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Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis
Abstracts Conclusions: An APRI score .1 correlates with significant fibrosis quantified by TE. BARD score $2 can predict advanced fibrosis. These two simple scores could be used as first line test to rule out patients without advanced fibrosis. OPT7-023 Intraobserver Reproducibility of Two- Dimensional Shear Wave Elastography in Children Alina Popescu,1 Corina Pienar,2 Puiu Iulian Velea,3 Oana Belei,4 Diana Gherhardt,5 Ioan Sporea5 1 Department of Ultrasound, ‘‘Victor Babes’’ University of Medicine and Pharmacy Timisoara, Romania, 2Department of Pediatrics, 2nd Pediatrics Clinic, Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’ University of Medicine and Pharmacy, Timisoara, Romania, 3Department of Pediatrics, 2nd Pediatrics Clinic, ‘‘Victor Babes’’ University of Medicine and Pharmacy, Timisoara, Romania, 4 Department of Pediatrics, 1st Pediatrics Clinic, ‘‘Victor Babes’’ University of Medicine and Pharmacy, Timisoara, Romania, 5 Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’ University of Medicine and Pharmacy, Timisoara, Romania Objectives: Assessment of liver fibrosis is vital in establishing the diagnosis, therapeutic options and prognosis of liver diseases. There are a limited number of studies evaluating 2D SWE techniques in children, all focusing on providing cut-offs for fibrosis staging. We aimed to evaluate a 2D SWE technique in children, by investigating intraobserver reproducibility of the method. Methods: We conducted a prospective study from November 2015- July 2016, recruiting 73 consecutive children (age range: 3-17 years, mean age 11.763.5 years) evaluated in the 2nd Pediatrics Clinic.We used the 2D-SWE.GE (Logiq E9, GE Healthcare, Chalfont St Giles- UK), with a C1-6-D probe. The trapezoid sample box was placed 1-2 cm under the liver capsule, in full liver parenchymal area, avoiding large tubular structures. We placed the ROI in the most homogenous area of the sample box. One examiner (with an experience of more than 50 examinations using this technique in adults) performed 10 liver stiffness measurements (LSM) for each child. For the intraobserver reproducibility analysis we calculated the medians of the first five and last five LSM. Results: LSM were similar across age categories- children older than 10 years vs younger children: 4.21 6 1 kPa vs 4.14 6 1 kPa, p5 0.78. We found higher LSM in obese children: 4.4 6 0.9 kPa vs 3.9 6 1.0 kPa, p5 0.06 and in boys: 4.3 6 1.0 kPa vs girls: 3.8 6 0.9 kPa, p5 0.05. In 4 children the measurement was unquantifiable due to the heterogeneous elastographic image. The intraobserver reproducibility showed that there were similar results for the first 5 LSM compared to the last five LSM (4.260.9 vs 4.360.9, p5ns), for the entire group, as well as for normal weight children (4.060.9 vs 4.161.0, p5ns) and obese children (4.460.9 vs 4.460.7, p5ns). Conclusions: Our study revealed that the use of 2D SWE.GE in children is reliable and highly reproducible. Moreover, we showed that a limited number of LSM is necessary to obtain such good results. OPT7-024 How to Improve the Reliability of Liver Fibrosis Evaluation Using 2D-Swe.Ge Ioan Sporea,1 Felix Bende,2 Roxana Sirli,1 Mirela Danila,1 Alina Popescu1 1 Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babes’’ Timisoara, Romania,
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Department of Ultrasound, University of Medicine and Pharmacy ‘‘Victor Babes’’ Objectives: To assess the impact of using quality criteria for liver stiffness (LS) evaluation by means of 2D Shear Wave Elastography from General Electrics (2D-SWE.GE), while using Transient Elastography (TE) as reference. Methods: We included 226 subjects in our study, with or without chronic liver disease, in whom LS was assessed using 2D-SWE.GE (LOGIQ E9, GE Healthcare) and TE (FibroScan, EchoSens). Reliable LS measurements were defined for TE as the median value of 10 measurements with a success rate of $60% and an interquartile range (IQR),30% of the median LS values. For 2D-SWE.GE 10 LS measurements were acquired in a homogenous area and the IQR and the IQR/M were calculated in each case. We divided our subjects into 3 groups according to the 2D-SWE.GE IQR/M: IQR/M,0.10: 41 (18.1%) cases; 0.10,IQR/M#0.30: 155 (68.6%) cases; IQR/M.0.30: 30 (13.3%) cases. We calculated the correlation coefficient between TE and 2DSWE.GE in each group. Results: All 226 (100%) subjects included had 10 valid measurements by means of 2D-SWE.GE and reliable results by TE. A strong positive correlation was found between LS values obtained by means of 2D-SWE.GE and TE in the IQR/M,0.10 group (r50.84, p,0.0001). A strong positive correlation was found between LS values obtained by means of 2D-SWE.GE and TE in the 0.10,IQR/M#0.30 group (r50.80, p,0.0001). A weak positive correlation was found between LS values obtained by means of 2DSWE.GE and TE in the IQR/M.0.30 group (r50.41, p50.02). The correlations were significantly stronger in the IQR/M,0.10 and 0.10,IQR/M#0.30 groups as compared to the IQR/M.0.30 group (both p50.0013). No statistical differences were found between the correlations in the IQR/M,0.10 and 0.10, IQR/M#0.30 groups (p50.43). Conclusions: Using the IQR/M,0.30 as quality criteria significantly increase the reliability of LS measurements by means of 2DSWE.GE. Using IQR/M,0.10 criteria does not significantly improve the reliability of 2D-SWE.GE LS measurements as compared to 0.10, IQR/M#0.30 criteria.
