Comparison of two-dimensional shear wave elastography and transient elastography in liver fibrosis staging

Objective: to compare liver stiffness cut-off values for assessing liver fibrosis using two-dimensional shear wave elastography with literature data on results obtained using equipment from the same vendor.

Material and methods: the study included 54 women and 48 men aged from 22 to 86 years (median – 56 years), who were underwent transient elastography (FibroScan, Echosens, France) and two-dimensional shear wave elastography (Aplio 500, Canon Medical Systems, Japan) during routine follow-up for various chronic liver diseases. A comparative analysis of the two-dimensional shear wave elastography results according to two stratification systems (METAVIR score system and Baveno VI consensus criteria) was carried out with a study used same vendor equipment. Transient elastography was used as the reference method in both studies.

Results: there was a strong direct correlation between liver stiffness measured by transient elastography and two-dimensional shear wave elastography (r = 0.790, P < 0.001). The cut-off values for liver fibrosis staging according to METAVIR score system and to Baveno VI consensus criteria in the studies used the single vendor equipment were comparable. Thus, the cut-off value for F4 stage of liver fibrosis was 10.3 kPa (own data) versus 10.5 kPa, the cut-off value for high probability of presence of compensated advanced chronic liver disease – 11.3 kPa (own data) versus 10.6 kPa.

Conclusions: two-dimensional shear wave elastography is highly informative for liver fibrosis assessment according to both systems (METAVIR score system and Baveno VI consensus criteria). The cut-off values obtained with the use of single vendor equipment are comparable.

1. Ivashkin V.T., Maevskaya M.V., Zharkova M.S., Zhigalova S.B., Kitsenko E.A., Manukyan G.V., Trukhmanov A.S., Maev I.V., Tikhonov I.N., Deeva T.A. Clinical recommendations of the Russian Scientific Liver Society and Russian Gastroenterological Association on diagnosis and treatment of liver fibrosis, cirrhosis and their complications. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021; 31 (6): 56–102. (in Russian)

2. Ronot M., Ferraioli G., Muller H.P., FriedrichRust M., Filice C., Vilgrain V., Cosgrove D., Lim A.K. Comparison of liver stiffness measurements by a 2D-shear wave technique and transient elastography: results from a European prospective multi-centre study. Eur. Radiol. 2021; 31 (3): 1578–1587. https://doi.org/10.1007/s00330-020- 07212-x

3. Dietrich C.F., Bamber J., Berzigotti A., Bota S., Cantisani V., Castera L., Cosgrove D., Ferraioli G., Friedrich-Rust M., Gilja O.H., Goertz R.S., Karlas T., de Knegt R., de Ledinghen V., Piscaglia F., Procopet B., Saftoiu A., Sidhu P.S., Sporea I., Thiele M. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med. 2017; 38 (4): e16–e47. https://doi.org/10.1055/s-0043-103952

4. Ferraioli G., Wong V.W., Castera L., Berzigotti A., Sporea I., Dietrich C.F., Choi B.I., Wilson S.R., Kudo M., Barr R.G. Liver ultrasound elastography: an update to the World Federation for Ultrasound in Medicine and Biology guidelines and recommendations. Ultrasound Med. Biol. 2018; 44 (12): 2419–2440. https://doi.org/10.1016/j.ultrasmedbio.2018.07.008

5. Barr R.G., Wilson S.R., Rubens D., Garcia-Tsao G., Ferraioli G. Update to the Society of Radiologists in Ultrasound liver elastography consensus statement. Radiology. 2020; 296 (2): 263–274. https://doi.org/10.1148/radiol.2020192437

6. Friedrich-Rust M., Poynard T., Castera L. Critical comparison of elastography methods to assess chronic liver disease. Nat. Rev. Gastroenterol. Hepatol. 2016; 13 (7): 402–411. https://doi.org/10.1038/nrgastro.2016.86

7. Pimanov S.I., Mitkova M.D., Mitkov V.V. Confounding factors in ultrasound liver elastography. Ultrasound and Functional Diagnostics. 2021; 4: 9–29. https://doi.org/10.24835/1607-0771- 2021-4-9-29 (in Russian)

8. Tsochatzis E.A., Gurusamy K.S., Ntaoula S., Cholongitas E., Davidson B.R., Burroughs A.K. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J. Hepatol. 2011; 54 (4): 650–659. https://doi.org/10.1016/j.jhep.2010.07.033

9. de Franchis R.; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol. 2015; 63 (3): 743–752. https://doi.org/10.1016/j.jhep.2015.05.022

10. Sporea I., Baldea V., Lupusoru R., Bende F., Mare R., Lazar A., Popescu A., Sirli R. Quantification of Steatosis and Fibrosis using a new system implemented in an ultrasound machine. Med. Ultrason. 2020; 22 (3): 265–271. https://pubmed.ncbi.nlm.nih.gov/32399537/

11. Mulabecirovic A., Mjelle A.B., Gilja O.H., Vesterhus M., Havre R.F. Liver elasticity in healthy individuals by two novel shear-wave elastography systems – comparison by age, gender, BMI and number of measurements. PLoS One. 2018; 13 (9): e0203486. https://doi.org/10.1371/journal.pone.0203486

12. Ferraioli G., Barr R.G., Farrokh A., Radzina M., Cui X.W., Dong Y., Rocher L., Cantisani V., Polito E., D’Onofrio M., Roccarina D., Yamashita Y., Dighe M.K., Dietrich C.F. How to perform shear wave elastography. Part I. Med. Ultrason. 2022; 24 (1): 95–106. https://doi.org/10.11152/mu-3217

13. Clinical practice guidelines Liver cirrhosis and fibrosis, https://cr.minzdrav.gov.ru/schema/715_1 (2021, accessed 20.09.2022). (in Russian)