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The role of sound touch elastography in assessment of liver fibrosis in chronic liver disease keeping APRI as the reference standard

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope

Abstract

Purpose

The study aims to determine the role of Sound Touch Elastography [STE] technique in staging liver fibrosis and predicting clinically significant gastro-esophageal varices among patients with chronic liver disease [CLD] keeping aspartate aminotransferase to platelet ratio index [APRI] as the reference standard.

Methods

A prospective short-term study including 60 eligible patients with CLD were staged as non-significant fibrosis [NSF], significant fibrosis [SF] and cirrhosis [C] based on APRI values. STE was performed on each patient obtaining multiple readings as per pre-defined standards. The intra-observer reliability between each measurement and its association with APRI staging was evaluated using relevant statistical variables. Further, Youden’s index was used to define the optimum cut-off values on STE in differentiating the stages of fibrosis and in predicting clinically significant gastro-esophageal varices.

Results

Based on APRI cut-off values, 41.7% [n = 25] of the study population had cirrhosis, while 45% [n = 27] had significant fibrosis and 13.3% [n = 8] had NSF. The STE values in kPa showed a positive correlation with APRI values [(rs) = 0.837, p < 0.001]. The intra-class correlation estimates based on a mean rating [k = 5] was found to be 0.97 [0.95–0.99], implying an excellent agreement between the measurements. Optimum cut-off values in staging SF and C were 7.26 kPa [J = 0.73, sensitivity—85.19%, specificity—87.5%; 95% CI] and 13.79 kPa [J = 0.84, sensitivity—96.0%, specificity—88.89%; 95% CI]. The AUROC for each of these stages were 0.926 [0.785–0.987] and 0.976 [0.890–0.999], respectively. 23.3% [n = 14] of the study population had clinically significant gastro-esophageal varices with a value above 18.84 kPa [J = 0.88] showing a sensitivity of 92.85% and a specificity of 95.65% in predicting the same.

Conclusion

The novel STE technique shows good accuracy in staging liver fibrosis as determined by APRI values and in prediction of clinically significant gastro-esophageal varices with excellent reliability. It shows promising prospects and can be integrated widely in clinical practice for assessment and staging of fibrosis in CLD.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

APRI:

Aspartate aminotransferase to platelet ratio index

AUROC:

Area under the receiver operating characteristic curve

C:

Cirrhosis

CLD:

Chronic liver disease

LSM:

Liver stiffness measurement

NSF:

Non-significant fibrosis

ROI:

Region of interest

SF:

Significant fibrosis

STE:

Sound touch elastography

SWE:

Shear wave elastography

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Authors and Affiliations

  1. Department of Radio-Diagnosis, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, 585105, India

    C. R. Sushaal & Vikram M. Patil

  2. Department of Gastroenterology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, 585105, India

    Shivanand Patil

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Contributions

All authors, i.e., CRS, VMP and SP have contributed to the study conception and design. Material preparation, data collection and analysis was performed by CRS and VMP; VMP performed the Sound Touch Elastography scan while SP performed the endoscopic evaluation in relevant patients. the first draft of the manuscript was written by CRS with contribution and inputs from all the co-authors. all authors have commented on previous versions of the manuscript and all authors have read and approved the final manuscript.

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Correspondence to C. R. Sushaal.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was performed in line with the Declaration of Helsinki. Approval for the study was granted by the Institutional Ethics Committee, Mahadevappa Rampure Medical College [Kalaburagi, Karnataka, India].

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

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No patient identifying data [including images, videos or recognizable information] has been used or displayed in this manuscript. all participating patients have individually consented to usage of particular non-identifiable data for research purpose and publication.

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Sushaal, C.R., Patil, V.M. & Patil, S. The role of sound touch elastography in assessment of liver fibrosis in chronic liver disease keeping APRI as the reference standard. Abdom Radiol 48, 3373–3381 (2023). https://doi.org/10.1007/s00261-023-04018-5

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