Real time shear wave elastography in chronic liver diseases: Accuracy for predicting liver fibrosis, in comparison with serum markers

doi:10.3748/wjg.v20.i38.13920

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 20, Issue 38

This Article

Academic Content and Language Evaluation of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (6442)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-5) series, Tables (1-6) series.

Item

Count

PDF

429

WORD

251

HTML

3450

Figures (1-5)

166

Tables (1-6)

128

Sum=4424

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

1110

Download

908

Sum=2018

Oct 14, 2014 (publication date) through Apr 19, 2024

Times Cited of This Article

Times Cited (35)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

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

Original Article

World J Gastroenterol. Oct 14, 2014; 20(38): 13920-13929
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13920

Table 1 Baseline characteristics of patients

Characteristics	n = 70
Age, yr (SD, range)	45.9	(15.7, 12.0-82.0)
Sex, male (%)	45	(64.3)
HBV/HCV/Alcohol/NAFLD/Other (%)	23 (32.9)/18 (25.7)/12 (17.1)/4 (5.7)/13 (18.6)
Body mass index, kg/m²(SD, range)	23.8	(2.9, 16.9-29.7)
Hemoglobin, g/dL (SD, range)	12.9	(2.2, 6.7-17.8)
Platelet count, 10³/mm³ (SD, range)	174.7	(55.3, 76.0-285.0)
Albumin, g/dL (SD, range)	3.9	(0.7, 1.6-5.3)
AST, U/L (IQR, range)	55	(31-111, 13-369)
ALT, U/L (IQR, range)	47	(24-99, 6-473)
Total bilirubin, mg/dL (IQR, range)	0.7	(0.5-1.1, 0.2-4.9)
GGT, U/L (IQR, range)	57	(31-157, 13-1569)
Prothrombin time, INR (IQR, range)	0.93	(0.87-1.00, 0.76-1.48)
APRI (IQR, range)	0.91	(0.51-1.35, 0.55-5.88)
Hyaluronic acid¹, ng/mL (IQR, range)	62	(23-176, 10-2796)
Type IV collagen¹, ng/mL (IQR, range)	182	(117-310, 66-2790)
Liver stiffness by SWE, kPa (IQR, range)	11.1	(7.3-18.4, 4.73-48.61)
Fibrosis stage (%)
F0-1	15	(21.4)
F2	20	(28.6)
F3	13	(18.6)
F4	22	(31.4)

¹n = 61. HBV: Hepatitis B virus; HCV: Hepatitis C virus; NAFLD: Nonalcoholic fatty liver disease; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma glutamyltranspeptidase; INR: International normalized ratio; SWE: Shear wave elastography; kPa: Kilopascals; SD:Standard deviation; IQR: Interquartile range.

Table 2 Liver stiffness cut-off values for the diagnosis of significant (≥ F2) and advanced (≥ F3) fibrosis and cirrhosis (F4) (n = 70)

Value	≥F2	≥F3	= F4
Number of patients, n (%)	55 (78.6)	35 (50.0)	22 (31.4)
Optimal cut-off¹ (kPa)	8.60	10.46	14.00
Sensitivity (%)	78.20	88.60	77.30
Specificity (%)	93.30	80.00	85.40
Negative likelihood ratio	11.73	4.43	5.30
Positive likelihood ratio	0.23	0.14	0.27

¹Cut-off value was calculated to maximize the sum of sensitivity and specificity. kPa: Kilopascals.

Table 3 Correlation between noninvasive serum markersand histologic fibrosis in chronic liver disease (n =70)

Fibrosis stage	r	P value
Age	0.344	0.004
Hemoglobin	-0.281	0.018
Platelet	-0.514	< 0.001
Albumin	-0.505	< 0.001
AST	0.215	0.074
ALT	-0.087	0.475
Total bilirubin	0.302	0.011
GGT	0.236	0.049
Prothrombin time (INR)	0.479	< 0.001
APRI	0.390	0.001
Hyaluronic acid¹	0.708	< 0.001
Type IV collagen¹	0.691	< 0.001
Liver stiffness by SWE	0.774	< 0.001

¹n = 61. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma glutamyltranspeptidase; INR: International normalized ratio; APRI: Aspartate aminotransferase to platelet ratio index; SWE: Shear wave elastography.

