title: Liver Fibrosis Evaluation Using Real-time Shear Wave Elastography in Hepatitis C-Monoinfected and Human Immunodeficiency Virus/Hepatitis C-Coinfected Patients.
abstract: OBJECTIVE
  A few studies have evaluated real-time shear wave elastography (SWE) for assessing liver fibrosis by measuring liver stiffness in patients with chronic hepatitis C virus (HCV) infection, but they excluded human immunodeficiency virus/HCV-coinfected patients. We investigated the diagnostic performance of liver stiffness measured by SWE as a noninvasive predictor of liver fibrosis in HCV using liver biopsy as a reference standard, including monoinfected and coinfected patients.
  
  
  METHODS
  We measured liver stiffness in patients with HCV undergoing liver biopsy (METAVIR fibrosis staging).
  
  
  RESULTS
  Eighty patients (53 monoinfected and 27 coinfected) were included. There was a significant correlation between liver stiffness and fibrosis stage (ρ = 0.685; P < .001). Areas under the receiver operating characteristic curve were 0.841, 0.879, and 0.975 when comparing fibrosis stages F0-F1 versus F2-F4, F0-F2 versus F3-F4, and F0-F3 versus F4, respectively. Suggested cutoff values were 8.5 kPa for F2, 10.4 kPa for F3, and 11.3 kPa for F4, with sensitivity and specificity of 81% and 84%, 81% and 95%, and 100% and 90%. There was no significant difference between the liver stiffness of monoinfected and coinfected patients (P = .453). When combining SWE with the fibrosis-4 score, accuracy increased from 82% to 88% and from 88% to 96%, with incongruent results of 26% and 29%, for F0-F1 versus F2-F4 and F0-F2 versus F3-F4.
  
  
  CONCLUSIONS
  Shear wave elastography of the liver is an effective noninvasive predictor of liver fibrosis in patients with HCV. There was no significant difference between monoinfected and coinfected patients; hence, the same cutoff values can be used for both groups. Combination of SWE with the fibrosis-4 score leads to higher accuracy, although at the expense of inconclusive results in some patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, BelgiumLaboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium wim.verlinden@uza.be.
authors.forename: Wim
authors.initials: W
authors.lastname: Verlinden
authors.affiliation: Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, BelgiumDepartment of Gastroenterology, Ziekenhuisnetwerk Antwerpen Stuivenberg Hospital, Antwerp, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bourgeois
authors.affiliation: Department of Gastroenterology, Ziekenhuisnetwerk Antwerpen Stuivenberg Hospital, Antwerp, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gigase
authors.affiliation: Department of Gastroenterology, Ziekenhuisnetwerk Antwerpen Stuivenberg Hospital, Antwerp, Belgium.
authors.forename: Clara
authors.initials: C
authors.lastname: Thienpont
authors.affiliation: Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Luisa
authors.initials: L
authors.lastname: Vonghia
authors.affiliation: Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, BelgiumLaboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vanwolleghem
authors.affiliation: Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Michielsen
authors.affiliation: Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, BelgiumLaboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Francque
mesh_terms: D000328:Adult; D019540:Area Under Curve; D060085:Coinfection / Q000150:complications*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: chronic hepatitis C; coinfection; fibrosis score; gastrointestinal ultrasound; liver stiffness; real-time shear wave elastography