Junzhao Ye1, Wei Wang2, Shiting Feng3, Yang Huang2, Xianhua Liao1, Ming Kuang4, Xiaoyan Xie2, Bing Liao5, Bihui Zhong6. 1. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Yuexiu District, Guangzhou, 510080, Guangdong, People's Republic of China. 2. Department of Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, People's Republic of China. 3. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, People's Republic of China. 4. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, People's Republic of China. 5. Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Yuexiu District, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong, People's Republic of China. bingl168@163.com. 6. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Yuexiu District, Guangzhou, 510080, Guangdong, People's Republic of China. sophiazhong@hotmail.com.
Abstract
BACKGROUND: Two-dimensional shear wave elastography (2D-SWE) is the latest generation of ultrasound elastography for the non-invasive assessment of liver fibrosis in chronic hepatitis B (CHB). We aimed to identify confounders of 2D-SWE in fibrosis grading. METHODS: A prospective cohort of 440 CHB patients (286 with liver biopsy and 154 with clinical decompensated cirrhosis) was consecutively enrolled from a clinical trial (registration number: ChiCTR-DCD-15006000) aimed at optimizing 2D-SWE assessments from 2015 to 2018. All patients underwent 2D-SWE examination, anthropometric measurement, and serum biomarker assessment. Steatosis was graded by the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF). RESULTS: Overall, the prevalence of incorrect fibrosis staging by 2D-SWE was 26.1% (n = 115), with 43.5% of patients under-staged and 56.5% over-staged. In multivariate analysis, the steatosis degree was an independent predictor of 2D-SWE discordance in the overall cohort, with moderate-severe steatosis for underestimation (odds ratio, [OR] = 4.3, 95% confidence interval [CI] 1.2-18.2, p = 0.049) and overestimation (OR = 8.2, 95% CI 2.9-23.5, p < 0.001), and mild steatosis for overestimation (OR = 3.7, 95% CI 1.5-9.0, p = 0.004). In patients with liver biopsy, both histological inflammation activity over 2 (OR = 5.0, 95% CI 2.0-25.3, p = 0.048) and moderate-severe steatosis (OR = 5.2, 95% CI 2.1-13.4, p < 0.001) were independent factors associated with discordance. For the risk of 2D-SWE mis-staging, a nomogram that integrated these confounders was established and the area under the receiver operating characteristic curve of the model was 0.861. CONCLUSIONS: Steatosis and inflammation activities were confounders for 2D-SWE. The combination of these confounders could predict mis-staging risks of CHB-related fibrosis with 2D-SWE and may be valuable to decision-making on liver biopsy for fibrosis staging.
BACKGROUND: Two-dimensional shear wave elastography (2D-SWE) is the latest generation of ultrasound elastography for the non-invasive assessment of liver fibrosis in chronic hepatitis B (CHB). We aimed to identify confounders of 2D-SWE in fibrosis grading. METHODS: A prospective cohort of 440 CHBpatients (286 with liver biopsy and 154 with clinical decompensated cirrhosis) was consecutively enrolled from a clinical trial (registration number: ChiCTR-DCD-15006000) aimed at optimizing 2D-SWE assessments from 2015 to 2018. All patients underwent 2D-SWE examination, anthropometric measurement, and serum biomarker assessment. Steatosis was graded by the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF). RESULTS: Overall, the prevalence of incorrect fibrosis staging by 2D-SWE was 26.1% (n = 115), with 43.5% of patients under-staged and 56.5% over-staged. In multivariate analysis, the steatosis degree was an independent predictor of 2D-SWE discordance in the overall cohort, with moderate-severe steatosis for underestimation (odds ratio, [OR] = 4.3, 95% confidence interval [CI] 1.2-18.2, p = 0.049) and overestimation (OR = 8.2, 95% CI 2.9-23.5, p < 0.001), and mild steatosis for overestimation (OR = 3.7, 95% CI 1.5-9.0, p = 0.004). In patients with liver biopsy, both histological inflammation activity over 2 (OR = 5.0, 95% CI 2.0-25.3, p = 0.048) and moderate-severe steatosis (OR = 5.2, 95% CI 2.1-13.4, p < 0.001) were independent factors associated with discordance. For the risk of 2D-SWE mis-staging, a nomogram that integrated these confounders was established and the area under the receiver operating characteristic curve of the model was 0.861. CONCLUSIONS:Steatosis and inflammation activities were confounders for 2D-SWE. The combination of these confounders could predict mis-staging risks of CHB-related fibrosis with 2D-SWE and may be valuable to decision-making on liver biopsy for fibrosis staging.
Authors: Eva Herrmann; Victor de Lédinghen; Christophe Cassinotto; Winnie C-W Chu; Vivian Y-F Leung; Giovanna Ferraioli; Carlo Filice; Laurent Castera; Valérie Vilgrain; Maxime Ronot; Jérôme Dumortier; Aymeric Guibal; Stanislas Pol; Jonel Trebicka; Christian Jansen; Christian Strassburg; Rongqin Zheng; Jian Zheng; Sven Francque; Thomas Vanwolleghem; Luisa Vonghia; Emanuel K Manesis; Pavlos Zoumpoulis; Ioan Sporea; Maja Thiele; Aleksander Krag; Claude Cohen-Bacrie; Aline Criton; Joel Gay; Thomas Deffieux; Mireen Friedrich-Rust Journal: Hepatology Date: 2017-11-15 Impact factor: 17.425