (2016) Prospective comparison of liver stiffness measurements between two point shear wave elastography methods: virtual touch quantification and elastography point quantification. Korean J Radiol 17:750–757

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ferraioli G, Tinelli C, Lissandrin R et al (2014) Ultrasound point shear wave elastography assessment of liver and spleen stiffness: effect of training on repeatability of measurements. Eur Radiol 24:1283–1289

    Article  PubMed  Google Scholar 

  14. Sporea I, Bota S, Grădinaru-Taşcău O, Şirli R, Popescu A (2014) Comparative study between two point shear wave elastographic techniques: acoustic radiation force impulse (ARFI) elastography and ElastPQ. Med Ultrason 16:309–314

  15. Ferraioli G, Maiocchi L, Lissandrin R, Tinelli C, De Silvestri A, Filice C (2016) Accuracy of the ElastPQ® technique for the assessment of liver fibrosis in patients with chronic hepatitis C: a “real life” single center study. J Gastrointestin Liver Dis 25:331–335

    PubMed  Google Scholar 

  16. Fraquelli M, Baccarin A, Casazza G et al (2016) Liver stiffness measurement reliability and main determinants of point shear-wave elastography in patients with chronic liver disease. Aliment Pharmacol Ther 44:356–365

    Article  CAS  PubMed  Google Scholar 

  17. Mare R, Sporea I, Lupuşoru R et al (2017) The value of ElastPQ for the evaluation of liver stiffness in patients with B and C chronic hepatopathies. Ultrasonics 77:144–151

    Article  PubMed  Google Scholar 

  18. Lee JE, Shin KS, Cho JS et al (2017) Non-invasive assessment of liver fibrosis with ElastPQ: comparison with transient elastography and serologic fibrosis marker tests, and correlation with liver pathology results. Ultrasound Med Biol 43:2515–2521

    Article  PubMed  Google Scholar 

  19. Sterling RK, Lissen E, Clumeck N et al (2006) Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 43:1317–1325

    Article  CAS  PubMed  Google Scholar 

  20. Dietrich CF, Bamber J, Berzigotti A et al (2017) EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med 38:e16–e47

    PubMed  Google Scholar 

  21. Passing H, Bablok W (1983) A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry, part I. J Clin Chem Clin Biochem 21:709–720

    CAS  PubMed  Google Scholar 

  22. Piscaglia F, Salvatore V, Mulazzani L et al (2017) Differences in liver stiffness values obtained with new ultrasound elastography machines and Fibroscan: a comparative study. Dig Liver Dis 49:802–808

    Article  PubMed  Google Scholar 

  23. Kumagai E, Korenaga K, Korenaga M et al (2016) Appropriate use of virtual touch quantification and FibroScan M and XL probes according to the skin capsular distance. J Gastroenterol 51:496–505

    Article  PubMed  Google Scholar 

  24. Myers RP, Pomier-Layrargues G, Kirsch R et al (2012) Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology 55:199–208

    Article  PubMed  Google Scholar 

  25. Boursier J, Hiriart JB, Lannes A et al (2017) Liver stiffness measurement with Fibroscan: Use the right probe in the right condition. Hepatology 66(S1):346A

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Clinical Nutrition; Department of Medicine, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Avenija Gojka Suska 6, 10000, Zagreb, Croatia

    Ivica Grgurevic, Tonci Bozin, Sanda Mustapic, Vladimir Matic, Ida Tjesic Drinkovic & Tomislav Bokun

  2. Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

    Nermin Salkic

  3. Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia

    Ivo Dumic-Cule

Authors
  1. Ivica Grgurevic
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  2. Nermin Salkic
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  3. Tonci Bozin
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  4. Sanda Mustapic
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  5. Vladimir Matic
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  6. Ivo Dumic-Cule
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  7. Ida Tjesic Drinkovic
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  8. Tomislav Bokun
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Corresponding author

Correspondence to Ivica Grgurevic.

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Guarantor

The scientific guarantor of this publication is Ivica Grgurevic, Department of Gastroenterology, Hepatology and Clinical Nutrition; Department of Medicine, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Cross sectional study

• Performed at one institution

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Grgurevic, I., Salkic, N., Bozin, T. et al. Magnitude dependent discordance in liver stiffness measurements using elastography point quantification with transient elastography as the reference test. Eur Radiol 29, 2448–2456 (2019). https://doi.org/10.1007/s00330-018-5831-2

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  • DOI: https://doi.org/10.1007/s00330-018-5831-2

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