European Radiology

, Volume 24, Issue 3, pp 638–648 | Cite as

Non-invasive evaluation of liver fibrosis: a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C

  • Anneloes E. Bohte
  • Annikki de Niet
  • Louis Jansen
  • Shandra Bipat
  • Aart J. Nederveen
  • Joanne Verheij
  • Valeska Terpstra
  • Ralph Sinkus
  • Karin M. J. van Nieuwkerk
  • Rob J. de Knegt
  • Bert C. Baak
  • Peter L. M. Jansen
  • Henk W. Reesink
  • Jaap Stoker
Gastrointestinal

Abstract

Objective

To compare the diagnostic accuracy of TE and MRE and establish cutoff levels and diagnostic strategies for both techniques, enabling selection of patients for liver biopsy.

Methods

One hundred three patients with chronic hepatitis B or C and liver biopsy were prospectively included. Areas under curves (AUROC) were compared for TE and MRE for METAVIR fibrosis grade ≥ F2 and ≥F3. We defined cutoff values for selection of patients with F0–F1 (sensitivity >95 %) and for significant fibrosis F2–F4 (specificity >95 %).

Results

Following exclusions, 85 patients were analysed (65 CHB, 19 CHC, 1 co-infected). Fibrosis stages were F0 (n = 3), F1 (n = 53), F2 (n = 15), F3 (n = 8) and F4 (n = 6). TE and MRE accuracy were comparable [AUROCTE ≥ F2: 0.914 (95 % CI: 0.857–0.972) vs. AUROCMRE ≥ F2: 0.909 (0.840–0.977), P = 0.89; AUROCTE ≥ F3: 0.895 (0.816–0.974) vs. AUROCMRE ≥ F3: 0.928 (0.874–0.982), P = 0.42]. Cutoff values of <5.2 and ≥8.9 kPa (TE) and <1.66 and ≥2.18 kPa (MRE) diagnosed 64 % and 66 % of patients correctly as F0–F1 or F2–F4. A conditional strategy in inconclusive test results increased diagnostic yield to 80 %.

Conclusion

TE and MRE have comparable accuracy for detecting significant fibrosis, which was reliably detected or excluded in two-thirds of patients. A conditional strategy further increased diagnostic yield to 80 %.

Key Points

Both ultrasound-based transient elastography and magnetic resonance elastography can assess hepatic fibrosis.

Both have comparable accuracy for detecting liver fibrosis in viral hepatitis.

The individual techniques reliably detect or exclude significant liver fibrosis in 66 %.

A conditional strategy for inconclusive findings increases the number of correct diagnoses.

Keywords

Elasticity imaging techniques Hepatitis C Hepatitis B Sensitivity and specificity 

Abbreviations

CHB

chronic hepatitis B

CHC

chronic hepatitis C

TE

ultrasound-based transient elastography

MRE

magnetic resonance elastography

AUROC

area under the receiver operator characteristic curve

ALT

alanine aminotransferase

AST

aspartate aminotransferase

xULN

times upper limit of normal

m-HAI

modified histology activity index

LSM

liver stiffness measurement

IQR

interquartile range

SE-EPI

spin-echo echo planar imaging

ROI

region of interest

kPa

kilopascal

rs

Spearman’s rho

PPV

positive predictive value

NPV

negative predictive value

LR

likelihood ratio

CI

confidence interval

AASLD

American Association for the Study of Liver Diseases

Notes

Acknowledgements

The authors wish to acknowledge Ton van der Meijden from the Free University Medical Center Amsterdam and Jurgen H. Runge from the Academic Medical Center Amsterdam for their help with the inclusion of participants in this study. This work was funded by the NutsOhra Foundation, The Netherlands.

We would like to point out that 12 patients included in this study were also included in a recently published study [26]. This study reports on reproducibility of MRE, which is a different endpoint from those of the present study. Therefore, we do not believe that including these patients in both studies has caused conflicting overlap in data reporting.

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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Anneloes E. Bohte
    • 1
    • 9
  • Annikki de Niet
    • 2
  • Louis Jansen
    • 2
  • Shandra Bipat
    • 1
  • Aart J. Nederveen
    • 1
  • Joanne Verheij
    • 3
  • Valeska Terpstra
    • 4
  • Ralph Sinkus
    • 5
  • Karin M. J. van Nieuwkerk
    • 6
  • Rob J. de Knegt
    • 7
  • Bert C. Baak
    • 8
  • Peter L. M. Jansen
    • 2
  • Henk W. Reesink
    • 2
  • Jaap Stoker
    • 1
  1. 1.Department of RadiologyAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Gastroenterology and HepatologyAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of PathologyAcademic Medical CenterAmsterdamThe Netherlands
  4. 4.Department of PathologyBronovo HospitalThe HagueThe Netherlands
  5. 5.Department of Radiology and IPMA, INSERM UMR 773, Beaujon University HospitalUniversity of Paris DiderotClichyFrance
  6. 6.Department of Gastroenterology and HepatologyFree University Medical CenterAmsterdamThe Netherlands
  7. 7.Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands
  8. 8.Department of Gastroenterology and HepatologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  9. 9.Academic Medical Center AmsterdamAmsterdamThe Netherlands

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