title: Utility of real-time shear wave elastography for assessing liver fibrosis in patients with chronic hepatitis C infection without cirrhosis: Comparison of liver fibrosis indices.
abstract: OBJECTIVE
  To clarify the diagnostic impact of liver fibrosis except for cirrhosis identified using shear wave elastography (SWE) in chronic hepatitis C (CHC) patients, and to compare the performance in diagnosing liver fibrosis among SWE and liver fibrosis indices.
  
  
  METHODS
  A total of 55 CHC patients who underwent liver biopsy were analyzed. The diagnostic performance for identifying significant liver fibrosis (F2-F3) for SWE, FIB-4 index, aspartate aminotransferase-to-platelet ratio index (APRI) and Forns' index was assessed using receiver-operator curve (ROC) analysis.
  
  
  RESULTS
  The median SWE elasticity value, FIB-4 index, APRI and Forns' index in the F0-F1 and F2-F3 groups were 6.3 kPa and 13.1 kPa; 1.52 and 4.45; 0.41 and 1.43; and 7.69 and 8.85, respectively (P < 0.001 for all four methods). Multivariate analysis showed that SWE was independently associated with the presence of significant liver fibrosis (odds ratio, 2.52; 95% confidence interval, 1.49-4.28; P < 0.001). The area under the ROC curve for SWE in diagnosing significant liver fibrosis was 0.94, indicating high diagnostic value, compared with 0.86, 0.88 and 0.83, for the FIB-4 index, APRI and Forns' index, respectively, which corresponds to moderate diagnostic value. The accuracy of SWE, FIB-4 index, APRI and Forns' index for diagnosing significant liver fibrosis was 90.9%, 76.4%, 74.5% and 67.2%, respectively.
  
  
  CONCLUSIONS
  SWE has excellent ability for diagnosing significant liver fibrosis in CHC even when patients with cirrhosis are excluded. The diagnostic performance of SWE is superior to that of three liver fibrosis indices.
authors.affiliation: Departments of Gastroenterology and Hepatology.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.affiliation: Departments of Gastroenterology and Hepatology.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.affiliation: Departments of Gastroenterology and Hepatology.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.affiliation: Departments of Gastroenterology and Hepatology.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ito
authors.affiliation: Radiology.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sone
authors.affiliation: Pathological Diagnosis.
authors.forename: Seiji
authors.initials: S
authors.lastname: Okuda
authors.affiliation: Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Tsuji
authors.affiliation: Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Imayoshi
authors.affiliation: Department of Radiological Technology, Suzuka University of Medicine Science, Suzuka, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Yasuda
keywords: hepatitis C; liver fibrosis; liver fibrosis index; shear wave elastography