Prospective comparison among transient elastography, supersonic shear imaging, and ARFI imaging for predicting fibrosis in nonalcoholic fatty liver disease

Myoung Seok Lee, Jeong Mo Bae, Sae Kyung Joo, Hyunsik Woo, Dong Hyeon Lee, Yong Jin Jung, Byeong Gwan Kim, Kook Lae Lee, Won Kim, Myoung Seok Lee, Jeong Mo Bae, Sae Kyung Joo, Hyunsik Woo, Dong Hyeon Lee, Yong Jin Jung, Byeong Gwan Kim, Kook Lae Lee, Won Kim

Abstract

The diagnostic performance of supersonic shear imaging (SSI) in comparison with those of transient elastography (TE) and acoustic radiation force impulse imaging (ARFI) for staging fibrosis in nonalcoholic fatty liver disease (NAFLD) patients has not been fully assessed, especially in Asian populations with relatively lean NAFLD compared to white populations. Thus, we focused on comparing the diagnostic performances of TE, ARFI, and SSI for staging fibrosis in a head-to-head manner, and identifying the clinical, anthropometric, biochemical, and histological features which might affect liver stiffness measurement (LSM) in our prospective biopsy-proven NAFLD cohort. In this study, ninety-four patients with biopsy-proven NAFLD were included prospectively. Liver stiffness was measured using TE, SSI, and ARFI within 1 month of liver biopsy. The diagnostic performance for staging fibrosis was assessed using receiver operating characteristic (ROC) analysis. Anthropometric data were evaluated as covariates influencing LSM by regression analyses. Liver stiffness correlated with fibrosis stage (p < 0.05); the area under the ROC curve of TE (kPa), SSI (kPa), and ARFI (m/s) were as follows: 0.757, 0.759, and 0.657 for significant fibrosis and 0.870, 0.809, and 0.873 for advanced fibrosis. Anthropometric traits were significant confounders affecting SSI, while serum liver injury markers significantly confounded TE and ARFI. In conclusion, the LSM methods had similar diagnostic performance for staging fibrosis in patients with NAFLD. Pre-LSM anthropometric evaluation may help predict the reliability of SSI.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the study…
Fig 1. Flow diagram of the study population.
Abbreviations: NAFLD, nonalcoholic fatty liver disease.
Fig 2. Scattered diagram showing the correlation…
Fig 2. Scattered diagram showing the correlation of shear-wave velocity (m/s) between ARFI and SSI.
Abbreviations: ARFI, acoustic radiation force impulse imaging; SSI, supersonic shear imaging.
Fig 3. Comparative AUROCs of ARFI (m/s),…
Fig 3. Comparative AUROCs of ARFI (m/s), TE (kPa), and SSI (kPa, m/s) for the diagnosis of each fibrosis stage.
A, for significant fibrosis. B, for advanced fibrosis. C, for cirrhosis. Abbreviations: AUROC, area under the receiver operating characteristic curve; ARFI, acoustic radiation force impulse imaging; TE, transient elastography; SSI, supersonic shear imaging.

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