title: Shear wave elastography: An accurate technique to stage liver fibrosis in chronic liver diseases.
abstract: OBJECTIVE
  The goals of this study were to assess the diagnostic accuracy of shear wave elastography (SWE) using the results of histopathological analysis as a standard of reference and compare the results of SWE and those of transient elastography (TE) to the degree of fibrosis as evaluated by histomorphometry.
  
  
  METHODS
  Adult patients who were scheduled to undergo liver biopsy were prospectively enrolled in the study. The diagnostic performances of SWE were assessed using AUROC curve analysis according to fibrosis thresholds defined by ≥F2 (significant fibrosis), ≥F3 (advanced fibrosis) and F4 (cirrhosis). Additional analyses using the Obuchowski measures for pairwise comparisons of fibrosis stages were performed. In a subgroup of 55 patients, the relationships between stiffness as measured using SWE and TE and the percentage of fibrosis were compared using Spearman's rank coefficient.
  
  
  RESULTS
  Among the initially enrolled 170 patients, 148/170 (87%) had successful SWE acquisition and formed the study population. SWE sensitivity and specificity were respectively 85.1% and 82.7% (≥F2), 88.9% and 90.3% (≥F3), 93.3% and 98.3% (F4). The AUROC curves of SWE along with their 95% confidence intervals (CI) were respectively 0.904 (95%CI: 0.845-0.946) for fibrosis ≥F2; 0.958 (95%CI: 0.912-0.984) for fibrosis ≥F3 and 0.988 (95%CI: 0.955-0.999) for fibrosis=F4. The global Obuchowski measure was 0.953±0.007. In the subgroup study, a significant correlation was found between the percentage of fibrosis and stiffness as assessed by SWE (r=0.77; 95%CI: 0.63-0.86; P<0.0001) and by TE (r=0.65; 95%CI: 0.47-0.78; P<0.01).
  
  
  CONCLUSIONS
  SWE is accurate to assess liver fibrosis in patients with chronic liver disease.
authors.affiliation: Service de radiologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Service de radiologie, centre hospitalier de Perpignan, 20, avenue du Languedoc, 66046 Perpignan cedex 9, France. Electronic address: aymeric.guibal@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Guibal
authors.affiliation: Service de radiologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Renosi
authors.affiliation: Service de radiologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 69317 Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Rode
authors.affiliation: Service d'anatomo-pathologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Scoazec
authors.affiliation: Fédération des spécialités digestives, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon cedex 03, France.
authors.forename: O
authors.initials: O
authors.lastname: Guillaud
authors.affiliation: Fédération de biochimie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Chardon
authors.affiliation: Hepatology research unit, biopredicitive, 75007 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Munteanu
authors.affiliation: Fédération des spécialités digestives, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon cedex 03, France.
authors.forename: J
authors.initials: J
authors.lastname: Dumortier
authors.affiliation: Service de radiologie, centre hospitalier de Perpignan, 20, avenue du Languedoc, 66046 Perpignan cedex 9, France.
authors.forename: F
authors.initials: F
authors.lastname: Collin
authors.affiliation: Service de radiologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
authors.forename: T
authors.initials: T
authors.lastname: Lefort
mesh_terms: D002908:Chronic Disease; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: Cirrhosis; Elasticity imaging techniques; Elastography; Liver fibrosis; Sonoelastography