Abstract
BackgroundNon-invasive shear wave-based techniques have been developed for estimating liver fibrosis in patients with chronic liver diseases. Two-dimensional shear wave elastography provides in real-time, a tow dimensional quantitative map of tissue stiffness and enables measuring the stiffness by adjustment of a region of interest of tissue. The aim of this study was to highlight the role of tow dimensional shear wave elastography (2D-SWE) in detecting the degree of liver fibrosis in patients with chronic hepatitis C and B, in correlation with liver enzymes level and fibrotest.ResultsThis study included 50 patients with chronic hepatitis C and B whose ages were (range, 30-65 years; mean, 48 years). Shear wave elastography cutoff values were 1.35 m/s, 5.48 KPa for (F>0); 1.66 m/s, 8.29 kPa for (F>1); 1.77 m/s, 9.40 kPa for (F>2); and 1.99 m/s, 11.9 kPa for (F>3). An excellent agreement was found between shear wave elastography and Fibrotest in staging of liver fibrosis in 88% of patients (κw=0.943, 95% CI, 0.88 to 1.00) achieving a highly statistical significance (P<0.001). There was a significant moderate positive concordance between US scoring and staging by 2D-SWE and staging by Fibrotest (rs, 0.49; P<0.01) and (rs, 0.48; P<0.01) respectively. However, no significant concordances were noticed between staging by AST and ALT and 2D-SWE and staging by Fibrotest (P>0.05).Conclusions2D shear wave elastography showed better diagnostic performance than visual assessment by conventional US for detection of chronic liver diseases, as well as for evaluation of their severity and prognosis. Elastograhy—Fibrotest combination gives best diagnostic performance in detecting the degree of fibrosis non-invasively and can be used reliably as a first-line pre-therapeutic evaluation of fibrosis in HCV and HBV-infected patients.
Highlights
Non-invasive shear wave-based techniques have been developed for estimating liver fibrosis in patients with chronic liver diseases
Study population From 57 patients referred to elastography unit, 7 patients were excluded due to inadequate breath hold (n=4) and inaccurate elastography measures (n=3)
Conventional ultrasonography and shear wave elastography were performed to all patients after liver enzyme tests and Fibrotest
Summary
Non-invasive shear wave-based techniques have been developed for estimating liver fibrosis in patients with chronic liver diseases. The most widely used histological score for liver fibrosis is the METAVIR (Meta-analysis of Histological Data in Viral Hepatitis) score, which incorporates five stages of fibrosis: F0 (no fibrosis), F1 (portal fibrosis without septa: minimal fibrosis), F2 (portal fibrosis with a few septa: moderate fibrosis or clinically significant fibrosis), F3 (portal fibrosis with many septa but no cirrhosis: severe fibrosis), and F4 (cirrhosis) [5, 6] This procedure is invasive, painful, and may lead to hemorrhage (0.3%) or death (0.01%). Liver biopsy is an invasive and painful procedure, and it is not accurate enough due to sampling errors and intra- and inter-observer variability, it has up to a 20% error rate in disease staging may result in over or under estimation of fibrosis stage It is certainly not the suitable procedure for serially repeated assessment of disease progression [8,9,10]
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