OPT7-025 Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis Eun Sun Lee, Byung Ihn Choi Department of Radiology, Chung-Ang University Hospital, South Korea Objectives: This study aimed to determine the diagnostic performance of hepatic fibrosis by shear wave elastography (SWE) with a propagation map for liver fibrosis, and to assess its reliability considering transient elastography (TE) as the reference standard. Methods: Our prospective study included 115 consecutive patients with suspected or alleged chronic hepatitis. Patients underwent SWE by two different operators and TE by sonographers on the same day. Results: The correlation coefficient of the intraclass correlation test between an experienced radiologist and a third year radiology resident was 0.878. There was a moderate correlation between the SWE and TE (r 5 0.511) for hepatic fibrosis. The best cut-off values predicting significant hepatic fibrosis and liver cirrhosis by SWE were .1.78 m/s (area under the receiver operating characteristic curve [AUROC] 5 0.777) and .2.24 m/s (AUROC 5 0.935), respectively.
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Ultrasound in Medicine and Biology
Conclusions: SWE with a propagation map is a reliable method for predicting hepatic fibrosis regardless of operator experience. Poster Session PPT7-001 Assessing Liver Stiffness by 2D-Shear Wave Elastography in a Healthy Cohort Ioan Sporea,1 Anesa Mulabecirovic,2 Felix Bende,3 Alina Popescu,1 Roxana Sirli,1 Odd Helge Gilja,2 Mette Vesterhus,4 Roald Flesland Havre2 1 Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babes’’ Timisoara, Romania, 2 Department of Clinical Medicine, K1, University of Bergen, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway, 3Department of Ultrasound, University of Medicine and Pharmacy ‘‘Victor Babes’’, 4Division of Cancer Medicine, Surgery, Inflammatory Diseases and Transplantation, Oslo University Hos, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway Objectives: To assess the normal range and agreement of liver stiffness measurements in healthy subjects, using 2D-Shear Wave Elastography from General Electric (2D-SWE-GE) compared with Transient Elastography (TE). Methods: We included 80 healthy subjects without known liver disease, in whom liver stiffness (LS) was evaluated in the same session using two elastographic methods, TE and 2D-SWE-GE. Reliable liver stiffness measurements (LSM) were defined for TE as the median value of ten measurements with a success rate (SR) of $60% and an interquartile range (IQR) ,30%, and for 2D-SWE-GE as the median value of 10 measurements acquired in a homogenous area and IQR ,30%. Results: Reliable LSM were obtained in 79 subjects (98.7%) by means of 2D-SWE-GE and in 80 subjects (100%) by means of TE (p50.9). The mean LSM value in our cohort of healthy subjects obtained by means of 2D-SWE-GE was 5.161.3 kPa, which was significantly higher than the LSM values assessed by TE (4.360.9 kPa, p, 0.0001). In 2D-SWE-GE mean LSM values were significantly higher for men than for women, 5.961.2 kPa vs. 4.761.2 kPa (p50.0005). Conclusions: 2D-SWE has a very good feasibility (98.7%) in healthy subjects. The mean LSM value determined by 2D-SWE-GEin healthy subjects is 5.161.3 kPa. LSM values obtained by means of 2D-SWEGE are higher than those obtained by TE in healthy subjects. PPT7-002 Controlled Attenuation Parameter for Prediction of Hepatic Steatosis in a Taiwanese Cohort with Chronic Hepatitis Shih-Jer Hsu, Jian-Jyun Yu, Min-Chin Chiu Department of Internal Medicine, National Taiwan University Hospital, Yunlin, Taiwan Objectives: The object of this study is to