Point shear wave elastography method for assessing liver stiffness

doi:10.3748/wjg.v20.i16.4787

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Apr 28, 2014; 20(16): 4787-4796
Published online Apr 28, 2014. doi: 10.3748/wjg.v20.i16.4787

Table 1 Main clinical and demographic characteristics of patients with chronic viral hepatitis n (%)

Characteristics	All patients(n = 134)	Patients with chronic hepatitis C (n = 102)
Sex, females	29 (23.4)	20 (21.3)
Age, yr (SD)	43.70 (11.4)	45.2 (11.0)
BMI, kg/m² (SD)	25.1 (4.5)	25.2 (4.9)
AST, IU/L (IQR)	46 (26-78)	46 (30-83)
ALT, IU/L (IQR)	69 (41-122)	70 (43-127)
Alkaline phosphatase, IU/L (IQR)	69 (59-87)	70 (59-95)
GGT, IU/L (IQR)	49 (26-80)	50 (36-88)
Total bilirubin, M/L (IQR)	0.62 (0.46-0.94)	0.60 (0.44-0.89)
Platelet count, 10³/mm³ (SD)	227.8 (76.0)	227.7 (70.1)
Prothrombin time, % (SD)	94.0 (15.5)	94.4 (17.0)
HCV infection	102 (76.1)	-
HBV infection	28 (20.9)	-
Other¹	4 (3.0)	-
Fibrosis score (METAVIR)²
F0	14 (10.5)	6 (5.9)
F1	56 (42.1)	44 (43.6)
F2	29 (21.8)	24 (23.8)
F3	20 (15.0)	17 (16.8)
F4	14 (10.5)	10 (9.9)
Activity grade (METAVIR)
A0	12 (9.0)	5 (4.9)
A1	77 (58.0)	57 (56.4)
A2	28 (21.0)	27 (26.7)
A3	16 (12.0)	12 (11.9)
Steatosis grade
S0	83 (62.4)	62 (61.3)
S1	30 (22.6)	23 (22.8)
S2	16 (12.0)	12 (11.9)
S3	4 (3.0)	4 (4.0)
LSM, kPa (IQR)	6.6 (5.0-8.9)	6.5 (5.0-8.9)
PSWE, kPa (IQR)	5.3 (3.9-6.6)	5.2 (3.9-6.6)

¹HCV/HBV coinfection: n = 2; HCV/HIV coinfection: n = 2;

²Data for one patient missing due to inadequate biopsy specimen length. SD values represent means, and IQR values represent medians. BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; LSM: Liver stiffness measurement; PSWE: Point shear wave elastography.

Table 2 Performance of point shear wave elastography (n = 98) and transient elastography (n = 101) in patients with chronic hepatitis C

Parameter	Method	F≥2	F≥3	F= 4
Cut-off in kPa	PSWE	5.7	5.8	7.2
Cut-off in kPa	TE	6.9	7.3	9.3
AUC	PSWE	0.80 (0.71-0.87)	0.88 (0.80-0.94)	0.95 (0.89-0.99)
AUC	TE	0.82 (0.73-0.89)	0.95 (0.88-0.98)	0.92 (0.85-0.97)
Sensitivity %	PSWE	62.0 (47.2-75.3)	85.2 (66.3-95.8)	90.0 (55.5-99.7)
Sensitivity %	TE	62.7 (48.1-75.9)	89.9 (70.8-97.6)	90.0 (55.5-99.7)
Specificity %	PSWE	91.7 (80.0-97.7)	84.5 (74.0-92.0)	88.6 (80.1-94.4)
Specificity %	TE	83.7 (70.3-92.7)	80.8 (69.9-89.1)	87.8 (79.2-93.7)
PPV %	PSWE	88.6 (73.3-96.8)	67.6 (49.5-82.6)	47.4 (24.4-71.1)
PPV %	TE	80.0 (64.1-91.1)	63.2 (45.7-78.4)	45.0 (23.1-78.5)
NPV %	PSWE	69.8 (57.0-80.8)	93.7 (84.7-98.3)	98.7 (93.1-100)
NPV %	TE	68.3 (55.0-79.7)	95.2 (86.5-99.0)	98.7 (93.2-100)
+LR	PSWE	7.4 (2.8-19.5)	5.5 (3.1-9.7)	7.9 (4.3-14.7)
+LR	TE	3.8 (2.0-7.5)	4.6 (2.8-7.6)	7.4 (4.1-13.3)
-LR	PSWE	0.4 (0.3-0.6)	0.2 (0.07-0.4)	0.1 (0.02-0.7)
-LR	TE	0.4 (0.3-0.6)	0.1 (0.05-0.4)	0.1 (0.02-0.7)

