Liver Imaging Group, Altman Clinical and Translational Research Institute, Department of Radiology, University of California, San Diego, 9452 Medical Center Drive, La Jolla, CA, 92037, USA.
Department of Pathology, University of California, San Diego, 9452 Medical Center Drive, La Jolla, CA, 92037, USA.
Eur Radiol. 2022 Apr;32(4):2457-2469. doi: 10.1007/s00330-021-08369-9. Epub 2021 Dec 2.
To compare the diagnostic accuracy of US shear wave elastography (SWE) and magnetic resonance elastography (MRE) for classifying fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD).
Patients from a prospective single-center cohort with clinical liver biopsy for known or suspected NAFLD underwent contemporaneous SWE and MRE. AUCs for classifying biopsy-determined liver fibrosis stages ≥ 1, ≥ 2, ≥ 3, and = 4, and their respective performance parameters at cutoffs providing ≥ 90% sensitivity or specificity were compared between SWE and MRE.
In total, 100 patients (mean age, 51.8 ± 12.9 years; 46% males; mean BMI 31.6 ± 4.7 kg/m) with fibrosis stage distribution (stage 0/1/2/3/4) of 43, 36, 5, 10, and 6%, respectively, were included. AUCs (and 95% CIs) for SWE and MRE were 0.65 (0.54-0.76) and 0.81 (0.72-0.89), 0.81 (0.71-0.91) and 0.94 (0.89-1.00), 0.85 (0.74-0.96) and 0.95 (0.89-1.00), and 0.91 (0.79-1.00) and 0.92 (0.83-1.00), for detecting fibrosis stage ≥ 1, ≥ 2, ≥ 3, and = 4, respectively. The differences were significant for detecting fibrosis stage ≥ 1 and ≥ 2 (p < 0.01) but not otherwise. At ≥ 90% sensitivity cutoff, MRE yielded higher specificity than SWE at diagnosing fibrosis stage ≥ 1, ≥ 2, and ≥ 3. At ≥ 90% specificity cutoff, MRE yielded higher sensitivity than SWE at diagnosing fibrosis stage ≥ 1 and ≥ 2.
In adults with NAFLD, MRE was more accurate than SWE in diagnosing stage ≥ 1 and ≥ 2 fibrosis, but not stage ≥ 3 or 4 fibrosis.
• For detecting any fibrosis or mild fibrosis, MR elastography was significantly more accurate than shear wave elastography. • For detecting advanced fibrosis and cirrhosis, MRE and SWE did not differ significantly in accuracy. • For excluding advanced fibrosis and potentially ruling out the need for biopsy, SWE and MRE did not differ significantly in negative predictive value. • Neither SWE nor MRE had sufficiently high positive predictive value to rule in advanced fibrosis.
比较超声剪切波弹性成像（SWE）和磁共振弹性成像（MRE）诊断非酒精性脂肪性肝病（NAFLD）患者纤维化分期的准确性。
前瞻性单中心队列研究中，对已知或疑似 NAFLD 的患者进行临床肝活检，同时进行 SWE 和 MRE。比较 SWE 和 MRE 对肝活检确定的纤维化分期≥1、≥2、≥3 和≥4 以及各自在提供≥90%灵敏度或特异性的截定点的分类性能参数。
共纳入 100 例患者（平均年龄 51.8±12.9 岁；46%为男性；平均 BMI 31.6±4.7 kg/m），纤维化分期分布分别为 43 例 0/1/2/3/4 期，36 例 0/1/2/3 期，5 例 0/1/2 期，10 例 0/1 期，6 例 0 期。SWE 和 MRE 的 AUC（95%CI）分别为 0.65（0.54-0.76）和 0.81（0.72-0.89）、0.81（0.71-0.91）和 0.94（0.89-1.00）、0.85（0.74-0.96）和 0.95（0.89-1.00）以及 0.91（0.79-1.00）和 0.92（0.83-1.00），用于检测纤维化分期≥1、≥2、≥3 和≥4。检测纤维化分期≥1 和≥2 时，SWE 和 MRE 之间的差异具有统计学意义（p<0.01），但其他分期无差异。在 90%灵敏度截定点，MRE 在诊断纤维化分期≥1、≥2 和≥3 时的特异性高于 SWE。在 90%特异性截定点，MRE 在诊断纤维化分期≥1 和≥2 时的灵敏度高于 SWE。
在患有非酒精性脂肪性肝病的成年人中，MRE 比 SWE 更准确地诊断出≥1 期和≥2 期纤维化，但不能诊断出≥3 期或 4 期纤维化。
