European Radiology

, Volume 29, Issue 12, pp 6477–6488 | Cite as

Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis

  • Thierry Lefebvre
  • Claire Wartelle-Bladou
  • Philip Wong
  • Giada Sebastiani
  • Jeanne-Marie Giard
  • Hélène Castel
  • Jessica Murphy-Lavallée
  • Damien Olivié
  • André Ilinca
  • Marie-Pierre Sylvestre
  • Guillaume Gilbert
  • Zu-Hua Gao
  • Bich N. Nguyen
  • Guy Cloutier
  • An TangEmail author



To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE).


This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method.


TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85–0.93), 0.90 (95% CI 0.85–0.94), and 0.94 (95% CI 0.91–0.96).


MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis.

Trial registration


Key Points

• The technical failure rate was similar between MRE and US-based elastography techniques.

• Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis.

• MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis.


Fibrosis Liver Classification Elasticity imaging techniques Prospective studies 



Autoimmune hepatitis


Area under the receiver operating characteristic curve


Chronic liver disease


Hepatitis B virus


Hepatitis C virus


Magnetic resonance elastography


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Point shear wave elastography


Transient elastography



We thank and acknowledge Mrs. Assia Belblidia, Mrs. Catherine Huet, and Mr. Walid El Abyad for their assistance in patient enrollment and image post-processing. ACUSON S2000 and S3000 ultrasound systems were lent by Siemens Healthineers. Magnetic resonance elastography hardware and software were provided in-kind by Philips Healthcare for this clinical trial.

Funding information

This study has received funding by grants from the Canadian Institutes of Health Research (CIHR)-Institute of Nutrition, Metabolism and Diabetes (INMD) (CIHR-INMD #273738 and #301520) and Fonds de recherche du Québec en Santé (FRQS) and Fondation de l’association des radiologistes du Québec (FARQ) Clinical Research Scholarship—Junior 1 and 2 Salary Award (FRQS-FARQ #26993 and #34939) to An Tang. Junior 1 Salary Award from (FRQS #27127) and research salary from McGill University to Giada Sebastiani. Junior 1 Salary Award from FRQS to Marie-Pierre Sylvestre (FRQS #34875).

Compliance with ethical standards


The scientific guarantor of this publication is Dr. An Tang.

Conflict of interest

The authors of this manuscript declare relationships with the following company: Philips Healthcare Canada (Guillaume Gilbert is an employee of Philips Healthcare Canada).

Statistics and biometry

Dr. Marie-Pierre Sylvestre is one of the authors and has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained for the two participating institutions, Centre hospitalier de l’Université de Montréal (CHUM) and McGill University Health Centre (MUHC).


• prospective

• cross-sectional study

• multicenter study

Supplementary material

330_2019_6331_MOESM1_ESM.docx (404 kb)
ESM 1 (DOCX 404 kb).


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Thierry Lefebvre
    • 1
    • 2
    • 3
  • Claire Wartelle-Bladou
    • 4
  • Philip Wong
    • 5
  • Giada Sebastiani
    • 5
  • Jeanne-Marie Giard
    • 2
    • 4
  • Hélène Castel
    • 2
    • 4
  • Jessica Murphy-Lavallée
    • 1
  • Damien Olivié
    • 1
  • André Ilinca
    • 1
    • 2
  • Marie-Pierre Sylvestre
    • 2
    • 6
  • Guillaume Gilbert
    • 1
    • 7
  • Zu-Hua Gao
    • 8
  • Bich N. Nguyen
    • 9
  • Guy Cloutier
    • 1
    • 10
    • 11
  • An Tang
    • 1
    • 2
    • 10
    Email author
  1. 1.Department of Radiology, Radio-Oncology and Nuclear MedicineUniversité de MontréalMontrealCanada
  2. 2.Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)MontrealCanada
  3. 3.Medical Physics UnitMcGill UniversityMontrealCanada
  4. 4.Department of Medicine, Division of Hepatology and Liver TransplantationUniversité de MontréalMontrealCanada
  5. 5.Department of Medicine, Division of Gastroenterology and HepatologyMcGill University Health Centre (MUHC)MontrealCanada
  6. 6.Department of Social and Preventive MedicineÉcole de santé publique de l’Université de Montréal (ESPUM)MontrealCanada
  7. 7.MR Clinical SciencePhilips Healthcare CanadaMarkhamCanada
  8. 8.Department of PathologyMcGill UniversityMontrealCanada
  9. 9.Service of PathologyCentre hospitalier de l’Université de Montréal (CHUM)MontrealCanada
  10. 10.Institute of Biomedical EngineeringUniversité de MontréalMontrealCanada
  11. 11.Laboratory of Biorheology and Medical Ultrasonics (LBUM)Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)MontrealCanada

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