Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis
Objectives To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE). Methods This prospective, cross-sectional, dual-center imaging study included 100 patients wit...
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| Veröffentlicht in: | European radiology Jg. 29; H. 12; S. 6477 - 6488 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.12.2019
Springer Nature B.V |
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| ISSN: | 0938-7994, 1432-1084, 1432-1084 |
| Online-Zugang: | Volltext |
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| Abstract | Objectives
To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE).
Methods
This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method.
Results
TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71;
p
< 0.05) or pSWE (0.88 vs. 0.73;
p
< 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75;
p
< 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85–0.93), 0.90 (95% CI 0.85–0.94), and 0.94 (95% CI 0.91–0.96).
Conclusion
MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis.
Trial registration
NCT02044523
Key Points
• The technical failure rate was similar between MRE and US-based elastography techniques.
• Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis.
• MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis. |
|---|---|
| AbstractList | To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE).OBJECTIVESTo perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE).This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method.METHODSThis prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method.TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85-0.93), 0.90 (95% CI 0.85-0.94), and 0.94 (95% CI 0.91-0.96).RESULTSTE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85-0.93), 0.90 (95% CI 0.85-0.94), and 0.94 (95% CI 0.91-0.96).MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis.CONCLUSIONMRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis.NCT02044523 KEY POINTS: • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis.TRIAL REGISTRATIONNCT02044523 KEY POINTS: • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis. To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE). This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method. TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85-0.93), 0.90 (95% CI 0.85-0.94), and 0.94 (95% CI 0.91-0.96). MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis. NCT02044523 KEY POINTS: • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis. Objectives To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE). Methods This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method. Results TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85–0.93), 0.90 (95% CI 0.85–0.94), and 0.94 (95% CI 0.91–0.96). Conclusion MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis. Trial registration NCT02044523 Key Points • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis. ObjectivesTo perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE).MethodsThis prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method.ResultsTE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85–0.93), 0.90 (95% CI 0.85–0.94), and 0.94 (95% CI 0.91–0.96).ConclusionMRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis.Trial registrationNCT02044523Key Points• The technical failure rate was similar between MRE and US-based elastography techniques.• Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis.• MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis. |
| Author | Wartelle-Bladou, Claire Sylvestre, Marie-Pierre Giard, Jeanne-Marie Gao, Zu-Hua Cloutier, Guy Wong, Philip Sebastiani, Giada Lefebvre, Thierry Tang, An Olivié, Damien Nguyen, Bich N. Castel, Hélène Gilbert, Guillaume Ilinca, André Murphy-Lavallée, Jessica |
| Author_xml | – sequence: 1 givenname: Thierry surname: Lefebvre fullname: Lefebvre, Thierry organization: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Medical Physics Unit, McGill University – sequence: 2 givenname: Claire surname: Wartelle-Bladou fullname: Wartelle-Bladou, Claire organization: Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal – sequence: 3 givenname: Philip surname: Wong fullname: Wong, Philip organization: Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC) – sequence: 4 givenname: Giada surname: Sebastiani fullname: Sebastiani, Giada organization: Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC) – sequence: 5 givenname: Jeanne-Marie surname: Giard fullname: Giard, Jeanne-Marie organization: Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal – sequence: 6 givenname: Hélène surname: Castel fullname: Castel, Hélène organization: Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal – sequence: 7 givenname: Jessica surname: Murphy-Lavallée fullname: Murphy-Lavallée, Jessica organization: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal – sequence: 8 givenname: Damien surname: Olivié fullname: Olivié, Damien organization: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal – sequence: 9 givenname: André surname: Ilinca fullname: Ilinca, André organization: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM) – sequence: 10 givenname: Marie-Pierre surname: Sylvestre fullname: Sylvestre, Marie-Pierre organization: Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Department of Social and Preventive Medicine, École de santé publique de l’Université de Montréal (ESPUM) – sequence: 11 givenname: Guillaume surname: Gilbert fullname: Gilbert, Guillaume organization: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, MR Clinical Science, Philips Healthcare Canada – sequence: 12 givenname: Zu-Hua surname: Gao fullname: Gao, Zu-Hua organization: Department of Pathology, McGill University – sequence: 13 givenname: Bich N. surname: Nguyen fullname: Nguyen, Bich N. organization: Service of Pathology, Centre hospitalier de l’Université de Montréal (CHUM) – sequence: 14 givenname: Guy surname: Cloutier fullname: Cloutier, Guy organization: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Institute of Biomedical Engineering, Université de Montréal, Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM) – sequence: 15 givenname: An orcidid: 0000-0001-8967-5503 surname: Tang fullname: Tang, An email: an.tang@umontreal.ca organization: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Institute of Biomedical Engineering, Université de Montréal |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31278577$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | European Society of Radiology 2019 European Radiology is a copyright of Springer, (2019). All Rights Reserved. |
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| DOI | 10.1007/s00330-019-06331-4 |
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| Keywords | Prospective studies Elasticity imaging techniques Liver Fibrosis Classification |
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To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography... To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and... ObjectivesTo perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography... |
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| Title | Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis |
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