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Precise fibrosis staging with shear wave elastography in chronic hepatitis B depends on liver inflammation and steatosis

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Abstract

Background

Two-dimensional shear wave elastography (2D-SWE) is the latest generation of ultrasound elastography for the non-invasive assessment of liver fibrosis in chronic hepatitis B (CHB). We aimed to identify confounders of 2D-SWE in fibrosis grading.

Methods

A prospective cohort of 440 CHB patients (286 with liver biopsy and 154 with clinical decompensated cirrhosis) was consecutively enrolled from a clinical trial (registration number: ChiCTR-DCD-15006000) aimed at optimizing 2D-SWE assessments from 2015 to 2018. All patients underwent 2D-SWE examination, anthropometric measurement, and serum biomarker assessment. Steatosis was graded by the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF).

Results

Overall, the prevalence of incorrect fibrosis staging by 2D-SWE was 26.1% (n = 115), with 43.5% of patients under-staged and 56.5% over-staged. In multivariate analysis, the steatosis degree was an independent predictor of 2D-SWE discordance in the overall cohort, with moderate–severe steatosis for underestimation (odds ratio, [OR] = 4.3, 95% confidence interval [CI] 1.2–18.2, p = 0.049) and overestimation (OR = 8.2, 95% CI 2.9–23.5, p < 0.001), and mild steatosis for overestimation (OR = 3.7, 95% CI 1.5–9.0, p = 0.004). In patients with liver biopsy, both histological inflammation activity over 2 (OR = 5.0, 95% CI 2.0–25.3, p = 0.048) and moderate–severe steatosis (OR = 5.2, 95% CI 2.1–13.4, p < 0.001) were independent factors associated with discordance. For the risk of 2D-SWE mis-staging, a nomogram that integrated these confounders was established and the area under the receiver operating characteristic curve of the model was 0.861.

Conclusions

Steatosis and inflammation activities were confounders for 2D-SWE. The combination of these confounders could predict mis-staging risks of CHB-related fibrosis with 2D-SWE and may be valuable to decision-making on liver biopsy for fibrosis staging.

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Funding

This study is supported by China foundation for hepatitis prevention and control (TQGB20140083), Special Project on the Integration of Industry, Education and Research of Guangzhou, China (201604020155), Science and Technology Program of Guangdong province, China (2013B021800290, 2014A020212118, 2017A020215015) and National Natural Science Foundation of China (81870404, 81670518, 81170392).

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Author notes

  1. Junzhao Ye and Wei Wang contributed equally to the study.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Yuexiu District, Guangzhou, 510080, Guangdong, People’s Republic of China

    Junzhao Ye, Xianhua Liao & Bihui Zhong

  2. Department of Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, People’s Republic of China

    Wei Wang, Yang Huang & Xiaoyan Xie

  3. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, People’s Republic of China

    Shiting Feng

  4. Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Yuexiu District, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong, People’s Republic of China

    Bing Liao

  5. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, People’s Republic of China

    Ming Kuang

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  1. Junzhao Ye
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Corresponding authors

Correspondence to Bing Liao or Bihui Zhong.

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Conflict of interest

Junzhao Ye, Wei Wang, Shiting Feng, Yang Huang, Xianhua Liao, Ming Kuang, Xiaoyan Xie, Bing Liao, and Bihui Zhong declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. This study does not contain any studies with animals performed by the authors.

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Informed consent was obtained from all individual participants included in the study.

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Ye, J., Wang, W., Feng, S. et al. Precise fibrosis staging with shear wave elastography in chronic hepatitis B depends on liver inflammation and steatosis. Hepatol Int 14, 190–201 (2020). https://doi.org/10.1007/s12072-020-10017-1

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  • DOI: https://doi.org/10.1007/s12072-020-10017-1

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