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Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis

European Radiology volume 25, pages 3214–3221 (2015)Cite this article

Abstract

Objectives

To investigate the performance of real-time 2D shear wave elastography (RT 2D-SWE) for non-invasive staging of liver disease in patients with chronic viral hepatitis (CVH).

Materials and methods

Naive CVH patients underwent liver (LS) and spleen stiffness (SS) measurements by an intercostal approach. Patients with ALT >3× upper limit of normal, cholestasis as revealed by dilated intrahepatic biliary tree, and liver congestion were excluded. Results were expressed in kPa and compared to histological stage (Ishak) of liver fibrosis (LF). Patients with decompensated liver cirrhosis (LC) were diagnosed using standard clinical, ultrasound, and endoscopic criteria.

Results

Of 123 patients, LS was successfully measured in 79.7 % and SS in 53.7 %. LS accurately differentiated between liver disease stages, with cut-off values of 8.1 (AUC 0.991) for F ≥ 3, 10.8 kPa (AUC 0.954) for F ≥ 5, and 27 kPa (AUC 0.961) for decompensated LC. SS was significantly different between non-cirrhotic stages (F0–4) and LC (cut-off 24 kPa; AUC 0.821). While both LS and SS increased with liver disease progression, the difference between them decreased, as reflected by the stiffness ratio index.

Conclusions

RT 2D-SWE can accurately differentiate between the stages of LF, and can distinguish LF from LC and compensated from decompensated LC.

Key Points

• RT 2D-SWE is an accurate method for assessment of liver fibrosis.

• RT 2D-SWE is applicable in 80 % of patients with chronic viral hepatitis.

• RT 2D-SWE accurately differentiates compensated from decompensated liver cirrhosis.

• Both liver and spleen stiffness increase with progression of liver fibrosis.

• In cirrhosis, the difference between liver and spleen stiffness decreases.

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Fig. 1
Fig. 2

Abbreviations

ALT:

Alanine aminotransferase

ARFI:

Acoustic radiation force impulse imaging

AUC:

Area under the receiver operating characteristic curve

LC:

Liver cirrhosis

LF:

Liver fibrosis

LS:

Liver stiffness

LSM:

Liver stiffness measurement

SE:

Sonoelastography

SRI:

Stiffness ratio index

SS:

Spleen stiffness

SSM:

Spleen stiffness measurement

RT 2D-SWE:

Real-time wo-dimensional shear wave elastography

ULN:

Upper limit of normal

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Acknowledgments

The scientific guarantor of this publication is Boris Brkljacic. 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 (patients) in this study. Methodology: cross-sectional observational study, performed at one institution.

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Affiliations

  1. Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia

    Ivica Grgurevic, Tomislav Bokun & Milan Kujundzic

  2. Department of Gastroenterology, University Hospital Center Split, University of Split School of Medicine, Split, Croatia

    Zeljko Puljiz & Darko Brnic

  3. Department of Pathology, University Hospital Dubrava, Zagreb, Croatia

    Renata Heinzl

  4. Intensive Care Unit, Varazdin General Hospital, Varazdin, Croatia

    Anita Lukic

  5. Department of Infectious diseases, University Hospital Center Split, University of Split School of Medicine, Split, Croatia

    Boris Luksic

  6. Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, University of Zagreb School of Medicine, Avenija Gojka Suska 6, Zagreb, 10 000, Croatia

    Boris Brkljacic

Authors
  1. Ivica Grgurevic
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  2. Zeljko Puljiz
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  3. Darko Brnic
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  4. Tomislav Bokun
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  5. Renata Heinzl
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  6. Anita Lukic
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  7. Boris Luksic
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  8. Milan Kujundzic
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  9. Boris Brkljacic
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Correspondence to Boris Brkljacic.

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Grgurevic, I., Puljiz, Z., Brnic, D. et al. Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis. Eur Radiol 25, 3214–3221 (2015). https://doi.org/10.1007/s00330-015-3728-x

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  • DOI: https://doi.org/10.1007/s00330-015-3728-x

Keywords

  • Viral hepatitis
  • Cirrhosis
  • Portal hypertension
  • Ultrasound
  • Elastography