title: Real-Time Shear Wave versus Transient Elastography for Predicting Fibrosis: Applicability, and Impact of Inflammation and Steatosis. A Non-Invasive Comparison.
abstract: OBJECTIVE
  Real-time shear wave elastography (2D-SWE) is a two-dimensional transient elastography and a competitor as a biomarker of liver fibrosis in comparison with the standard reference transient elastography by M probe (TE-M). The aims were to compare several criteria of applicability, and to assess inflammation and steatosis impact on elasticity values, two unmet needs.
  
  
  METHODS
  We took FibroTest as the fibrosis reference and ActiTest and SteatoTest as quantitative estimates of inflammation and steatosis. After standardization of estimates, analyses used curve fitting, quantitative Lin concordance coefficient [LCC], and multivariate logistic regression.
  
  
  RESULTS
  A total of 2,251 consecutive patients were included. We validated the predetermined 0.2 kPa cut-off as a too low minimal elasticity value identifying not-reliable 2D-SWE results (LCC with FibroTest = 0.0281[-0.119;0.175]. Other criteria, elasticity CV, body mass index and depth of measures were not sufficiently discriminant. The applicability of 2D-SWE (95%CI) 89.6%(88.2-90.8), was significantly higher than that of TE, 85.6%(84.0-87.0; P<0.0001). In patients with non-advanced fibrosis (METAVIR F0F1F2), elasticity values estimated by 2D-SWE was less impacted by inflammation and steatosis than elasticity value estimated by TE-M: LCC (95%CI) 0.039 (0.021;0.058) vs 0.090 (0.068;0.112;P<0.01) and 0.105 (0.068;0.141) vs 0.192 (0.153;0.230; P<0.01) respectively. The three analyses methods gave similar results.
  
  
  CONCLUSIONS
  Elasticity results including very low minimal signal in the region of interest should be considered not reliable. 2D-SWE had a higher applicability than TE, the reference elastography, with less impact of inflammation and steatosis especially in patients with non-advanced fibrosis, as presumed by blood tests.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01927133.
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.|INSERM, UMR S938, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Tam
authors.initials: T
authors.lastname: Pham
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Hugo
authors.initials: H
authors.lastname: Perazzo
authors.affiliation: Hepatology Research Unit, BioPredictive, Paris, France.
authors.forename: Mona
authors.initials: M
authors.lastname: Munteanu
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Luckina
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Elaribi
authors.affiliation: Hepatology Research Unit, BioPredictive, Paris, France.
authors.forename: Yen
authors.initials: Y
authors.lastname: Ngo
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Luminita
authors.initials: L
authors.lastname: Bonyhay
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Noemie
authors.initials: N
authors.lastname: Seurat
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Legroux
authors.affiliation: Hepatology Research Unit, BioPredictive, Paris, France.
authors.forename: An
authors.initials: A
authors.lastname: Ngo
authors.affiliation: Hepatology Research Unit, BioPredictive, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Deckmyn
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.affiliation: Hepato-Gastroenterology, APHP UPMC Liver Center, Paris, France.
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.affiliation: Radiology, APHP UPMC Liver Center, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lucidarme
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers