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Shear wave elastography for liver fibrosis in chronic hepatitis B: Adapting the cut-offs to alanine aminotransferase levels improves accuracy

  • Ultrasound
  • Published:
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Abstract

Objectives

To determine and validate alanine aminotransferase (ALT)-adapted dual cut-offs of liver stiffness measurements (LSMs) for assessing liver fibrosis with two-dimensional shear wave elastography (2D-SWE) in patients with chronic hepatitis B (CHB) infection.

Methods

Patients with CHB infection who underwent liver biopsy to assess liver fibrosis were consecutively included. 2D-SWE confirmation thresholds with a positive likelihood ratio ≥10 and 2D-SWE exclusion thresholds with a negative likelihood ratio ≤0.1 were identified to rule in or rule out significant fibrosis and cirrhosis, respectively.

Results

The first 515 patients (index cohort) and the next 421 patients (validation cohort) were included in the final analysis. The low and high cut-offs to rule out and rule in patients with significant fibrosis (≥ F2) were 5.4 kPa and 9.0 kPa, respectively, in patients with ALT levels ≤ 2 × the upper limit of normal (ULN) and 7.1 kPa and 11.2 kPa in patients with ALT levels > 2 × ULN. For cirrhosis (F4), the corresponding values were 8.1 kPa and 12.3 kPa in patients with ALT levels ≤ 2 × ULN and 11.9 kPa and 24.7 kPa in patients with ALT levels > 2 × ULN. The dual cut-off values showed an overall accuracy of more than 90% for diagnosis of the presence or absence of significant fibrosis and cirrhosis in the index and validation cohorts. There were no significant differences in the accuracy values between the cohorts (all p>0.05).

Conclusion

The ALT-adapted dual cut-offs of LSMs showed high accuracy for diagnosis of the presence or absence of significant fibrosis and cirrhosis in patients with CHB infection.

Key Points

• The ALT-adapted dual cut-off values of LSMs showed high accuracy for diagnosis of the presence or absence of significant fibrosis and cirrhosis.

• ALT levels did not influence the overall diagnostic accuracy for predicting significant fibrosis and cirrhosis.

• The ALT-adapted dual cut-offs in patients with ALT levels > 2 × ULN were markedly higher than those in patients with ALT levels ≤ 2 × ULN.

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Abbreviations

2D-SWE:

Two-dimensional shear wave elastography

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

APRI:

Aspartate aminotransferase-to-platelet index

AST:

Aspartate aminotransferase

AUROCs:

Areas under the ROC curves

BMI:

Body mass index

CHB:

Chronic hepatitis B

GGT:

Gamma-glutamyl transpeptidase

kPa:

Kilopascal

LB:

Liver biopsy

LR+:

Positive likelihood ratio

LR-:

Negative likelihood ratio

LSM:

Liver stiffness measurement

ROC:

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviation

TE:

Transient elastography

ULN:

Upper limit of normal

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Acknowledgements

The authors wish to thank Cai-Xia Zhang, PhD (School of Public Health, Sun Yat-Sen University) for her statistical advice.

Funding

This study has received funding by National Natural Science Foundation of China (Grants 81601503 and 81471672) and Science, Technology and Innovation Commission of Shenzhen Municipality (Grant JCY J20170307161018414).

Author information

Author notes

  1. Jie Zeng and Jian Zheng contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China

    Jie Zeng, Jie-Yang Jin, Yong-Jiang Mao, Huan-Yi Guo & Rong-Qin Zheng

  2. Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Sun Yat-Sen University, Guangzhou, China

    Jian Zheng

  3. Department of Medical Ultrasonics, Third Hospital of Longgang, Shenzhen, China

    Jian Zheng

  4. Department of Hepatobiliary Surgery and Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China

    Ming-De Lu

  5. Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, SZ University Town, Shenzhen, 518055, China

    Hai-Rong Zheng

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  1. Jie Zeng
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Corresponding authors

Correspondence to Hai-Rong Zheng or Rong-Qin Zheng.

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Guarantor

The scientific guarantor of this publication is Rong-Qin Zheng.

Conflict of interest

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.

Statistics and biometry

Cai-Xia Zhang, PhD (School of Public Health, Sun Yat-Sen University) kindly provided statistical advice for this manuscript.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in two articles entitled "Comparison of 2-D shear wave elastography and transient elastography for assessing liver fibrosis in chronic hepatitis B" and “Diagnostic accuracy of two-dimensional shear wave elastography for the non-invasive staging of hepatic fibrosis in chronic hepatitis B: a cohort study with internal validation”.

Methodology

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• performed at one institution

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Zeng, J., Zheng, J., Jin, JY. et al. Shear wave elastography for liver fibrosis in chronic hepatitis B: Adapting the cut-offs to alanine aminotransferase levels improves accuracy. Eur Radiol 29, 857–865 (2019). https://doi.org/10.1007/s00330-018-5621-x

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