title: Non-invasive evaluation of liver fibrosis: a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of TE and MRE and establish cutoff levels and diagnostic strategies for both techniques, enabling selection of patients for liver biopsy.
  
  
  METHODS
  One hundred three patients with chronic hepatitis B or C and liver biopsy were prospectively included. Areas under curves (AUROC) were compared for TE and MRE for METAVIR fibrosis grade ≥ F2 and ≥F3. We defined cutoff values for selection of patients with F0-F1 (sensitivity >95%) and for significant fibrosis F2-F4 (specificity >95%).
  
  
  RESULTS
  Following exclusions, 85 patients were analysed (65 CHB, 19 CHC, 1 co-infected). Fibrosis stages were F0 (n = 3), F1 (n = 53), F2 (n = 15), F3 (n = 8) and F4 (n = 6). TE and MRE accuracy were comparable [AUROCTE ≥ F2: 0.914 (95% CI: 0.857-0.972) vs. AUROCMRE ≥ F2: 0.909 (0.840-0.977), P = 0.89; AUROCTE ≥ F3: 0.895 (0.816-0.974) vs. AUROCMRE ≥ F3: 0.928 (0.874-0.982), P = 0.42]. Cutoff values of <5.2 and ≥8.9 kPa (TE) and <1.66 and ≥2.18 kPa (MRE) diagnosed 64% and 66% of patients correctly as F0-F1 or F2-F4. A conditional strategy in inconclusive test results increased diagnostic yield to 80%.
  
  
  CONCLUSIONS
  TE and MRE have comparable accuracy for detecting significant fibrosis, which was reliably detected or excluded in two-thirds of patients. A conditional strategy further increased diagnostic yield to 80%.
  
  
  CONCLUSIONS
  • Both ultrasound-based transient elastography and magnetic resonance elastography can assess hepatic fibrosis. • Both have comparable accuracy for detecting liver fibrosis in viral hepatitis. • The individual techniques reliably detect or exclude significant liver fibrosis in 66 %. • A conditional strategy for inconclusive findings increases the number of correct diagnoses.
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands, a.e.bohte@amc.nl.
authors.forename: Anneloes E
authors.initials: AE
authors.lastname: Bohte
authors.forename: Annikki
authors.initials: A
authors.lastname: de Niet
authors.forename: Louis
authors.initials: L
authors.lastname: Jansen
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Nederveen
authors.forename: Joanne
authors.initials: J
authors.lastname: Verheij
authors.forename: Valeska
authors.initials: V
authors.lastname: Terpstra
authors.forename: Ralph
authors.initials: R
authors.lastname: Sinkus
authors.forename: Karin M J
authors.initials: KM
authors.lastname: van Nieuwkerk
authors.forename: Rob J
authors.initials: RJ
authors.lastname: de Knegt
authors.forename: Bert C
authors.initials: BC
authors.lastname: Baak
authors.forename: Peter L M
authors.initials: PL
authors.lastname: Jansen
authors.forename: Henk W
authors.initials: HW
authors.lastname: Reesink
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult