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Non-invasive evaluation of liver fibrosis: a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C

  • Gastrointestinal
  • Published:
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Abstract

Objective

To compare the diagnostic accuracy of TE and MRE and establish cutoff levels and diagnostic strategies for both techniques, enabling selection of patients for liver biopsy.

Methods

One hundred three patients with chronic hepatitis B or C and liver biopsy were prospectively included. Areas under curves (AUROC) were compared for TE and MRE for METAVIR fibrosis grade ≥ F2 and ≥F3. We defined cutoff values for selection of patients with F0–F1 (sensitivity >95 %) and for significant fibrosis F2–F4 (specificity >95 %).

Results

Following exclusions, 85 patients were analysed (65 CHB, 19 CHC, 1 co-infected). Fibrosis stages were F0 (n = 3), F1 (n = 53), F2 (n = 15), F3 (n = 8) and F4 (n = 6). TE and MRE accuracy were comparable [AUROCTE ≥ F2: 0.914 (95 % CI: 0.857–0.972) vs. AUROCMRE ≥ F2: 0.909 (0.840–0.977), P = 0.89; AUROCTE ≥ F3: 0.895 (0.816–0.974) vs. AUROCMRE ≥ F3: 0.928 (0.874–0.982), P = 0.42]. Cutoff values of <5.2 and ≥8.9 kPa (TE) and <1.66 and ≥2.18 kPa (MRE) diagnosed 64 % and 66 % of patients correctly as F0–F1 or F2–F4. A conditional strategy in inconclusive test results increased diagnostic yield to 80 %.

Conclusion

TE and MRE have comparable accuracy for detecting significant fibrosis, which was reliably detected or excluded in two-thirds of patients. A conditional strategy further increased diagnostic yield to 80 %.

Key Points

• Both ultrasound-based transient elastography and magnetic resonance elastography can assess hepatic fibrosis.

• Both have comparable accuracy for detecting liver fibrosis in viral hepatitis.

• The individual techniques reliably detect or exclude significant liver fibrosis in 66 %.

• A conditional strategy for inconclusive findings increases the number of correct diagnoses.

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Abbreviations

CHB:

chronic hepatitis B

CHC:

chronic hepatitis C

TE:

ultrasound-based transient elastography

MRE:

magnetic resonance elastography

AUROC:

area under the receiver operator characteristic curve

ALT:

alanine aminotransferase

AST:

aspartate aminotransferase

xULN:

times upper limit of normal

m-HAI:

modified histology activity index

LSM:

liver stiffness measurement

IQR:

interquartile range

SE-EPI:

spin-echo echo planar imaging

ROI:

region of interest

kPa:

kilopascal

rs :

Spearman’s rho

PPV:

positive predictive value

NPV:

negative predictive value

LR:

likelihood ratio

CI:

confidence interval

AASLD:

American Association for the Study of Liver Diseases

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Acknowledgements

The authors wish to acknowledge Ton van der Meijden from the Free University Medical Center Amsterdam and Jurgen H. Runge from the Academic Medical Center Amsterdam for their help with the inclusion of participants in this study. This work was funded by the NutsOhra Foundation, The Netherlands.

We would like to point out that 12 patients included in this study were also included in a recently published study [26]. This study reports on reproducibility of MRE, which is a different endpoint from those of the present study. Therefore, we do not believe that including these patients in both studies has caused conflicting overlap in data reporting.

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Authors and Affiliations

  1. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

    Anneloes E. Bohte, Shandra Bipat, Aart J. Nederveen & Jaap Stoker

  2. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

    Annikki de Niet, Louis Jansen, Peter L. M. Jansen & Henk W. Reesink

  3. Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands

    Joanne Verheij

  4. Department of Pathology, Bronovo Hospital, The Hague, The Netherlands

    Valeska Terpstra

  5. Department of Radiology and IPMA, INSERM UMR 773, Beaujon University Hospital, University of Paris Diderot, Clichy, France

    Ralph Sinkus

  6. Department of Gastroenterology and Hepatology, Free University Medical Center, Amsterdam, The Netherlands

    Karin M. J. van Nieuwkerk

  7. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands

    Rob J. de Knegt

  8. Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Bert C. Baak

  9. Academic Medical Center Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands

    Anneloes E. Bohte

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  1. Anneloes E. Bohte
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Correspondence to Anneloes E. Bohte.

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Bohte, A.E., de Niet, A., Jansen, L. et al. Non-invasive evaluation of liver fibrosis: a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C. Eur Radiol 24, 638–648 (2014). https://doi.org/10.1007/s00330-013-3046-0

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