title: Liver fibrosis evaluation using real-time shear wave elastography: applicability and diagnostic performance using methods without a gold standard.
abstract: OBJECTIVE
  Real-time shear wave elastography (SWE) is a new two-dimensional transient elastography which had no assessment of factors associated with reliability, and had limited comparisons with other validated fibrosis biomarkers. The aim was to assess the applicability and performances of SWE for the diagnosis of fibrosis as compared with FibroTest (FT) and liver stiffness measurement (LSM) by transient elastography using two probes (TE-M and TE-XL).
  
  
  METHODS
  Without a gold standard, the strength of concordance, discordance analysis and latent class analysis (LCM) were applied.
  
  
  RESULTS
  422 patients were included. The applicability of SWE (90.0%) was significantly lower than that of FT (97.9%; p <0.0001) and did not differ from those of TE-M (90.5%) and TE-XL (90.3%); it was higher though for SWE (86%) in 22 patients with ascites vs. 55% using TE-M (p=0.04). For the diagnosis of all fibrosis stages as presumed by FT, the performance of SWE was highly significant (Obuchowski measure 0.807 ± 0.013 [m ± se]), but lower than those of TE-M (0.852; p=0.0007) and TE-XL (0.834; p=0.046). SWE had a low performance for discrimination between F0 and F1. For the diagnosis of cirrhosis using LCM, SWE specificities were all equal to 99%, and SWE sensitivities ranged from 0.47 to 0.64. For the diagnosis of non-cirrhotic stages, the results were heterogeneous.
  
  
  CONCLUSIONS
  The performance of SWE for the diagnosis of cirrhosis was similar to those of FT and TE. SWE applicability was lower than that of FT, but greater than that of TE in patients with ascites.
authors: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France. tpoynard@teaser.fr
authors: Thierry
authors: T
authors: Poynard
authors: Mona
authors: M
authors: Munteanu
authors: Elena
authors: E
authors: Luckina
authors: Hugo
authors: H
authors: Perazzo
authors: Yen
authors: Y
authors: Ngo
authors: Luca
authors: L
authors: Royer
authors: Larysa
authors: L
authors: Fedchuk
authors: Florence
authors: F
authors: Sattonnet
authors: Raluca
authors: R
authors: Pais
authors: Pascal
authors: P
authors: Lebray
authors: Marika
authors: M
authors: Rudler
authors: Dominique
authors: D
authors: Thabut
authors: Vlad
authors: V
authors: Ratziu
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity