Abstract
ObjectivesTo compare the diagnostic accuracy of US shear wave elastography (SWE) and magnetic resonance elastography (MRE) for classifying fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD).MethodsPatients from a prospective single-center cohort with clinical liver biopsy for known or suspected NAFLD underwent contemporaneous SWE and MRE. AUCs for classifying biopsy-determined liver fibrosis stages ≥ 1, ≥ 2, ≥ 3, and = 4, and their respective performance parameters at cutoffs providing ≥ 90% sensitivity or specificity were compared between SWE and MRE.ResultsIn total, 100 patients (mean age, 51.8 ± 12.9 years; 46% males; mean BMI 31.6 ± 4.7 kg/m2) with fibrosis stage distribution (stage 0/1/2/3/4) of 43, 36, 5, 10, and 6%, respectively, were included. AUCs (and 95% CIs) for SWE and MRE were 0.65 (0.54–0.76) and 0.81 (0.72–0.89), 0.81 (0.71–0.91) and 0.94 (0.89–1.00), 0.85 (0.74–0.96) and 0.95 (0.89–1.00), and 0.91 (0.79–1.00) and 0.92 (0.83–1.00), for detecting fibrosis stage ≥ 1, ≥ 2, ≥ 3, and = 4, respectively. The differences were significant for detecting fibrosis stage ≥ 1 and ≥ 2 (p < 0.01) but not otherwise. At ≥ 90% sensitivity cutoff, MRE yielded higher specificity than SWE at diagnosing fibrosis stage ≥ 1, ≥ 2, and ≥ 3. At ≥ 90% specificity cutoff, MRE yielded higher sensitivity than SWE at diagnosing fibrosis stage ≥ 1 and ≥ 2.ConclusionsIn adults with NAFLD, MRE was more accurate than SWE in diagnosing stage ≥ 1 and ≥ 2 fibrosis, but not stage ≥ 3 or 4 fibrosis.Key Points• For detecting any fibrosis or mild fibrosis, MR elastography was significantly more accurate than shear wave elastography.• For detecting advanced fibrosis and cirrhosis, MRE and SWE did not differ significantly in accuracy.• For excluding advanced fibrosis and potentially ruling out the need for biopsy, SWE and MRE did not differ significantly in negative predictive value.• Neither SWE nor MRE had sufficiently high positive predictive value to rule in advanced fibrosis.
Highlights
With an estimated global prevalence of 25%, nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide [1]
Neither shear wave elastography (SWE) nor magnetic resonance elastography (MRE) had sufficiently high positive predictive value to rule in advanced fibrosis
Confoundercorrected chemical-shift-encoded (CSE)-MRI was performed as part of the MRE exam in order to estimate proton-density fat fraction (PDFF), which was used to stratify the cohort in the exploratory analyses
Summary
With an estimated global prevalence of 25%, nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide [1]. NAFLD comprises both nonalcoholic fatty liver and nonalcoholic steatohepatitis (NASH), the latter of which is characterized by hepatocellular injury, inflammation, and higher potential for developing fibrosis. The severity of liver fibrosis in NASH strongly predicts long-term outcomes including liver transplantation and overall mortality [2]. Liver fibrosis may progress to cirrhosis, conferring increased risk of hepatocellular carcinoma and liver-related mortality. Therapeutic intervention in patients with NASH-related fibrosis may stabilize or even reverse fibrosis [3, 4]. Accurate diagnosis and staging of liver fibrosis enable risk stratification, monitoring for progression, and targeting interventions in these patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
