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 (original) (raw)

Abstract

Objectives

To determine the accuracy of two-dimensional shear wave elastography (2D-SWE) for noninvasive staging of hepatic fibrosis in chronic hepatitis B (CHB).

Methods

Patients with CHB infection who underwent liver biopsy were consecutively included. Receiver-operating characteristic (ROC) curves were constructed to assess the overall accuracy and identify optimal cutoff values.

Results

Three hundred three patients were analysed. The diagnostic performance characteristics were determined for the first 202 patients (the index cohort) and were validated on the next 101 patients (validation cohort). The areas under the ROC curves for significant fibrosis, severe fibrosis and cirrhosis were all greater than 0.90 and did not differ significantly between the index and validation cohorts. Using the cutoff values generated from the index cohort, the validation cohort 2D-SWE had negative predictive values of 82.6 % (95 % confidence interval [CI]: 68.4 % − 92.3 %) for significant fibrosis, 95.1 % (95 % CI: 86.3 % − 99.0 %) for severe fibrosis and 97.4 % (95 % CI: 90.8 % − 99.7 %) for cirrhosis. The positive predictive values were 83.6 % (95 % CI: 71.2 % − 92.2 %), 65.0 % (95 % CI: 48.1 − 79.5 %) and 60.0 % (95 % CI: 38.7 % − 78.9 %), respectively.

Conclusion

The 2D-SWE showed good diagnostic accuracy in staging liver fibrosis in patients with CHB infection and assisted in excluding liver fibrosis and cirrhosis.

Key Points

• Two-dimensional shear wave elastography showed good diagnostic accuracy in assessing liver fibrosis.

• Diagnostic performance did not differ significantly between the index and validation cohorts.

• Two-dimensional shear wave elastography assisted in excluding liver fibrosis and cirrhosis.

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Abbreviations

CHB:

Chronic hepatitis B

LB:

Liver biopsy

TE:

Transient elastography

pSWE:

Point shear-wave elastography

2D-SWE:

Two-dimensional shear wave elastography

US:

Ultrasound

HBV:

Hepatitis B virus

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

ALP:

Alkaline phosphatase

GGT:

Gamma-glutamyl transpeptidase

BMI:

Body mass index

ROI:

Region of interest

SD:

Standard deviation

LSM:

Liver stiffness measurement

SR:

Success rate

IQR:

Interquartile range

ROC:

Receiver-operating characteristic

AUROC:

Area under the ROC curve

PPV:

Positive predictive value

NPV:

Negative predictive value

LR+:

Positive likelihood ratio

LR-:

Negative likelihood ratio

CI:

Confidence interval

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Acknowledgments

The scientific guarantors of this publication are Rong-Qin Zheng and Ming-De Lu. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
    Jie Zeng, Ze-Ping Huang, Jian Zheng, Tao Wu & Rong-Qin Zheng
  2. Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
    Guang-Jian Liu
  3. Departments of Hepatobiliary Surgery and Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
    Ming-De Lu

Authors

  1. Jie Zeng
  2. Guang-Jian Liu
  3. Ze-Ping Huang
  4. Jian Zheng
  5. Tao Wu
  6. Rong-Qin Zheng
  7. Ming-De Lu

Corresponding authors

Correspondence toRong-Qin Zheng or Ming-De Lu.

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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.Eur Radiol 24, 2572–2581 (2014). https://doi.org/10.1007/s00330-014-3292-9

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