Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Two-Dimensional-Shear Wave Elastography with a Propagation Map: Prospective Evaluation of Liver Fibrosis Using Histopathology as the Reference Standard

  • Dong Ho Lee (Department of Radiology, Seoul National University Hospital) ;
  • Eun Sun Lee (Department of Radiology, Chung-Ang University Hospital) ;
  • Jae Young Lee (Department of Radiology, Seoul National University Hospital) ;
  • Jae Seok Bae (Department of Radiology, Seoul National University Hospital) ;
  • Haeryoung Kim (Department of Pathology, Seoul National University Hospital) ;
  • Kyung Bun Lee (Department of Pathology, Seoul National University Hospital) ;
  • Su Jong Yu (Department of Internal Medicine, Seoul National University Hospital) ;
  • Eun Ju Cho (Department of Internal Medicine, Seoul National University Hospital) ;
  • Jeong-Hoon Lee (Department of Internal Medicine, Seoul National University Hospital) ;
  • Young Youn Cho (Department of Internal Medicine, Chung-Ang University Hospital) ;
  • Joon Koo Han (Department of Radiology, Seoul National University Hospital) ;
  • Byung Ihn Choi (Department of Radiology, Chung-Ang University Hospital)
  • Received : 2019.12.29
  • Accepted : 2020.04.13
  • Published : 2020.12.01
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Abstract

Objective: The aim of this study was to prospectively evaluate whether liver stiffness (LS) assessments, obtained by two-dimensional (2D)-shear wave elastography (SWE) with a propagation map, can evaluate liver fibrosis stage using histopathology as the reference standard. Materials and Methods: We prospectively enrolled 123 patients who had undergone percutaneous liver biopsy from two tertiary referral hospitals. All patients underwent 2D-SWE examination prior to biopsy, and LS values (kilopascal [kPa]) were obtained. On histopathologic examination, fibrosis stage (F0-F4) and necroinflammatory activity grade (A0-A4) were assessed. Multivariate linear regression analysis was performed to determine the significant factors affecting the LS value. The diagnostic performance of the LS value for staging fibrosis was assessed using receiver operating characteristic (ROC) analysis, and the optimal cut-off value was determined by the Youden index. Results: Reliable measurements of LS values were obtained in 114 patients (92.7%, 114/123). LS values obtained from 2D-SWE with the propagation map positively correlated with the progression of liver fibrosis reported from histopathology (p < 0.001). According to the multivariate linear regression analysis, fibrosis stage was the only factor significantly associated with LS (p < 0.001). The area under the ROC curve of LS from 2D-SWE with the propagation map was 0.773, 0.865, 0.946, and 0.950 for detecting F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The optimal cut-off LS values were 5.4, 7.8, 9.4, and 12.2 kPa for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The corresponding sensitivity and specificity of the LS value for detecting cirrhosis were 90.9% and 88.4%, respectively. Conclusion: The LS value obtained from 2D-SWE with a propagation map provides excellent diagnostic performance in evaluating liver fibrosis stage, determined by histopathology.

Keywords

Acknowledgement

The shear-wave dispersion slope method was provided by Canon Medical Systems Corporation, and this study was technically supported by Canon Medical Systems Korea.

