Ryu Hwaseong, Ahn Su Joa, Yoon Jeong Hee, Lee Jeong Min
Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea.
Ultrasonography. 2019 Oct;38(4):345-354. doi: 10.14366/usg.19001. Epub 2019 Mar 23.
The purpose of this study was to compare the technical success rate and reliability of measurements made using three shear wave elastography (SWE) techniques and to assess the inter-platform reproducibility of the resultant liver stiffness measurements.
This prospective study included 54 patients with liver disease. Liver stiffness (LS) measurements were obtained using 2-point SWE techniques (Virtual Touch Quantification and S-Shearwave) and 2-dimensional (2D) SWE, with transient elastography (TE) serving as the reference standard. The technical success rates and measurement reliability of the three techniques were compared. LS values measured using the three SWE techniques and TE were compared using Spearman correlation coefficients and 95% Bland-Altman limits of agreement. Intra-class correlation coefficients (ICC) were used to analyze the inter-platform reproducibility of LS measurements.
The three SWE techniques and TE showed similar technical success rates (P=0.682) but demonstrated significant differences in the reliability of LS measurements (P=0.006) and mean LS measurements (P<0.001). Despite strong correlations (r=0.73-0.94) between SWE systems, various degrees of inter-platform reproducibility (ICC, 0.58-0.92) were observed for the three SWE techniques. The best agreement was observed between S-Shearwave and TE (ICC, 0.92), and the worst agreement was observed between 2D-SWE and TE (ICC, 0.58). In the BlandAltman analysis, a tendency toward lower LS values with the three SWE techniques than with TE in patients with F3 and F4 disease was observed.
Significant inter-system variability was observed in LS measurements made using the three SWE techniques. Therefore, LS values measured using different SWE techniques should not be used interchangeably for longitudinal follow-up.
本研究旨在比较三种剪切波弹性成像（SWE）技术的技术成功率和测量可靠性，并评估所得肝脏硬度测量值的平台间再现性。
这项前瞻性研究纳入了54例肝病患者。使用两点SWE技术（虚拟触诊定量和S剪切波）和二维（2D）SWE获得肝脏硬度（LS）测量值，以瞬时弹性成像（TE）作为参考标准。比较了这三种技术的技术成功率和测量可靠性。使用Spearman相关系数和95%布兰德-奥特曼一致性界限比较了使用三种SWE技术和TE测量的LS值。使用组内相关系数（ICC）分析LS测量的平台间再现性。
三种SWE技术和TE显示出相似的技术成功率（P=0.682），但在LS测量的可靠性（P=0.006）和平均LS测量值（P<0.001）方面存在显著差异。尽管SWE系统之间存在强相关性（r=0.73 - 0.94），但三种SWE技术观察到不同程度的平台间再现性（ICC，0.58 - 0.92）。S剪切波和TE之间的一致性最好（ICC，0.92），2D - SWE和TE之间的一致性最差（ICC，0.58）。在布兰德-奥特曼分析中，观察到F3和F4期疾病患者中，三种SWE技术测量的LS值有低于TE测量值的趋势。
使用三种SWE技术进行的LS测量中观察到显著的系统间变异性。因此，使用不同SWE技术测量的LS值在纵向随访中不应互换使用。
