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. 2016 Feb;35(2):401-12.
doi: 10.7863/ultra.15.03036. Epub 2016 Jan 18.

Performance of 2-Dimensional Ultrasound Shear Wave Elastography in Liver Fibrosis Detection Using Magnetic Resonance Elastography as the Reference Standard: A Pilot Study

Pengfei Song  1 , Daniel C Mellema  1 , Shannon P Sheedy  1 , Duane D Meixner  1 , Ryan M Karshen  1 , Matthew W Urban  1 , Armando Manduca  1 , William Sanchez  1 , Matthew R Callstrom  1 , James F Greenleaf  1 , Shigao Chen  2
Affiliations

Performance of 2-Dimensional Ultrasound Shear Wave Elastography in Liver Fibrosis Detection Using Magnetic Resonance Elastography as the Reference Standard: A Pilot Study

Pengfei Song et al. J Ultrasound Med. 2016 Feb.

Abstract

Objectives: To investigate the correlation between 2-dimensional (2D) ultrasound shear wave elastography (SWE) and magnetic resonance elastography (MRE) in liver stiffness measurement and the diagnostic performance of 2D SWE for liver fibrosis when imaging from different intercostal spaces and using MRE as the reference standard.

Methods: Two-dimensional SWE was performed on 47 patients. One patient was excluded from the study. Each of the remaining 46 patients underwent same-day MRE for clinical purposes. The study was compliant with the Health Insurance Portability and Accountability Act and approved by the Institutional Review Board. Informed consent was obtained from each patient. Two-dimensional SWE measurements were acquired from the ninth, eighth, and seventh intercostal spaces. The correlation with MRE was calculated at each intercostal space and multiple intercostal spaces combined. The performance of 2D SWE in diagnosing liver fibrosis was evaluated by receiver operating characteristic curve analysis using MRE as the standard.

Results: The 47 patients who initially underwent 2D SWE included 22 female and 25 male patients (age range, 19-77 years). The highest correlation between 2D SWE and MRE was from the eighth and seventh intercostal spaces (r = 0.68-0.76). The ranges of the areas under the receiver operating characteristic curves for separating normal or inflamed livers from fibrotic livers using MRE as the clinical reference were 0.84 to 0.92 when using the eighth and seventh intercostal spaces individually and 0.89 to 0.90 when combined.

Conclusions: The results suggest that 2D SWE and MRE are well correlated when SWE is performed at the eighth and seventh intercostal spaces. The ninth intercostal space is less reliable for diagnosing fibrosis with 2D SWE. Combining measurements from multiple intercostal spaces does not significantly improve the performance of 2D SWE for detection of fibrosis.

Keywords: liver fibrosis; magnetic resonance elastography; shear wave elastography.

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Figures

Figure 1
Figure 1
2-D ultrasound SWE images in a patient without fibrosis (a) and in a patient with advanced fibrosis (b).
Figure 2
Figure 2
Plot of the average Interquartile Range (IQR)/Median ratios of shear wave speed measurements from individual intercostal spaces. The error bar was plotted from the standard deviation.
Figure 3
Figure 3
Scatter plots and linear regression analysis of shear wave speed measurements by MRE and 2-D SWE at different intercostal spaces.
Figure 4
Figure 4
Scatter plots and linear regression analysis of shear wave speed measurements by MRE and 2-D SWE when combining measurements from different intercostal spaces.
Figure 5
Figure 5
ROC curves of LE9 2-D SWE in differentiating normal or inflamed livers from fibrotic livers with MRE ≤ 1.71 m/s as the threshold.
Figure 6
Figure 6
ROC curves of LE9 2-D SWE in differentiating normal or inflamed livers from fibrotic livers with MRE ≤ 1.71 m/s as the threshold. The shear wave speed measurements were combined from multiple intercostal spaces.
Figure 7
Figure 7
Box plot of the shear wave speed measurements from 2-D SWE and MRE for all the patients. On each box, the central red mark is the median, the edges of the box are the 25th and 75th percentiles, the whiskers extend to the most extreme data points (±2.7 standard deviation) excluding the outliers, which are plotted individually (the red cross mark).
Figure 8
Figure 8
Intra- and inter-rater reliability tests for the SWE technique used in this study. The data points were from the 8th intercostal space under PEN mode. The Pearson correlation (r) and the intra-class correlation (ICC) are also shown in the plot.
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