Feasibility of transient elastography versus real-time two-dimensional shear wave elastography in difficult-to-scan patients.
OBJECTIVE
Transient elastography (TE) is hampered in some patients by failures and unreliable results. We hypothesized that real time two-dimensional shear wave elastography (2D-SWE), the FibroScan XL probe, and repeated TE exams, could be used to obtain reliable liver stiffness measurements in patients with an invalid TE examination.


METHODS
We reviewed 1975 patients with 5764 TE exams performed between 2007 and 2014, to identify failures and unreliable exams. Fifty-four patients with an invalid TE at their latest appointment entered a comparative feasibility study of TE vs. 2D-SWE.


RESULTS
The initial TE exam was successful in 93% (1835/1975) of patients. Success rate increased from 89% to 96% when the XL probe became available (OR: 1.07, 95% CI 1.06-1.09). Likewise, re-examining those with a failed or unreliable TE led to a reliable TE in 96% of patients. Combining availability of the XL probe with TE re-examination resulted in a 99.5% success rate on a per-patient level. When comparing the feasibility of TE vs. 2D-SWE, 96% (52/54) of patients obtained a reliable TE, while 2D-SWE was reliable in 63% (34/54, p < 0.001). The odds of a successful 2D-SWE exam decreased with higher skin-capsule distance (OR = 0.77, 95% CI 0.67-0.98).


CONCLUSIONS
Transient elastography can be accomplished in nearly all patients by use of the FibroScan XL probe and repeated examinations. In difficult-to-scan patients, the feasibility of TE is superior to 2D-SWE.
a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark ;|b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;
Benjamin
B
Staugaard
a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark ;|b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;
Peer Brehm
PB
Christensen
a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark ;
Belinda
B
Mössner
a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark ;|b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;
Janne Fuglsang
JF
Hansen
b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;|c Department of Gastroenterology and Hepatology , Odense University Hospital , Odense , Denmark ;
Bjørn Stæhr
BS
Madsen
d Department of Medicine , Lillebaelt Hospital , Kolding , Denmark ;
Jacob
J
Søholm
b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;|c Department of Gastroenterology and Hepatology , Odense University Hospital , Odense , Denmark ;
Aleksander
A
Krag
b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;|c Department of Gastroenterology and Hepatology , Odense University Hospital , Odense , Denmark ;|e OPEN, Odense Patient Data Exploratory Network , Odense University Hospital , Odense , Denmark.
Maja
M
Thiele
D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Aixplorer; applicability; failure rate; liver fibrosis; obesity; supersonic shear imaging