Table 4 Comparison of diagnostic performance between noninvasive serum marker for discriminating F0-1 vs F2-4 (significant fibrosis), F0-2 vs F3-4 (advanced fibrosis) and F0-3 vs F4 (cirrhosis) (n =61)

	AUROC	95%CI	Pairwise comparison of ROC curves
	AUROC	95%CI	Factor	Difference between areas (95%CI)	P value
Significant fibrosis
SWE	0.908	0.806-0.967	HA	0.097 (-0.012-0.205)	0.081
			Type IV	0.067 (-0.003-0.167)	0.189
			APRI	0.217 (0.074-0.359)	0.003
HA	0.812	0.691-0.900	Type IV	0.030 (-0.092-0.152)	0.634
			APRI	0.120 (-0.041-0.281)	0.145
Type IV	0.841	0.725-0.922	APRI	0.150 (-0.006-0.305)	0.059
APRI	0.691	0.560-0.803
Advanced fibrosis
SWE	0.893	0.787-0.957	HA	0.004 (-0.093-0.101)	0.939
			Type IV	0.017 (-0.080-0.113)	0.735
			APRI	0.150 (0.013-0.287)	0.032
HA	0.897	0.792-0.960	Type IV	0.020 (-0.074-0.115)	0.671
			APRI	0.154 (0.014-0.293)	0.031
Type IV	0.876	0.767-0.947	APRI	0.133 (-0.010-0.277)	0.069
APRI	0.743	0.615-0.846
Cirrhosis
SWE	0.877	0.768-0.947	HA	0.002 (-0.114-0.118)	0.974
			Type IV	0.027 (-0.084-0.138)	0.631
			APRI	0.194 (0.031-0.358)	0.002
HA	0.879	0.770-0.948	Type IV	0.029 (-0.072-0.130)	0.571
			APRI	0.196 (0.022-0.371)	0.027
Type IV	0.850	0.736-0.928	APRI	0.167 (-0.003-0.338)	0.055
APRI	0.683	0.551-0.796

ROC: Receiver-operating characteristic curves; AUROC: Area under the ROC curve; SWE: Shear wave elastography; HA: Hyaluronic acid; Type IV: Type IV collagen; APRI: Aspartate aminotransferase to platelet ratio index.

Table 5 Comparison of diagnostic performance between shear wave elastography and noninvasive serum markers for discriminating F0-1 vs F2-4 (significant fibrosis) and F0-2 vs F3-4 (advanced fibrosis) in patients with chronic viral hepatitis (n =36)

	AUROC	95%CI	Pairwise comparison of ROC curves
			Factor	Difference between areas (95%CI)	P value
Significant fibrosis
SWE	0.935	0.800-0.989	HA	0.277 (0.070-0.485)	0.009
			Type IV	0.158 (-0.009-0.325)	0.063
			APRI	0.077 (-0.066-0.220)	0.289
HA	0.658	0.482-0.807	Type IV	0.119 (-0.084-0.326)	0.257
			APRI	0.200 (-0.029-0.429)	0.086
Type IV	0.777	0.608-0.898	APRI	0.081 (-0.126-0.288)	0.445
APRI	0.858	0.701-0.951
Advanced fibrosis
SWE	0.914	0.771-0.980	HA	0.094 (-0.054-0.243)	0.214
			Type IV	0.120 (-0.030-0.271)	0.118
			APRI	0.086 (-0.061-0.234)	0.250
HA	0.819	0.656-0.927	Type IV	0.026 (-0.120-0.172)	0.725
			APRI	0.008 (-0.168-0.183)	0.931
Type IV	0.793	0.626-0.909	APRI	0.034 (-0.153-0.221)	0.722
APRI	0.827	0.665-0.932

Table 6 Comparison of diagnostic performance between shear wave elastography and noninvasive serum markers for discriminating F0-1 vs F2-4 (significant fibrosis) and F0-2 vs F3-4 (advanced fibrosis) with non-viral chronic liver diseases (n = 25)

	AUROC	95%CI	Pairwise comparison of ROC curves
			Factor	Difference between areas (95%CI)	P value
Significant fibrosis
SWE	0.979	0.826-0.988	HA	0.035 (-0.058-0.128)	0.465
			Type IV	0.035 (-0.051-0.121)	0.429
			APRI	0.389 (0.163-0.615)	0.001
HA	0.944	0.773-0.993	Type IV	0.000 (-0.103-0.103)	1.000
			APRI	0.354 (0.137-0.572)	0.001
Type IV	0.944	0.773-0.993	APRI	0.354 (0.130-0.578)	0.002
APRI	0.590	0.378-0.781
Advanced fibrosis
SWE	0.910	0.726-0.985	HA	0.077 (-0.042-0.196)	0.206
			Type IV	0.090 (-0.034-0.214)	0.156
			APRI	0.295 (0.060-0.530)	0.014
HA	0.987	0.839-1.000	Type IV	0.013 (-0.034-0.060)	0.593
			APRI	0.372 (0.155-0.589)	0.001
Type IV	1.000	0.862-1.000	APRI	0.385 (0.160-0.609)	0.001
APRI	0.615	0.401-0.801

Citation: Jeong JY, Kim TY, Sohn JH, Kim Y, Jeong WK, Oh YH, Yoo KS. Real time shear wave elastography in chronic liver diseases: Accuracy for predicting liver fibrosis, in comparison with serum markers. World J Gastroenterol 2014; 20(38): 13920-13929
URL: https://www.wjgnet.com/1007-9327/full/v20/i38/13920.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i38.13920