Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease

Marcello Mancini, Angelo Salomone Megna, Monica Ragucci, Massimo De Luca, Giuseppina Marino Marsilia, Gerardo Nardone, Pietro Coccoli, Anna Prinster, Lorenzo Mannelli, Emilia Vergara, Serena Monti, Raffaele Liuzzi, Mariarosaria Incoronato

Research output: Contribution to journalArticle

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Abstract

The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The aim of the study was to determine reproducibility of real-time shear wave elastography using a hepatic biopsy as the reference standard to identify patients with chronic liver disease. Forty patients with chronic liver disease and 12 normal subjects received shear wave elastography performed by skilled operators. Interoperator reproducibility was studied in 29 patients. Fibrosis was evaluated using the Metavir score. The median and range shear wave elastography values in chronic liver disease subjects were 6.15 kPa and 3.14–16.7 kPa and were 4.49 kPa and 2.92–7.32 kPa in normal subjects, respectively. With respect to fibrosis detected by liver biopsy, shear wave elastography did not change significantly between F0 and F1 (p = 0.334), F1 and F2 (p = 0.611), or F3 and F4 (0.327); a significant difference was observed between the F0-F2 and F3-F4 groups (p = 0.002). SWE also correlated with inflammatory activity (Rs = 0.443, p = 0.0023) and ALT levels (Rs = 0.287, p = 0.0804). Age, sex and body mass index did not affect shear wave elastography measurements. Using receiver operator characteristic curves, two threshold values for shear wave elastography were identified: 5.62 kPa for patients with fibrosis (F2; sensitivity 80%, specificity 69.4%, and accuracy 77%) and 7.04 kPa for patients with severe fibrosis (F3; sensitivity 88.9%, specificity 81%, and accuracy 89%). Overall interobserver agreement was excellent and was analysed using an interclass correlation coefficient (0.94; CI 0.87–0.97). This study shows that shear wave elastography executed by skilled operators can be performed on almost all chronic liver disease patients with high reproducibility. It is not influenced by age, sex or body mass index, identifies severely fibrotic patients and is also related to inflammatory activity.

Original languageEnglish
Article numbere0185391
JournalPLoS One
Volume12
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

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Elasticity Imaging Techniques
Shear waves
liver diseases
Liver
reproducibility
shears
Liver Diseases
Chronic Disease
fibrosis
Fibrosis
Biopsy
body mass index
biopsy
Body Mass Index
Sensitivity and Specificity
liver
gender
reference standards
Liver Cirrhosis
prognosis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Mancini, M., Salomone Megna, A., Ragucci, M., De Luca, M., Marino Marsilia, G., Nardone, G., ... Incoronato, M. (2017). Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease. PLoS One, 12(10), [e0185391]. https://doi.org/10.1371/journal.pone.0185391

Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease. / Mancini, Marcello; Salomone Megna, Angelo; Ragucci, Monica; De Luca, Massimo; Marino Marsilia, Giuseppina; Nardone, Gerardo; Coccoli, Pietro; Prinster, Anna; Mannelli, Lorenzo; Vergara, Emilia; Monti, Serena; Liuzzi, Raffaele; Incoronato, Mariarosaria.

In: PLoS One, Vol. 12, No. 10, e0185391, 01.10.2017.

Research output: Contribution to journalArticle

Mancini, M, Salomone Megna, A, Ragucci, M, De Luca, M, Marino Marsilia, G, Nardone, G, Coccoli, P, Prinster, A, Mannelli, L, Vergara, E, Monti, S, Liuzzi, R & Incoronato, M 2017, 'Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease', PLoS One, vol. 12, no. 10, e0185391. https://doi.org/10.1371/journal.pone.0185391
Mancini M, Salomone Megna A, Ragucci M, De Luca M, Marino Marsilia G, Nardone G et al. Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease. PLoS One. 2017 Oct 1;12(10). e0185391. https://doi.org/10.1371/journal.pone.0185391
Mancini, Marcello ; Salomone Megna, Angelo ; Ragucci, Monica ; De Luca, Massimo ; Marino Marsilia, Giuseppina ; Nardone, Gerardo ; Coccoli, Pietro ; Prinster, Anna ; Mannelli, Lorenzo ; Vergara, Emilia ; Monti, Serena ; Liuzzi, Raffaele ; Incoronato, Mariarosaria. / Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease. In: PLoS One. 2017 ; Vol. 12, No. 10.
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abstract = "The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The aim of the study was to determine reproducibility of real-time shear wave elastography using a hepatic biopsy as the reference standard to identify patients with chronic liver disease. Forty patients with chronic liver disease and 12 normal subjects received shear wave elastography performed by skilled operators. Interoperator reproducibility was studied in 29 patients. Fibrosis was evaluated using the Metavir score. The median and range shear wave elastography values in chronic liver disease subjects were 6.15 kPa and 3.14–16.7 kPa and were 4.49 kPa and 2.92–7.32 kPa in normal subjects, respectively. With respect to fibrosis detected by liver biopsy, shear wave elastography did not change significantly between F0 and F1 (p = 0.334), F1 and F2 (p = 0.611), or F3 and F4 (0.327); a significant difference was observed between the F0-F2 and F3-F4 groups (p = 0.002). SWE also correlated with inflammatory activity (Rs = 0.443, p = 0.0023) and ALT levels (Rs = 0.287, p = 0.0804). Age, sex and body mass index did not affect shear wave elastography measurements. Using receiver operator characteristic curves, two threshold values for shear wave elastography were identified: 5.62 kPa for patients with fibrosis (F2; sensitivity 80{\%}, specificity 69.4{\%}, and accuracy 77{\%}) and 7.04 kPa for patients with severe fibrosis (F3; sensitivity 88.9{\%}, specificity 81{\%}, and accuracy 89{\%}). Overall interobserver agreement was excellent and was analysed using an interclass correlation coefficient (0.94; CI 0.87–0.97). This study shows that shear wave elastography executed by skilled operators can be performed on almost all chronic liver disease patients with high reproducibility. It is not influenced by age, sex or body mass index, identifies severely fibrotic patients and is also related to inflammatory activity.",
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