evaluate the performance of controlled attenuation parameters (CAP) for the prediction of liver steatosis in Taiwanese patients with chronic hepatitis. Methods: Chronic hepatitis patients with liver biopsy performed within recent 2 years were enrolled. CAP was acquired using a FibroScan Ò M probe. CAP values were compared across histologic steatosis grades. Results: Ninety-three patients (mean age 67.2 years; 58% male) were enrolled. The etiologies of chronic hepatitis were hepatitis C 58%, hepatitis B 31%, and others 11%. The case numbers of respective steatosis grades
Volume 43, Number S1, 2017 were: S0, 56; S1, 31; S2-3, 6. The mean 6 SD of CAP for each steatosis grade was 202 6 31 (S0), 230 6 37 (S1), and 289 6 47 (S2-3) (P, 0.001 by Kruskal-Wallis test). The area under the receiver operating characteristic curve of the CAP for predicting steatosis (S0 vs. S1-3) was 0.765. Conclusions: CAP is useful in prediction of steatosis for Taiwanese patients with chronic hepatitis.
PPT7-003 Correlation between Fibroscan and ARFI Two-Location Measurement with Metavir Liver Fibrosis Score Cheng-Jen Chen,1 Pei-Kwei Tsay,2 Tse-Hwa Hsu,3 Shiu-Feng Huang,4 Wan-Ting Yu,4 Chun-Yen Lin,1 Dar-In Tai1 1 Department of Gastroenterology Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan, 2Division of Molecular and Genomic Medicine, National Health Research Institute, 3Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, 4 Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine Objectives: Non-invasive assessment of liver fibrosis with Fibroscan and acoustic radiation force impulse (AFRI) imaging are two most popular modalities to measure liver fibrosis. Fibroscan is a well-established modality which measure both liver fibrosis and steatosis. However, there is considerable failure rate, and without image quidding the data may be misleading in the present of focal lesion in R hepatic lobe. ARFI may select an optimal location for measurement but there are concerns on the variations. To decrease the variation, ARFI two-location measurement with standardized protocol was evaluated in this study. Methods: A consecutive series of patients who received liver histology study were prospectively enrolled. All participant received hemogram, liver biochemistry, viral markers, ARFI and fibroscan within 4 weeks of histology study. A standardized protocol was used to both fibroscan and ARFI with a single technologist. Then both data from Fibroscan and ARFI were correlated with liver histology. Results: A total of 80 patients that included 35 Non B and Non C, 8 autoimmune liver diseases, 27 chronic hepatitis B and 10 hepatitis C were enrolled. The correlation between Fibroscan and ARFI two-location measurement is good (R250.592). The area under the curve for metavir 4 fibrosis are 0.878 and 0.914 for fibroscan and ARFI respectively. A relatively lower value in fibroscan than in ARFI is noted in the present of severe steatosis. Conclusions: The correlation between Fibroscan and ARFI is good. However, ARFI tends to have a better linearity with histology fibrosis grades than Fibroscan in patients with severe steatosis.
PPT7-004 Diagnostic Value and Reliability of Color Overlay Pattern of Shear - Wave Elastography for Assessing Palpable Breast Mass Ok Hee Woo, Hye Seon Shin Department of Radiology, Korea University Guro Hospital, South Korea Objectives: To evaluate the correlation between quantitative values of stiffness of palpable breast lesion and pathologic results by using shear wave elastography (SWE), and to assess SWE color overlay pattern of the palpable breast lesions and investigate association with BI-RADS category.
