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European Radiology

, Volume 24, Issue 10, pp 2572–2581 | Cite as

Diagnostic accuracy of two-dimensional shear wave elastography for the non-invasive staging of hepatic fibrosis in chronic hepatitis B: a cohort study with internal validation

  • Jie Zeng
  • Guang-Jian Liu
  • Ze-Ping Huang
  • Jian Zheng
  • Tao Wu
  • Rong-Qin ZhengEmail author
  • Ming-De LuEmail author
Ultrasound

Abstract

Objectives

To determine the accuracy of two-dimensional shear wave elastography (2D-SWE) for noninvasive staging of hepatic fibrosis in chronic hepatitis B (CHB).

Methods

Patients with CHB infection who underwent liver biopsy were consecutively included. Receiver-operating characteristic (ROC) curves were constructed to assess the overall accuracy and identify optimal cutoff values.

Results

Three hundred three patients were analysed. The diagnostic performance characteristics were determined for the first 202 patients (the index cohort) and were validated on the next 101 patients (validation cohort). The areas under the ROC curves for significant fibrosis, severe fibrosis and cirrhosis were all greater than 0.90 and did not differ significantly between the index and validation cohorts. Using the cutoff values generated from the index cohort, the validation cohort 2D-SWE had negative predictive values of 82.6 % (95 % confidence interval [CI]: 68.4 % − 92.3 %) for significant fibrosis, 95.1 % (95 % CI: 86.3 % − 99.0 %) for severe fibrosis and 97.4 % (95 % CI: 90.8 % − 99.7 %) for cirrhosis. The positive predictive values were 83.6 % (95 % CI: 71.2 % − 92.2 %), 65.0 % (95 % CI: 48.1 − 79.5 %) and 60.0 % (95 % CI: 38.7 % − 78.9 %), respectively.

Conclusion

The 2D-SWE showed good diagnostic accuracy in staging liver fibrosis in patients with CHB infection and assisted in excluding liver fibrosis and cirrhosis.

Key Points

• Two-dimensional shear wave elastography showed good diagnostic accuracy in assessing liver fibrosis.

• Diagnostic performance did not differ significantly between the index and validation cohorts.

• Two-dimensional shear wave elastography assisted in excluding liver fibrosis and cirrhosis.

Keywords

Elasticity imaging techniques Ultrasound Hepatitis B Staging Sensitivity and specificity 

Abbreviations

CHB

Chronic hepatitis B

LB

Liver biopsy

TE

Transient elastography

pSWE

Point shear-wave elastography

2D-SWE

Two-dimensional shear wave elastography

US

Ultrasound

HBV

Hepatitis B virus

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

ALP

Alkaline phosphatase

GGT

Gamma-glutamyl transpeptidase

BMI

Body mass index

ROI

Region of interest

SD

Standard deviation

LSM

Liver stiffness measurement

SR

Success rate

IQR

Interquartile range

ROC

Receiver-operating characteristic

AUROC

Area under the ROC curve

PPV

Positive predictive value

NPV

Negative predictive value

LR+

Positive likelihood ratio

LR-

Negative likelihood ratio

CI

Confidence interval

Notes

Acknowledgments

The scientific guarantors of this publication are Rong-Qin Zheng and Ming-De Lu. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  1. 1.Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional UltrasoundSun Yat-Sen UniversityGuangzhouChina
  2. 2.Department of Medical UltrasonicsSixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  3. 3.Departments of Hepatobiliary Surgery and Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional UltrasoundSun Yat-Sen UniversityGuangzhouChina

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