Medicine Department, Hospital General of Castellon, University Jaume I and University of Valencia, Castellon, Spain.
J Viral Hepat. 2012 Oct;19(10):711-5. doi: 10.1111/j.1365-2893.2012.01608.x. Epub 2012 Mar 27.
Transient elastography is a useful method to assess liver fibrosis, but uncertainties still exist regarding reliability and reproducibility of the technique. We aimed to improve knowledge on interobserver variability with the procedure and tried to find factors associated with such variability. This was a cross-sectional study to compare the results of transient elastography performed by two different operators, one test made just after the other. We assessed both results with correlation tests and with repeated parametric or nonparametric tests, as needed. We also carried out a multivariate analysis to find factors associated with discrepancy in the results obtained by the two operators. We included a total of 333 pairs of transient elastography tests, belonging to 274 different patients. A total of 325 pairs of tests (97.6%) were valid. Results of the first and the second tests were, respectively, median (and interquartile range) of direct measurement 6.2 (4.6-10.6) and 6.0 (4.4-10.1) kPa (P = 0.012), and mean ± standard deviation of log(10) of direct measurement 0.892 ± 0.316 and 0.871 ± 0.324 (P = 0.001). In 87 pairs of tests (26.7%), a discrepancy of at least 2 kPa between both results was found, and in 15 pairs of tests (4.6%), a discrepancy of at least 10 kPa was found. Discordance of at least one stage between both measurements was noted in 74 pairs of tests (22.8%). An association was found between higher stiffness and discrepancy between both operators (P < 0.001). Although transient elastography is a very convenient test to assess liver fibrosis in clinical practice, interobserver discrepancy in results is common and represents a significant problem with the technique. Discrepant results are more common in patients with higher values of stiffness.
瞬时弹性成像（TE）是一种评估肝纤维化的有用方法，但该技术的可靠性和可重复性仍存在不确定性。我们旨在提高对该方法观察者间变异性的认识，并试图找到与这种变异性相关的因素。这是一项横断面研究，比较了两名不同操作者进行的瞬时弹性成像结果，一次检查紧接着另一次检查。我们通过相关检验以及需要时的重复参数或非参数检验来评估这两种结果。我们还进行了多变量分析，以找到与两名操作者获得的结果差异相关的因素。我们共纳入了 333 对瞬时弹性成像检查，来自 274 名不同的患者。共有 325 对检查（97.6%）是有效的。第一次和第二次检查的结果分别为直接测量中位数（四分位间距）6.2（4.6-10.6）和 6.0（4.4-10.1）kPa（P = 0.012），直接测量的对数（10）的平均值±标准差分别为 0.892±0.316 和 0.871±0.324（P = 0.001）。在 87 对检查（26.7%）中，发现两次结果之间至少存在 2 kPa 的差异，在 15 对检查（4.6%）中，发现至少 10 kPa 的差异。在 74 对检查（22.8%）中，两次测量之间的至少一个阶段存在差异。我们发现硬度越高，两名操作者之间的差异越大（P < 0.001）。虽然瞬时弹性成像在临床实践中是一种非常方便的评估肝纤维化的检查方法，但结果的观察者间差异很常见，是该技术的一个重大问题。在硬度值较高的患者中，差异结果更为常见。