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Department of Ultrasound, University of Medicine and Pharmacy ‘‘Victor Babes’’ Objectives: To assess the impact of using quality criteria for liver stiffness (LS) evaluation by means of 2D Shear Wave Elastography from General Electrics (2D-SWE.GE), while using Transient Elastography (TE) as reference. Methods: We included 226 subjects in our study, with or without chronic liver disease, in whom LS was assessed using 2D-SWE.GE (LOGIQ E9, GE Healthcare) and TE (FibroScan, EchoSens). Reliable LS measurements were defined for TE as the median value of 10 measurements with a success rate of $60% and an interquartile range (IQR),30% of the median LS values. For 2D-SWE.GE 10 LS measurements were acquired in a homogenous area and the IQR and the IQR/M were calculated in each case. We divided our subjects into 3 groups according to the 2D-SWE.GE IQR/M: IQR/M,0.10: 41 (18.1%) cases; 0.10,IQR/M#0.30: 155 (68.6%) cases; IQR/M.0.30: 30 (13.3%) cases. We calculated the correlation coefficient between TE and 2DSWE.GE in each group. Results: All 226 (100%) subjects included had 10 valid measurements by means of 2D-SWE.GE and reliable results by TE. A strong positive correlation was found between LS values obtained by means of 2D-SWE.GE and TE in the IQR/M,0.10 group (r50.84, p,0.0001). A strong positive correlation was found between LS values obtained by means of 2D-SWE.GE and TE in the 0.10,IQR/M#0.30 group (r50.80, p,0.0001). A weak positive correlation was found between LS values obtained by means of 2DSWE.GE and TE in the IQR/M.0.30 group (r50.41, p50.02). The correlations were significantly stronger in the IQR/M,0.10 and 0.10,IQR/M#0.30 groups as compared to the IQR/M.0.30 group (both p50.0013). No statistical differences were found between the correlations in the IQR/M,0.10 and 0.10, IQR/M#0.30 groups (p50.43). Conclusions: Using the IQR/M,0.30 as quality criteria significantly increase the reliability of LS measurements by means of 2DSWE.GE. Using IQR/M,0.10 criteria does not significantly improve the reliability of 2D-SWE.GE LS measurements as compared to 0.10, IQR/M#0.30 criteria.
OPT7-025 Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis Eun Sun Lee, Byung Ihn Choi Department of Radiology, Chung-Ang University Hospital, South Korea Objectives: This study aimed to determine the diagnostic performance of hepatic fibrosis by shear wave elastography (SWE) with a propagation map for liver fibrosis, and to assess its reliability considering transient elastography (TE) as the reference standard. Methods: Our prospective study included 115 consecutive patients with suspected or alleged chronic hepatitis. Patients underwent SWE by two different operators and TE by sonographers on the same day. Results: The correlation coefficient of the intraclass correlation test between an experienced radiologist and a third year radiology resident was 0.878. There was a moderate correlation between the SWE and TE (r 5 0.511) for hepatic fibrosis. The best cut-off values predicting significant hepatic fibrosis and liver cirrhosis by SWE were .1.78 m/s (area under the receiver operating characteristic curve [AUROC] 5 0.777) and .2.24 m/s (AUROC 5 0.935), respectively.
S98
Ultrasound in Medicine and Biology
Conclusions: SWE with a propagation map is a reliable method for predicting hepatic fibrosis regardless of operator experience. Poster Session PPT7-001 Assessing Liver Stiffness by 2D-Shear Wave Elastography in a Healthy Cohort Ioan Sporea,1 Anesa Mulabecirovic,2 Felix Bende,3 Alina Popescu,1 Roxana Sirli,1 Odd Helge Gilja,2 Mette Vesterhus,4 Roald Flesland Havre2 1 Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babes’’ Timisoara, Romania, 2 Department of Clinical Medicine, K1, University of Bergen, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway, 3Department of Ultrasound, University of Medicine and Pharmacy ‘‘Victor Babes’’, 4Division of Cancer Medicine, Surgery, Inflammatory Diseases and Transplantation, Oslo University Hos, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway Objectives: To assess the normal range and agreement of liver stiffness measurements in healthy subjects, using 2D-Shear Wave Elastography from General Electric (2D-SWE-GE) compared with Transient Elastography (TE). Methods: We included 80 healthy subjects without known liver disease, in whom liver stiffness (LS) was evaluated in the same session using two elastographic methods, TE and 2D-SWE-GE. Reliable liver stiffness measurements (LSM) were defined for TE as the median value of ten measurements with a success rate (SR) of $60% and an interquartile range (IQR) ,30%, and for 2D-SWE-GE as the median value