title: Point Shear Wave Elastography by Acoustic Radiation Force Impulse Quantification in Comparison to Transient Elastography for the Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C: A Prospective International Multicenter Study.
abstract: OBJECTIVE
  The aim of the present prospective European multicenter study was to demonstrate the non-inferiority of point shear wave elastography (pSWE) compared to transient elastography (TE) for the assessment of liver fibrosis in patients with chronic hepatitis C.
  
  
  METHODS
  241 patients with chronic hepatitis C were prospectively enrolled at 7 European study sites and received pSWE, TE and blood tests. Liver biopsy was performed with histological staging by a central pathologist. In addition, for inclusion of cirrhotic patients, a maximum of 10 % of patients with overt liver cirrhosis confirmed by imaging methods were allowed by protocol (n = 24).
  
  
  RESULTS
  Owing to slower than expected recruitment due to a reduction of liver biopsies, the study was closed after 4 years before the target enrollment of 433 patients with 235 patients in the 'intention to diagnose' analysis and 182 patients in the 'per protocol' analysis. Therefore, the non-inferiority margin was enhanced to 0.075 but non-inferiority of pSWE could not be proven. However, Paired comparison of the diagnostic accuracy of pSWE and TE revealed no significant difference between the two methods in the 'intention to diagnose' and 'per protocol' analysis (0.81 vs. 0.85 for F ≥ 2, p = 0.15; 0.88 vs. 0.92 for F ≥ 3, p = 0.11; 0.89 vs. 0.94 for F = 4, p = 0.19). Measurement failure was significantly higher for TE than for pSWE (p = 0.030).
  
  
  CONCLUSIONS
  Non-inferiority of pSWE compared to TE could not be shown. However, the diagnostic accuracy of pSWE and TE was comparable for the noninvasive staging of liver fibrosis in patients with chronic hepatitis C.
authors.affiliation: Department of Internal Medicine 1, J. W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Friedrich-Rust
authors.affiliation: Department of Ultrasound, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Lupsor
authors.affiliation: Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: de Knegt
authors.affiliation: Institute of Pathology, Institute of Pathology, Mannheim, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Dries
authors.affiliation: Hepatology, Institute for Interdisciplinary Medicine, Hamburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Buggisch
authors.affiliation: Department of Internal Medicine, Medical School Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gebel
authors.affiliation: Department of Internal Medicine 1, J. W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Maier
authors.affiliation: Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J. W. Goethe-University, Frankfurt, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Gastroenterology and Infectious Disease, University Hospital Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Sagir
authors.affiliation: Department of Medicine II, Campus Grosshadern, University Hospital Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Zachoval
authors.affiliation: Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J. W. Goethe-University, Frankfurt, Germany.
authors.forename: Y
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Internal Medicine 1, J. W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: M D
authors.initials: MD
authors.lastname: Schneider
authors.affiliation: Imaging, University Iuliu Hatieganu, Cluj, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Badea
authors.affiliation: Gastroenterology and Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Rifai
authors.affiliation: Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Poynard
authors.affiliation: Department of Internal Medicine 1, J. W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: Department of Internal Medicine 1, J. W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Sarrazin
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult