Liver Elastography in Primary Sclerosing Cholangitis Patients Using Three Different Scanner Systems

Anders Batman Mjelle,Guri Fossdal,Odd Helge Gilja,Mette Vesterhus

doi:10.1016/j.ultrasmedbio.2020.03.025

Abstract

The aim of the study described here was to characterize three different liver elastography methods in primary sclerosing cholangitis (PSC) patients, for the first time exploring 2-D shear wave elastography (2-D-SWE) in PSC patients and its putative advantages over point shear wave elastography (pSWE). Sixty-six adult PSC patients (51 males, 77%) underwent liver elastography: Transient elastography (TE), pSWE and 2-D-SWE were applied head-to-head after B-mode ultrasonography and blood tests. Liver stiffness measurements (LSMs) by pSWE yielded lower values than those by TE; 2-D-SWE had less steep slope but was overall not significantly different from TE. Correlation between LSMs by pSWE and TE was excellent (intraclass correlation coefficient = 0.92); correlation for 2-D-SWE with either pSWE or TE was moderate but improved with exclusion of overweight individuals. LSMs correlated with the Enhanced Liver Fibrosis test (ELF) across all scanner systems. Our study indicates that LSM by different systems is feasible in PSC patients and that 2-D-SWE tends to underestimate stiffness compared with TE.

Highlights

Primary sclerosing cholangitis (PSC) is a progressive fibroinflammatory disease affecting primarily the bile ducts, causing strictures and dilations and progressing over time through increasing stages of liver fibrosis and eventually cirrhosis
Intersystem differences are known (Mjelle et al 2016; Dietrich et al 2017; Mulabecirovic et al 2018a, 2018b) and may result from the different system technologies, but it is unknown how these are affected by the patchy fibrosis distribution in complex cholestatic diseases such as PSC, which is histologically different from viral hepatitis and metabolic liver diseases
We found good feasibility and moderate to excellent correlations for 2-D shear wave elastography (2-D-SWE).GE, point shear wave elastography (pSWE) and Transient elastography (TE), respectively

Summary

Introduction

Primary sclerosing cholangitis (PSC) is a progressive fibroinflammatory disease affecting primarily the bile ducts, causing strictures and dilations and progressing over time through increasing stages of liver fibrosis and eventually cirrhosis. The natural history of PSC is notoriously unpredictable, with population-based studies reporting substantial variation in disease progression (Broome et al 1996; Boonstra et al 2013). Histologic disease stage is associated with prognosis in PSC but requires invasive biopsies and is flawed by sampling error and inter-observer variation. Liver elastography has gained a significant role as a method for non-invasive evaluation of liver fibrosis in chronic liver diseases, enabling quantification of liver stiffness as a proxy for fibrosis with a high diagnostic accuracy. Liver elastography encompasses several technically different methods all based on the measurement of shear wave velocity, such as TE, point shear wave elastography (pSWE) and 2-D shear wave elastography (2-D-SWE). PSWE and 2-D-SWE allow simultaneous B-mode visualization of the liver, which may be.

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