title: Two-dimensional shear-wave elastography and conventional US: the optimal evaluation of liver fibrosis and cirrhosis.
abstract: OBJECTIVE
  To evaluate the individual and combined performances of two-dimensional (2D) shear-wave elastography (SWE) and conventional ultrasonography (US) in assessing liver fibrosis and cirrhosis to determine when 2D SWE should be added to routine US.
  
  
  METHODS
  This prospective study was approved by the institutional ethics committee, and the patients provided written informed consent. Between April 2012 and March 2013, conventional US and 2D SWE examinations were performed in 198 patients (mean age, 37.7 years; age range, 18-67 years) with chronic liver disease. Liver biopsy was used as a reference standard for 167 patients; the other 31 patients had decompensated liver cirrhosis. Receiver operating characteristic (ROC) curves were obtained to assess the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared by using a Delong test.
  
  
  RESULTS
  Two-dimensional SWE was significantly superior to US in diagnosis of significant fibrosis (score of F2 or greater) (AUC, 0.862 vs 0.725; P = .001) and early cirrhosis (score of F4) (AUC, 0.926 vs 0.789; P = .007). Combining 2D SWE with US did not increase the performance of depicting either significant fibrosis or liver cirrhosis (P = .713 and 0.410, respectively) relative to 2D SWE alone. There was no significant difference between 2D SWE and US in diagnosis of decompensated cirrhosis (AUC, 0.878 vs 0.925; P = .323). In addition, combining 2D SWE with US did not increase the performance relative to that of US alone (P = .372).
  
  
  CONCLUSIONS
  Conventional US is sufficient to detect decompensated cirrhosis. Two-dimensional SWE is significantly superior to US in detecting liver fibrosis. Combining 2D SWE and US did not improve the diagnostic performance for either fibrosis or cirrhosis.
authors.affiliation: From the Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zheng
authors.forename: Huanyi
authors.initials: H
authors.lastname: Guo
authors.forename: Jie
authors.initials: J
authors.lastname: Zeng
authors.forename: Zeping
authors.initials: Z
authors.lastname: Huang
authors.forename: Bowen
authors.initials: B
authors.lastname: Zheng
authors.forename: Jie
authors.initials: J
authors.lastname: Ren
authors.forename: Erjiao
authors.initials: E
authors.lastname: Xu
authors.forename: Kai
authors.initials: K
authors.lastname: Li
authors.forename: Rongqin
authors.initials: R
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018084:Ultrasonography, Interventional