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Eur Radiol. 2019 Jul 5. doi: 10.1007/s00330-019-06331-4. [Epub ahead of print]

Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis.

Author information

1
Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.
2
Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
3
Medical Physics Unit, McGill University, Montreal, Canada.
4
Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada.
5
Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada.
6
Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada.
7
MR Clinical Science, Philips Healthcare Canada, Markham, Canada.
8
Department of Pathology, McGill University, Montreal, Canada.
9
Service of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
10
Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.
11
Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
12
Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada. an.tang@umontreal.ca.
13
Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada. an.tang@umontreal.ca.
14
Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada. an.tang@umontreal.ca.

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.

KEYWORDS:

Classification; Elasticity imaging techniques; Fibrosis; Liver; Prospective studies

PMID:
31278577
DOI:
10.1007/s00330-019-06331-4

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