Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France; IMAG, CNRS, Montpellier University, CHU Montpellier, Montpellier, France.
Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
Clin Gastroenterol Hepatol. 2020 Dec;18(13):2971-2979.e3. doi: 10.1016/j.cgh.2020.04.034. Epub 2020 Apr 26.
BACKGROUND & AIMS: Inter-platform variation in liver stiffness evaluation (LSE) could hinder dissemination and clinical implementation of new ultrasound methods. We aimed to determine whether measurements of liver stiffness by bi-dimensional shear wave elastography (2D-SWE) with a Supersonic Imagine apparatus are comparable to those made by vibration-controlled transient elastography (VCTE).
We collected data from 1219 consecutive patients with chronic liver disease who underwent LSE by VCTE and 2D-SWE (performed by blinded operators), on the same day, at a single center in France from September 2011 through June 2019. We assessed the ability of liver stiffness value distributions and 2D-SWE performances to identify patients with compensated advanced chronic liver disease (cACLD) according to the Baveno VI criteria, based on VCTE cut-off values.
VCTE and 2D-SWE values correlated (Pearson's correlation coefficient, 0.882; P < .0001; Lin concordance coefficient, 0.846; P < .0001). The median stiffness values were 6.7 kPa with VCTE (interquartile range, 4.8-11.6 kPa) and 7.1 kPa with 2D-SWE (interquartile range, 5.4-11.1 kPa) (P = .736). 2D-SWE values were slightly higher in the low percentiles and lower in the high percentiles; the best match with VCTE values were at approximately 7-9 kPa. The area under the curve of 2D-SWE for identifying of VCTE values below 10 was 0.964 (95% CI, 0.952-0.976) and for VCTE values above 15 kPa was 0.976 (95% CI, 0.963-0.988), with Youden index-associated cut-off values of 9.5 and 13kPa and best accuracy cut-off values of 10 kPa and 14 kPa, respectively. A 2D-SWE cut-off value of 10 kPa detected VCTE values below 10k Pa with 92% sensitivity, 87% specificity, and 91% accuracy.
Measurement of liver stiffness by VCTE or 2D-SWE produces comparable results. 2D-SWE accurately identifies patients with cACLD according to the Baveno VI criteria based on VCTE cut-off values. A 10 kPa 2D-SWE cut-off value can be used to rule out cACLD.
肝硬度评估（LSE）在不同平台上的差异可能会阻碍新超声方法的传播和临床应用。本研究旨在确定二维剪切波弹性成像（2D-SWE）与超声瞬时弹性成像（VCTE）测量肝硬度的结果是否具有可比性。
我们收集了 2011 年 9 月至 2019 年 6 月在法国某单一中心连续接受 VCTE 和 2D-SWE（由盲法操作员进行）的 1219 例慢性肝病患者的数据。我们根据 VCTE 截断值，评估了肝硬度值分布和 2D-SWE 性能在识别根据 Baveno VI 标准诊断为代偿性晚期慢性肝病（cACLD）患者方面的能力。
VCTE 和 2D-SWE 值呈正相关（Pearson 相关系数为 0.882；P<0.0001；Lin 一致性系数为 0.846；P<0.0001）。VCTE 中位数为 6.7kPa（四分位间距为 4.8-11.6kPa），2D-SWE 中位数为 7.1kPa（四分位间距为 5.4-11.1kPa）（P=0.736）。2D-SWE 在低值范围稍高，在高值范围稍低；与 VCTE 值最匹配的范围约为 7-9kPa。2D-SWE 对 VCTE 值低于 10kPa 的曲线下面积为 0.964（95%CI，0.952-0.976），对 VCTE 值高于 15kPa 的曲线下面积为 0.976（95%CI，0.963-0.988），对应的约登指数截断值为 9.5kPa 和 13kPa，最佳准确性截断值为 10kPa 和 14kPa。2D-SWE 截断值为 10kPa 时，对 VCTE 值低于 10kPa 的患者的敏感性为 92%，特异性为 87%，准确性为 91%。
VCTE 或 2D-SWE 测量肝硬度的结果具有可比性。2D-SWE 可根据 VCTE 截断值准确识别符合 Baveno VI 标准的 cACLD 患者。2D-SWE 截断值为 10kPa 可用于排除 cACLD。