of 10 measurements acquired in a homogenous area and IQR ,30%. Results: Reliable LSM were obtained in 79 subjects (98.7%) by means of 2D-SWE-GE and in 80 subjects (100%) by means of TE (p50.9). The mean LSM value in our cohort of healthy subjects obtained by means of 2D-SWE-GE was 5.161.3 kPa, which was significantly higher than the LSM values assessed by TE (4.360.9 kPa, p, 0.0001). In 2D-SWE-GE mean LSM values were significantly higher for men than for women, 5.961.2 kPa vs. 4.761.2 kPa (p50.0005). Conclusions: 2D-SWE has a very good feasibility (98.7%) in healthy subjects. The mean LSM value determined by 2D-SWE-GEin healthy subjects is 5.161.3 kPa. LSM values obtained by means of 2D-SWEGE are higher than those obtained by TE in healthy subjects. PPT7-002 Controlled Attenuation Parameter for Prediction of Hepatic Steatosis in a Taiwanese Cohort with Chronic Hepatitis Shih-Jer Hsu, Jian-Jyun Yu, Min-Chin Chiu Department of Internal Medicine, National Taiwan University Hospital, Yunlin, Taiwan Objectives: The object of this study is to evaluate the performance of controlled attenuation parameters (CAP) for the prediction of liver steatosis in Taiwanese patients with chronic hepatitis. Methods: Chronic hepatitis patients with liver biopsy performed within recent 2 years were enrolled. CAP was acquired using a FibroScan Ò M probe. CAP values were compared across histologic steatosis grades. Results: Ninety-three patients (mean age 67.2 years; 58% male) were enrolled. The etiologies of chronic hepatitis were hepatitis C 58%, hepatitis B 31%, and others 11%. The case numbers of respective steatosis grades
Volume 43, Number S1, 2017 were: S0, 56; S1, 31; S2-3, 6. The mean 6 SD of CAP for each steatosis grade was 202 6 31 (S0), 230 6 37 (S1), and 289 6 47 (S2-3) (P, 0.001 by Kruskal-Wallis test). The area under the receiver operating characteristic curve of the CAP for predicting steatosis (S0 vs. S1-3) was 0.765. Conclusions: CAP is useful in prediction of steatosis for Taiwanese patients with chronic hepatitis.
PPT7-003 Correlation between Fibroscan and ARFI Two-Location Measurement with Metavir Liver Fibrosis Score Cheng-Jen Chen,1 Pei-Kwei Tsay,2 Tse-Hwa Hsu,3 Shiu-Feng Huang,4 Wan-Ting Yu,4 Chun-Yen Lin,1 Dar-In Tai1 1 Department of Gastroenterology Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan, 2Division of Molecular and Genomic Medicine, National Health Research Institute, 3Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, 4 Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine Objectives: Non-invasive assessment of liver fibrosis with Fibroscan and acoustic radiation force impulse (AFRI) imaging are two most popular modalities to measure liver fibrosis. Fibroscan is a well-established modality which measure both liver fibrosis and steatosis. However, there is considerable failure rate, and without image quidding the data may be misleading in the present of focal lesion in R hepatic lobe. ARFI may select an optimal location for measurement but there are concerns on the variations. To decrease the variation, ARFI two-location measurement with standardized protocol was evaluated in this study. Methods: A consecutive series of patients who received liver histology study were prospectively enrolled. All participant received hemogram, liver biochemistry, viral markers, ARFI and fibroscan within 4 weeks of histology study. A standardized protocol was used to both fibroscan and ARFI with a single technologist. Then both data from Fibroscan and ARFI were correlated with liver histology. Results: A total of 80 patients that included 35 Non B and Non C, 8 autoimmune liver diseases, 27 chronic hepatitis B and 10 hepatitis C were enrolled. The correlation between Fibroscan and ARFI two-location measurement is good (R250.592). The area under the curve for metavir 4 fibrosis are 0.878 and 0.914 for fibroscan and ARFI respectively. A relatively lower value in fibroscan than in ARFI is noted in the present of severe steatosis. Conclusions: The correlation between Fibroscan and ARFI is good. However, ARFI tends to have a better linearity with histology fibrosis grades than Fibroscan in patients with severe steatosis.
PPT7-004 Diagnostic Value and Reliability of Color Overlay Pattern of Shear - Wave Elastography for Assessing Palpable Breast Mass Ok Hee Woo, Hye Seon Shin Department of Radiology, Korea University Guro Hospital, South Korea Objectives: To evaluate the correlation between quantitative values of stiffness of palpable breast lesion and pathologic results by using shear wave elastography (SWE), and to assess SWE color overlay pattern of the palpable breast lesions and investigate association with BI-RADS category.