Abstract
Background
Evaluation of liver fibrosis is important to assess prognosis and guide the treatment for chronic hepatitis B.
Objective
To analyze and compare transient, point, and two-dimensional (2D) shear wave elastography techniques in grading the liver fibrosis.
Methods
Based on the severity of liver inflammation and fibrosis (Scheuer criteria), 158 patients with chronic hepatitis B were assigned into group 1 (either G or S classification < 2) or group 2 (either G or S classification ≥ 2). Group 2 patients commonly require anti-viral treatment. All patients received transient (FibroScan), point (STQ), and 2D (STE) elastography examinations. Receiver operating characteristic curves were calculated from three elastography techniques in individual or in combination.
Results
A total of 158 patients were enrolled into the study, with 39.2% (62) female and mean age of 42.8 (standard deviation 19.1) years old. Transient elastography could not differentiate between group 1 and group 2 patients (P = 0.12), whereas point and 2D elastography examinations could distinguish patients in group 1 from group 2 (P < 0.01 for both STQ and STE). Administration of combined three elastography techniques showed the best diagnostic accuracy (90.1%) for liver fibrosis, which was confirmed with hepatic biopsy examination.
Conclusion
Point and 2D elastography were superior to transient elastography to detect liver fibrosis and guide clinical anti-viral treatment. Analysis of combined transient, point, and 2D elastography techniques showed the better diagnostic accuracy for liver fibrosis.
Similar content being viewed by others
References
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ (2015) Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 386:1546–1555
Wright TL (2006) Introduction to chronic hepatitis B infection. Am J Gastroenterol 101(Suppl 1):S1–S6
Calvaruso V, Craxi A (2014) Regression of fibrosis after HBV antiviral therapy. Is cirrhosis reversible? Liver Int 34(Suppl 1):85–90
Friedman SL, Bansal MB (2006) Reversal of hepatic fibrosis—fact or fantasy? Hepatology 43:S82–S88
Pinzani M, Vizzutti F (2008) Fibrosis and cirrhosis reversibility: clinical features and implications. Clin Liver Dis 2:901–913
Sarin SK, Kumar M, Lau GK et al (2016) Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 10:1–98
Kose S, Ersan G, Tatar B, Adar P, Sengel BE (2015) Evaluation of percutaneous liver biopsy complications in patients with chronic viral hepatitis. Eurasian J Med 47:161–164
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
Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK (2017) Ultrasound elastography: review of techniques and clinical applications. Theranostics 7:1303–1329
Barr RG, Ferraioli G, Palmeri ML et al (2016) Elastography assessment of liver fibrosis: society of radiologists in ultrasound consensus conference statement. Ultrasound Q 32:94–107
Gerber L, Kasper D, Fitting D et al (2015) Assessment of liver fibrosis with 2-D shear wave elastography in comparison to transient elastography and acoustic radiation force impulse imaging in patients with chronic liver disease. Ultrasound Med Biol 41:2350–2359
Zeng J, Zheng J, Huang Z et al (2017) Comparison of 2-D shear wave elastography and transient elastography for assessing liver fibrosis in chronic hepatitis B. Ultrasound Med Biol 43:1563–1570
Poynard T, Pham T, Perazzo H et al (2016) Real-time shear wave versus transient elastography for predicting fibrosis: applicability, and impact of inflammation and steatosis. A non-invasive comparison. PLoS ONE 11:e0163276
Ferraioli G, Tinelli C, Lissandrin R et al (2014) Point shear wave elastography method for assessing liver stiffness. World J Gastroenterol 20:4787–4796
Paul SB, Das P, Mahanta M et al (2017) Assessment of liver fibrosis in chronic hepatitis: comparison of shear wave elastography and transient elastography. Abdom Radiol (NY) 42:2864–2873
Zhuang Y, Ding H, Zhang Y, Sun H, Xu C, Wang W (2017) 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 283:873–882
Scheuer PJ (1991) Classification of chronic viral hepatitis: a need for reassessment. J Hepatol 13:372–374
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
Bercoff J, Tanter M, Fink M (2004) Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control 51:396–409
Xiao G, Zhu S, Xiao X, Yan L, Yang J, Wu G (2017) Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis. Hepatology 66:1486–1501
Bhat M, Tazari M, Sebastiani G (2017) Performance of transient elastography and serum fibrosis biomarkers for non-invasive evaluation of recurrent fibrosis after liver transplantation: a meta-analysis. PLoS ONE 12:e0185192
Geng XX, Huang RG, Lin JM, Jiang N, Yang XX (2016) Transient elastography in clinical detection of liver cirrhosis: a systematic review and meta-analysis. Saudi J Gastroenterol 22:294–303
Venkatesh SK, Ehman RL (2014) Magnetic resonance elastography of liver. Magn Reson Imaging Clin N Am 22:433–446
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of Ruijin Hospital, Shanghai Jiaotong University School of Medicine.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Ren, X., Xia, S., Ni, Z. et al. Analysis of three ultrasound elastography techniques for grading liver fibrosis in patients with chronic hepatitis B. Radiol med 123, 735–741 (2018). https://doi.org/10.1007/s11547-018-0905-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-018-0905-4