title: Non-invasive assessment of liver fibrosis in patients with hepatitis C: Shear wave elastography and colour Doppler velocity profile technique versus liver biopsy.
abstract: OBJECTIVE
  Determination of the presence and degree of liver fibrosis is essential for the prognosis and treatment of patients with chronic hepatitis C. Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy. We determined the efficacy of shear wave elastography (SWE) and colour Doppler velocity as non-invasive methods for the assessment of liver fibrosis compared to liver biopsy among patients with chronic hepatitis C virus (HCV) infection.
  
  
  METHODS
  In total, 117 patients with chronic HCV infection and 50 healthy age- and sex-matched control subjects were included. For each patient and control, abdominal ultrasonography, Doppler ultrasonography of the right portal vein (PV), and SWE were performed, whereas liver biopsy was performed for patients.
  
  
  RESULTS
  The mean value of the right PV maximum velocity was lower in patients with different stages of fibrosis than in controls (p<0.001). The mean value of liver stiffness determined by SWE was significantly higher in patients with different stages of fibrosis than in controls. Cutoff values for liver stiffness determined by SWE for assessing fibrosis stages were F2⩾4.815, F3⩾6.335, and F4=7.540 with a sensitivity of 84.6%, 96.2%, and 100.0%; specificity of 88.5%, 93.8%, and 100.0%; positive predictive value (PPV) of 93.6%, 98.0%, and 100.0%; negative predictive value (NPV) of 74.2%, 88.2%, and 100.0%; and overall accuracy of 85.9%, 95.6%, and 100.0% [area under the ROC curve (AUC): 0.89, 0.96, and 1.0], respectively. Cutoff values for the right PV maximum velocity for assessing fibrosis stages were F2<23.4, F3<21, and F4<20 with a sensitivity of 65.0%, 57.4%, and 57.1%; specificity of 59.8%, 76.4%, and 75.5%; PPV of 33.8%, 58.3%, and 32.0%; NPV of 84.4%, 75.7%, and 89.7%; and overall accuracy of 61.1%, 69.5%, and 72.5% (AUC: 0.614, 0.696, and 0.625), respectively.
  
  
  CONCLUSIONS
  SWE is effective for the non-invasive assessment of liver fibrosis in patients with HCV infection. SWE provides a more accurate correlation with liver fibrosis stage than colour Doppler velocity profile for the assessment of liver fibrosis, especially in advanced stages (F3 and F4).
authors.affiliation: Assuit University, Tropical Medicine & Gastroenterology Department, Assiut, Egypt. Electronic address: ehab_mostafa99@yahoo.com.
authors.forename: Ehab F
authors.initials: EF
authors.lastname: Moustafa
authors.affiliation: Assuit University, Tropical Medicine & Gastroenterology Department, Assiut, Egypt.
authors.forename: Nahed
authors.initials: N
authors.lastname: Makhlouf
authors.affiliation: Assuit University, Tropical Medicine & Gastroenterology Department, Assiut, Egypt.
authors.forename: Sahar M
authors.initials: SM
authors.lastname: Hassany
authors.affiliation: Assuit University, Tropical Medicine & Gastroenterology Department, Assiut, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Helmy
authors.affiliation: Assuit University, Tropical Medicine & Gastroenterology Department, Assiut, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
authors.affiliation: Assuit University, Radiology Department, Assiut, Egypt.
authors.forename: Moustafa
authors.initials: M
authors.lastname: Othman
authors.affiliation: Assuit University, Radiology Department, Assiut, Egypt.
authors.forename: Hany
authors.initials: H
authors.lastname: Seif
authors.affiliation: Assuit University, Public Health and Community Medicine Department, Assiut, Egypt.
authors.forename: Manal
authors.initials: M
authors.lastname: Darwish
authors.affiliation: Assuit University, Pathology Department, Assiut, Egypt.
authors.forename: Howayda
authors.initials: H
authors.lastname: Hassan
authors.affiliation: Assuit University, Tropical Medicine & Gastroenterology Department, Assiut, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hessen
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
keywords: Chronic HCV; Doppler ultrasound; Liver fibrosis; Shear wave elastography