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Shear wave elastography for liver fibrosis in chronic hepatitis B: Adapting the cut-offs to alanine aminotransferase levels improves accuracy

Authors
  • Zeng, Jie1
  • Zheng, Jian2, 3
  • Jin, Jie-Yang1
  • Mao, Yong-Jiang1
  • Guo, Huan-Yi1
  • Lu, Ming-De4
  • Zheng, Hai-Rong5
  • Zheng, Rong-Qin1
  • 1 Sun Yat-Sen University, Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, 600 Tianhe Road, Guangzhou, 510630, China , Guangzhou (China)
  • 2 Sun Yat-Sen University, Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China , Guangzhou (China)
  • 3 Third Hospital of Longgang, Department of Medical Ultrasonics, Shenzhen, China , Shenzhen (China)
  • 4 Sun Yat-Sen University, Department of Hepatobiliary Surgery and Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China , Guangzhou (China)
  • 5 Chinese Academy of Sciences, Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, 1068 Xueyuan Avenue, SZ University Town, Shenzhen, 518055, China , Shenzhen (China)
Type
Published Article
Journal
European Radiology
Publisher
Springer-Verlag
Publication Date
Jul 23, 2018
Volume
29
Issue
2
Pages
857–865
Identifiers
DOI: 10.1007/s00330-018-5621-x
Source
Springer Nature
Keywords
License
Yellow

Abstract

ObjectivesTo determine and validate alanine aminotransferase (ALT)-adapted dual cut-offs of liver stiffness measurements (LSMs) for assessing liver fibrosis with two-dimensional shear wave elastography (2D-SWE) in patients with chronic hepatitis B (CHB) infection.MethodsPatients with CHB infection who underwent liver biopsy to assess liver fibrosis were consecutively included. 2D-SWE confirmation thresholds with a positive likelihood ratio ≥10 and 2D-SWE exclusion thresholds with a negative likelihood ratio ≤0.1 were identified to rule in or rule out significant fibrosis and cirrhosis, respectively.ResultsThe first 515 patients (index cohort) and the next 421 patients (validation cohort) were included in the final analysis. The low and high cut-offs to rule out and rule in patients with significant fibrosis (≥ F2) were 5.4 kPa and 9.0 kPa, respectively, in patients with ALT levels ≤ 2 × the upper limit of normal (ULN) and 7.1 kPa and 11.2 kPa in patients with ALT levels > 2 × ULN. For cirrhosis (F4), the corresponding values were 8.1 kPa and 12.3 kPa in patients with ALT levels ≤ 2 × ULN and 11.9 kPa and 24.7 kPa in patients with ALT levels > 2 × ULN. The dual cut-off values showed an overall accuracy of more than 90% for diagnosis of the presence or absence of significant fibrosis and cirrhosis in the index and validation cohorts. There were no significant differences in the accuracy values between the cohorts (all p>0.05).ConclusionThe ALT-adapted dual cut-offs of LSMs showed high accuracy for diagnosis of the presence or absence of significant fibrosis and cirrhosis in patients with CHB infection.Key Points• The ALT-adapted dual cut-off values of LSMs showed high accuracy for diagnosis of the presence or absence of significant fibrosis and cirrhosis.• ALT levels did not influence the overall diagnostic accuracy for predicting significant fibrosis and cirrhosis.• The ALT-adapted dual cut-offs in patients with ALT levels > 2 × ULN were markedly higher than those in patients with ALT levels ≤ 2 × ULN.

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