Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis
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To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE).
This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method.
TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85–0.93), 0.90 (95% CI 0.85–0.94), and 0.94 (95% CI 0.91–0.96).
MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis.
• The technical failure rate was similar between MRE and US-based elastography techniques.
• Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis.
• MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis.
KeywordsFibrosis Liver Classification Elasticity imaging techniques Prospective studies
Area under the receiver operating characteristic curve
Chronic liver disease
Hepatitis B virus
Hepatitis C virus
Magnetic resonance elastography
Nonalcoholic fatty liver disease
Point shear wave elastography
We thank and acknowledge Mrs. Assia Belblidia, Mrs. Catherine Huet, and Mr. Walid El Abyad for their assistance in patient enrollment and image post-processing. ACUSON S2000 and S3000 ultrasound systems were lent by Siemens Healthineers. Magnetic resonance elastography hardware and software were provided in-kind by Philips Healthcare for this clinical trial.
This study has received funding by grants from the Canadian Institutes of Health Research (CIHR)-Institute of Nutrition, Metabolism and Diabetes (INMD) (CIHR-INMD #273738 and #301520) and Fonds de recherche du Québec en Santé (FRQS) and Fondation de l’association des radiologistes du Québec (FARQ) Clinical Research Scholarship—Junior 1 and 2 Salary Award (FRQS-FARQ #26993 and #34939) to An Tang. Junior 1 Salary Award from (FRQS #27127) and research salary from McGill University to Giada Sebastiani. Junior 1 Salary Award from FRQS to Marie-Pierre Sylvestre (FRQS #34875).
Compliance with ethical standards
The scientific guarantor of this publication is Dr. An Tang.
Conflict of interest
The authors of this manuscript declare relationships with the following company: Philips Healthcare Canada (Guillaume Gilbert is an employee of Philips Healthcare Canada).
Statistics and biometry
Dr. Marie-Pierre Sylvestre is one of the authors and has significant statistical expertise.
Written informed consent was obtained from all subjects in this study.
Institutional Review Board approval was obtained for the two participating institutions, Centre hospitalier de l’Université de Montréal (CHUM) and McGill University Health Centre (MUHC).
• cross-sectional study
• multicenter study
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