Non-invasive evaluation of liver fibrosis: a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C

Anneloes E Bohte, Annikki de Niet, Louis Jansen, Shandra Bipat, Aart J Nederveen, Joanne Verheij, Valeska Terpstra, Ralph Sinkus, Karin M J van Nieuwkerk, Rob J de Knegt, Bert C Baak, Peter L M Jansen, Henk W Reesink, Jaap Stoker

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85 Citations (Scopus)

Abstract

OBJECTIVE: To compare the diagnostic accuracy of TE and MRE and establish cutoff levels and diagnostic strategies for both techniques, enabling selection of patients for liver biopsy.

METHODS: One hundred three patients with chronic hepatitis B or C and liver biopsy were prospectively included. Areas under curves (AUROC) were compared for TE and MRE for METAVIR fibrosis grade ≥ F2 and ≥F3. We defined cutoff values for selection of patients with F0-F1 (sensitivity >95%) and for significant fibrosis F2-F4 (specificity >95%).

RESULTS: Following exclusions, 85 patients were analysed (65 CHB, 19 CHC, 1 co-infected). Fibrosis stages were F0 (n = 3), F1 (n = 53), F2 (n = 15), F3 (n = 8) and F4 (n = 6). TE and MRE accuracy were comparable [AUROCTE ≥ F2: 0.914 (95% CI: 0.857-0.972) vs. AUROCMRE ≥ F2: 0.909 (0.840-0.977), P = 0.89; AUROCTE ≥ F3: 0.895 (0.816-0.974) vs. AUROCMRE ≥ F3: 0.928 (0.874-0.982), P = 0.42]. Cutoff values of <5.2 and ≥8.9 kPa (TE) and <1.66 and ≥2.18 kPa (MRE) diagnosed 64% and 66% of patients correctly as F0-F1 or F2-F4. A conditional strategy in inconclusive test results increased diagnostic yield to 80%.

CONCLUSION: TE and MRE have comparable accuracy for detecting significant fibrosis, which was reliably detected or excluded in two-thirds of patients. A conditional strategy further increased diagnostic yield to 80%.

KEY POINTS: • Both ultrasound-based transient elastography and magnetic resonance elastography can assess hepatic fibrosis. • Both have comparable accuracy for detecting liver fibrosis in viral hepatitis. • The individual techniques reliably detect or exclude significant liver fibrosis in 66 %. • A conditional strategy for inconclusive findings increases the number of correct diagnoses.

Original languageEnglish
Pages (from-to)638-648
Number of pages11
JournalEuropean Radiology
Volume24
Issue number3
DOIs
Publication statusPublished - 1 Mar 2014

Keywords

  • Adult
  • Area Under Curve
  • Biopsy
  • Elasticity Imaging Techniques
  • Female
  • Hepatitis B, Chronic
  • Hepatitis C, Chronic
  • Humans
  • Liver Cirrhosis
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Prospective Studies
  • ROC Curve
  • Sensitivity and Specificity
  • Young Adult

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