Quantitative Elastography of Liver Fibrosis and Spleen Stiffness in Chronic Hepatitis B Carriers: Comparison of Shear-Wave Elastography and Transient Elastography with Liver Biopsy Correlation

Abstract

Purpose: To document utility of shear-wave (SW) elastography for assessing liver fibrosis in chronic hepatitis B and to com- pare its performance with that of transient elastography. Materials and Methods: Ethics committee approved the study, and informed con- sent was obtained. Patients with liver biopsy correlation (n = 226) and healthy patients (n = 171) were analyzed. Results of SW elastography of liver, SW elastography of spleen, and transient elastography of liver were compared and correlated according to METAVIR scores. Areas un- der the receiver operating characteristic curve (AUCs), binary logistic regression, and Delong test were used. Results: AUC for SW elastography of liver, transient elastography of liver, and SW elastography of spleen was, respectively, 0.86, 0.80, and 0.81 for fibrosis (?F1 stage); 0.88, 0.78, and 0.82 for moderate fibrosis (?F2 stage); 0.93, 0.83, and 0.83 for severe fibrosis (?F3 stage); and 0.98, 0.92, and 0.84 for cirrhosis (F4 stage). SW elastography of liver showed significantly higher accuracy than transient elastog- raphy of liver and SW elastography of spleen in all fibrosis stages (P = .01–.04). SW elastography of spleen showed similar accuracy with transient elastography of liver (P = .21–.99). Combination SW elastography of liver and SW elastography of spleen to predict fibrosis staging showed diagnostic accuracy not further improved compared with SW elastography of liver alone (similar AUC; ?F1, P = .87; ?F2, P = .81; ?F3, P = .84; ?F4, P = .88). SW elas- tography of liver had higher successful rate than transient elastography of liver (98.9% vs 89.6%). Prevalence of dis- cordance in at least two stages with liver histologic staging was 10.2% (23 of 226) for SW elastography of liver and 28.2% (58 of 206) for SW elastography of spleen. Conclusion: SW elastography provides more accurate correlation of liver elasticity with liver fibrosis stage compared with transient elastography, especially in identification of stage F2 or greater.