Liver fibrosis evaluation using real-time shear wave elastography: applicability and diagnostic performance using...

Area of Science:

• Hepatology
• Medical Imaging
• Diagnostic Biomarkers

Background:

• Real-time shear wave elastography (SWE) is an emerging 2D transient elastography technique.
• Limited data exists on SWE's reliability factors and comparisons with established fibrosis biomarkers.
• Validated biomarkers include FibroTest (FT) and transient elastography (TE) with M and XL probes.

Purpose of the Study:

• To evaluate the diagnostic applicability and performance of SWE for liver fibrosis.
• To compare SWE against FibroTest (FT) and transient elastography (TE-M, TE-XL) for fibrosis assessment.

Main Methods:

• Strength of concordance, discordance analysis, and latent class analysis (LCM) were employed due to the absence of a gold standard.
• 422 patients were included in the study.
• Applicability and diagnostic performance metrics were compared across SWE, FT, TE-M, and TE-XL.

Main Results:

• SWE applicability (90.0%) was lower than FT (97.9%) but comparable to TE-M (90.5%) and TE-XL (90.3%).
• SWE showed higher applicability (86%) than TE-M (55%) in patients with ascites.
• SWE performance (Obuchowski measure 0.807) was significant for all fibrosis stages but lower than TE-M (0.852) and TE-XL (0.834); it struggled to differentiate F0 from F1.
• For cirrhosis diagnosis via LCM, SWE specificity was 99%, with sensitivities ranging from 0.47 to 0.64.

Conclusions:

• SWE demonstrates diagnostic performance for cirrhosis comparable to FT and TE.
• SWE applicability is less than FT but superior to TE in patients with ascites.
• Further evaluation is needed for SWE's utility in non-cirrhotic stages.