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

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

Publication History

Received: 11 April 2020

Accepted: 18 January 2021

Article published online:
28 April 2021

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