In parentheses: 95%CI. PSWE: Point shear wave elastography; TE: Transient elastography; kPa: Kilopascals; AUC: Area under the curve; PPV: Positive predictive value; NPV: Negative predictive value; +LR: Positive likelihood ratio; -LR: Negative likelihood ratio.

Table 3 Characteristics of the subjects assessed to determine the reproducibility of point shear wave elastography measurements

Characteristic	Total	Group 1	Group 2
Characteristic	n = 116	n = 47	n = 69
Sex, females (%)	44 (37.9)	10 (21.3)^b	34 (49.3)
Age, yr (SD)	41.9 (13.5)	44.1 (12.5)^a	38.9 (13.8)
BMI, kg/m² (SD)	23.2 (4.1)	23.7 (2.7)	23.0 (4.9)
PSWE measurement, rater 1 (IQR)	3.95 (3.3-5.2)	5.34 (4.1-7.3)^b	3.53 (3.2-4.1)
PSWE measurement, rater 2 (IQR)	3.92 (3.3-5.2)	5.34 (4.1-7.1)^b	3.52 (3.1-4.0)

SD values represent means, and IQR values represent medians.

^aP < 0.05;

^bP < 0.01. PSWE: point shear wave elastography; BMI: body mass index. Group 1: Patients with chronic viral hepatitis; Group 2: Healthy volunteers.

Table 4 Intraobserver and interobserver agreement of point shear wave elastography measurements performed by two raters

Measurements	Rater 1	Rater 2	Rater 1 vs Rater 2
Measurements	CCC (95%CI)	CCC (95%CI)	CCC (95%CI)
1, 2, 3, 4, 5 vs 6, 7, 8, 9, 10	0.96 (0.95-0.97)	0.96 (0.95-0.97)	-
1, 3, 5, 7, 9 vs 2, 4, 6, 8, 10	0.95 (0.93-0.96)	0.96 (0.94-0.97)	-
1, 2, 3, 4, 5	-	-	0.91 (0.88-0.94)
6, 7, 8, 9, 10	-	-	0.93 (0.91-0.95)
1, 3, 5, 7, 9	-	-	0.93 (0.91-0.95)
2, 4, 6, 8, 10	-	-	0.92 (0.90-0.94)
All	-	-	0.93 (0.90-0.95)
1 vs 5	0.93 (0.91-0.95)	0.85 (0.80-0.90)	-
5 vs 10	0.83 (0.79-0.88)	0.88 (0.84-0.92)	-
2 vs 5	0.87 (0.84-0.91)	0.84 (0.79-0.89)	-
3 vs 8	0.93 (0.91-0.95)	0.84 (0.79-0.88)	-
1	-	-	0.89 (0.85-0.93)
2	-	-	0.83 (0.78-0.88)
5	-	-	0.85 (0.80-0.90)
8	-	-	0.84 (0.79-0.90)

CCC: Concordance correlation coefficient; CI: Confidence interval.

Citation: Ferraioli G, Tinelli C, Lissandrin R, Zicchetti M, Bello BD, Filice G, Filice C. Point shear wave elastography method for assessing liver stiffness. World J Gastroenterol 2014; 20(16): 4787-4796
URL: https://www.wjgnet.com/1007-9327/full/v20/i16/4787.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i16.4787