References

  1. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet 1997;349:825-832
  2. Friedman SL, Maher JJ, Bissell DM. Mechanisms and therapy of hepatic fibrosis: report of the AASLD single topic basic research conference. Hepatology 2000;32:1403-1408
  3. Friedman SL. Liver fibrosis-From bench to bedside. J Hepatol 2003;38:S38-S53
  4. Deffieux T, Gennisson JL, Bousquet L, Corouge M, Cosconea S, Amroun D, et al. Investigating liver stiffness and viscosity for fibrosis, steatosis and activity staging using shear wave elastography. J Hepatol 2015;62:317-324
  5. Rockey DC. Antifibrotic therapy in chronic liver disease. Clin Gastroenterol Hepatol 2005;3:95-107
  6. Rockey DC, Bissell DM. Noninvasive measures of liver fibrosis. Hepatology 2006;43:S113-S120
  7. Lee DH, Lee JM, Han JK, Choi BI. MR elastography of healthy liver parenchyma: normal value and reliability of the liver stiffness value measurement. J Magn Reson Imaging 2013;38:1215-1223
  8. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495-500
  9. Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Filice G, Filice C, et al. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology 2012;56:2125-2133
  10. Park SH, Kim SY, Suh CH, Lee SS, Kim KW, Lee SJ, et al. What we need to know when performing and interpreting US elastography. Clin Mol Hepatol 2016;22:406-414
  11. Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008;134:960-974
  12. Jeong WK, Lim HK, Lee HK, Jo JM, Kim Y. Principles and clinical application of ultrasound elastography for diffuse liver disease. Ultrasonography 2014;33:149-160
  13. Joo I, Kim SY, Park HS, Lee ES, Kang HJ, Lee JM. Validation of a new point shear-wave elastography method for noninvasive assessment of liver fibrosis: a prospective multicenter study. Korean J Radiol 2019;20:1527-1535
  14. Zheng J, Guo H, Zeng J, Huang Z, Zheng B, Ren J, et al. Two-dimensional shear-wave elastography and conventional US: the optimal evaluation of liver fibrosis and cirrhosis. Radiology 2015;275:290-300
  15. Feng JC, Li J, Wu XW, Peng XY. Diagnostic accuracy of SuperSonic shear imaging for staging of liver fibrosis: a meta-analysis. J Ultrasound Med 2016;35:329-339
  16. Kim DW, Suh CH, Kim KW, Pyo J, Park C, Jung SC. Technical performance of two-dimensional shear wave elastography for measuring liver stiffness: a systematic review and meta-analysis. Korean J Radiol 2019;20:880-893
  17. Kang HJ, Lee JY, Lee KB, Joo I, Suh KS, Lee HK, et al. Addition of reliability measurement index to point shear wave elastography: prospective validation via diagnostic performance and reproducibility. Ultrasound Med Biol 2019;45:1594-1602
  18. Lee ES, Lee JB, Park HR, Yoo J, Choi JI, Lee HW, et al. Shear wave liver elastography with a propagation map: diagnostic performance and inter-observer correlation for hepatic fibrosis in chronic hepatitis. Ultrasound Med Biol 2017;43:1355-1363
  19. Chung M, Baird GL, Weiss KE, Beland MD. 2D shear wave elastography: measurement acquisition and reliability criteria in noninvasive assessment of liver fibrosis. Abdom Radiol (NY) 2019;44:3285-3294
  20. Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 3: liver. Ultrasound Med Biol 2015;41:1161-1179
  21. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med 2017;38:e16-e47
  22. Ferraioli G, Wong VW, Castera L, Berzigotti A, Sporea I, Dietrich CF, et al. Liver ultrasound elastography: an update to the world federation for ultrasound in medicine and biology guidelines and recommendations. Ultrasound Med Biol 2018;44:2419-2440
  23. De Groote J, Desmet VJ, Gedigk P, Korb G, Popper H, Poulsen H, et al. A classification of chronic hepatitis. Lancet 1968;2:626-628
  24. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996;24:289-293
  25. Lo RC, Kim H. Histopathological evaluation of liver fibrosis and cirrhosis regression. Clin Mol Hepatol 2017;23:302-307
  26. Herrmann E, de Ledinghen V, Cassinotto C, Chu WCW, Leung VYF, Ferraioli G, et al. Assessment of biopsy-proven liver fibrosis by two-dimensional shear wave elastography: an individual patient data-based meta-analysis. Hepatology 2018;67:260-272
  27. Yoneda M, Suzuki K, Kato S, Fujita K, Nozaki Y, Hosono K, et al. Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology 2010;256:640-647
  28. Palmeri ML, Wang MH, Rouze NC, Abdelmalek MF, Guy CD, Moser B, et al. Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol 2011;55:666-672
  29. Yoon JH, Lee JM, Joo I, Lee ES, Sohn JY, Jang SK, et al. Hepatic fibrosis: prospective comparison of MR elastography and US shear-wave elastography for evaluation. Radiology 2014;273:772-782
  30. Lee DH, Lee JM, Yi NJ, Lee KW, Suh KS, Lee JH, et al. Hepatic stiffness measurement by using MR elastography: prognostic values after hepatic resection for hepatocellular carcinoma. Eur Radiol 2017;27:1713-1721
  31. Park CC, Nguyen P, Hernandez C, Bettencourt R, Ramirez K, Fortney L, et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsyproven nonalcoholic fatty liver disease. Gastroenterology 2017;152:598-607.e2
  32. Xu P, Lyu L, Ge H, Sami MU, Liu P, Hu C, et al. Segmental liver stiffness evaluated with magnetic resonance elastography is responsive to endovascular intervention in patients with Budd-Chiari syndrome. Korean J Radiol 2019;20:773-780
  33. Yoon H, Shin HJ, Kim MJ, Lee MJ. Quantitative imaging in pediatric hepatobiliary disease. Korean J Radiol 2019;20:1342-1357