Non-invasive evaluation of liver fibrosis: a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C
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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.
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 %).
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 %.
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 %.
• 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.
KeywordsElasticity imaging techniques Hepatitis C Hepatitis B Sensitivity and specificity
chronic hepatitis B
chronic hepatitis C
ultrasound-based transient elastography
magnetic resonance elastography
area under the receiver operator characteristic curve
times upper limit of normal
modified histology activity index
liver stiffness measurement
spin-echo echo planar imaging
region of interest
positive predictive value
negative predictive value
American Association for the Study of Liver Diseases
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 . 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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