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Ultrasound point shear wave elastography assessment of liver and spleen stiffness: effect of training on repeatability of measurements

  • Ultrasound
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Abstract

Objectives

To evaluate reproducibility of measurements of spleen stiffness (SS) and liver stiffness (LS) at several sites by using point shear wave elastography (pSWE) and to investigate any training effect.

Methods

Healthy volunteers were consecutively enrolled. Measurements of SS and LS were performed by an expert (observer 1) and a novice (observer 2) at three different sites of liver and spleen. To assess the effect of training the study was conducted in two periods (period 1 and period 2). Concordance correlation coefficient was used to assess intra-observer and inter-observer reproducibility.

Results

A total of 92 subjects (67 men and 25 women) were enrolled in the study. Both intra-observer and inter-observer agreement were higher for the liver than for the spleen. Overall, the highest intra-observer and inter-observer agreement were obtained for the assessment of LS through intercostal space, and for measurements at this site there was a significantly better performance of observer 2 after the training period. For both observers, training improved the repeatability of SS measurements at all sites. A good intra-observer agreement was obtained only for measurements at the spleen lower pole.

Conclusions

The results of this study show that a learning curve in pSWE acquisition should be taken into account both for SS and LS measurements.

Key Points

Reproducibility of SS measurements depends on the expertise of the operator.

To achieve good reproducibility between measurements a training period is required.

A learning curve in pSWE acquisition should be taken into account.

SS measurements are less reproducible than LS measurements.

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Abbreviations

CCC:

concordance correlation coefficient

LS:

liver stiffness

pSWE:

point shear wave elastography

ROI:

region of interest

SS:

spleen stiffness

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Acknowledgements

The authors wish to thank all the members of the Elastography Study Group of the Department of Infectious Diseases:

Elisabetta Above, M.D.; Giorgio Barbarini, M.D.; Raffaele Bruno, M.D.; Silvia Corona, M.Sc.; Carolina Dellafiore, M.D.; Marta Di Gregorio, M.D.; Roberto Gulminetti, M.D.; Paolo Lanzarini, M.D.; Serena Ludovisi, M.D.; Laura Maiocchi, M.D.; Antonello Malfitano, M.D.; Giuseppe Michelone, M.D.; Lorenzo Minoli, M.D.; Mario Mondelli, M.D.; Stefano Novati, M.D.; Savino F.A. Patruno, M.D.; Alessandro Perretti, M.D.; Gianluigi Poma, M.D.; Paolo Sacchi, M.D.; Domenico Zanaboni, M.D.; Marco Zaramella, M.D.

The authors would like also to thank Ms. Livia Astroni, Mr. Filippo Cuda, Mr. Lorenzo Guioli, Ms. Rossella Lattuada, Ms. Maura Marchisoni, Ms. Giampiera Nava, Ms. Loredana Pavesi, Ms. Barbara Ricci, nurses in the outpatient ward of the Infectious Diseases Department; Ms. Nadia Locatelli, Secretary of the Ultrasound Unit; Ms. Paola Bolzoni, Ms. Anna Cuollo, Ms Giuseppina Discenza, nurses in the “Medicina Diagnostica e dei Servizi” Dept. for their valuable help in complying with the study protocol.

The ultrasound equipment Acuson S2000 was made available for the study by Siemens Healthcare, Erlangen, Germany. Siemens Healthcare was not involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The content of the manuscript is solely under the responsibility of the authors.

The scientific guarantor of this publication is Carlo Filice, MD, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy. 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. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects in this study. Methodology: prospective, cross sectional study, performed at one institution.

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Correspondence to Giovanna Ferraioli.

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Ferraioli, G., Tinelli, C., Lissandrin, R. et al. Ultrasound point shear wave elastography assessment of liver and spleen stiffness: effect of training on repeatability of measurements. Eur Radiol 24, 1283–1289 (2014). https://doi.org/10.1007/s00330-014-3140-y

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  • DOI: https://doi.org/10.1007/s00330-014-3140-y

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