title: Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shear-wave elastography and transient elastography with liver biopsy correlation.
abstract: OBJECTIVE
  To document utility of shear-wave (SW) elastography for assessing liver fibrosis in chronic hepatitis B and to compare its performance with that of transient elastography.
  
  
  METHODS
  Ethics committee approved the study, and informed consent was obtained. Patients with liver biopsy correlation (n = 226) and healthy patients (n = 171) were analyzed. Results of SW elastography of liver, SW elastography of spleen, and transient elastography of liver were compared and correlated according to METAVIR scores. Areas under the receiver operating characteristic curve (AUCs), binary logistic regression, and Delong test were used.
  
  
  RESULTS
  AUC for SW elastography of liver, transient elastography of liver, and SW elastography of spleen was, respectively, 0.86, 0.80, and 0.81 for fibrosis (≥ F1 stage); 0.88, 0.78, and 0.82 for moderate fibrosis (≥ F2 stage); 0.93, 0.83, and 0.83 for severe fibrosis (≥ F3 stage); and 0.98, 0.92, and 0.84 for cirrhosis (F4 stage). SW elastography of liver showed significantly higher accuracy than transient elastography of liver and SW elastography of spleen in all fibrosis stages (P = .01-.04). SW elastography of spleen showed similar accuracy with transient elastography of liver (P = .21-.99). Combination SW elastography of liver and SW elastography of spleen to predict fibrosis staging showed diagnostic accuracy not further improved compared with SW elastography of liver alone (similar AUC; ≥ F1, P = .87; ≥ F2, P = .81; ≥ F3, P = .84; ≥ F4, P = .88). SW elastography of liver had higher successful rate than transient elastography of liver (98.9% vs 89.6%). Prevalence of discordance in at least two stages with liver histologic staging was 10.2% (23 of 226) for SW elastography of liver and 28.2% (58 of 206) for SW elastography of spleen.
  
  
  CONCLUSIONS
  SW elastography provides more accurate correlation of liver elasticity with liver fibrosis stage compared with transient elastography, especially in identification of stage F2 or greater.
authors.affiliation: From the Institute of Digestive Disease (J.S., V.W.W., G.L.W., A.M.C., S.H.C., H.L.C., W.C.C.), Department of Imaging and Interventional Radiology (V.Y.L., J.A., A.T.A., W.C.C.), Department of Medicine and Therapeutics (J.S., V.W.W., G.L.W., A.M.C., S.H.C., H.L.C.), and Department of Anatomical and Cellular Pathology (A.W.C., P.C.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, Hong Kong, SAR, China 852.
authors.forename: Vivian Yee-fong
authors.initials: VY
authors.lastname: Leung
authors.forename: Jiayun
authors.initials: J
authors.lastname: Shen
authors.forename: Vincent Wai-sun
authors.initials: VW
authors.lastname: Wong
authors.forename: Jill
authors.initials: J
authors.lastname: Abrigo
authors.forename: Grace Lai-hung
authors.initials: GL
authors.lastname: Wong
authors.forename: Angel Mei-ling
authors.initials: AM
authors.lastname: Chim
authors.forename: Shirley Ho-ting
authors.initials: SH
authors.lastname: Chu
authors.forename: Anthony Wing-hung
authors.initials: AW
authors.lastname: Chan
authors.forename: Paul Cheung-lung
authors.initials: PC
authors.lastname: Choi
authors.forename: Anil T
authors.initials: AT
authors.lastname: Ahuja
authors.forename: Henry Lik-yuen
authors.initials: HL
authors.lastname: Chan
authors.forename: Winnie Chiu-wing
authors.initials: WC
authors.lastname: Chu
mesh_terms: D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000000981:diagnostic imaging* / Q000473:pathology