Korean J Radiol.  2013 Apr;14(2):202-212. 10.3348/kjr.2013.14.2.202.

Staging of Hepatic Fibrosis: Comparison of Magnetic Resonance Elastography and Shear Wave Elastography in the Same Individuals

• Yoon JH
• Lee JM
• Woo HS
• Yu MH
• Joo I
• Lee ES
• Sohn JY
• Lee KB
• Han JK
• Choi BI

• KMID: 1482778
• DOI: http://doi.org/10.3348/kjr.2013.14.2.202

Abstract

OBJECTIVE
To cross-validate liver stiffness (LS) measured on shear wave elastography (SWE) and on magnetic resonance elastography (MRE) in the same individuals.
MATERIALS AND METHODS
We included 94 liver transplantation (LT) recipients and 114 liver donors who underwent either MRE or SWE before surgery or biopsy. We determined the technical success rates and the incidence of unreliable LS measurements (LSM) of SWE and MRE. Among the 69 patients who underwent both MRE and SWE, the median and coefficient of variation (CV) of the LSM from each examination were compared and correlated. Areas under the receiver operating characteristic curve in both examinations were calculated in order to exclude the presence of hepatic fibrosis (HF).
RESULTS
The technical success rates of MRE and SWE were 96.4% and 92.2%, respectively (p = 0.17), and all of the technical failures occurred in LT recipients. SWE showed 13.1% unreliable LSM, whereas MRE showed no such case (p < 0.05). There was moderate correlation in the LSM in both examinations (r = 0.67). SWE showed a significantly larger median LSM and CV than MRE. Both examinations showed similar diagnostic performance for excluding HF (Az; 0.989, 1.000, respectively).
CONCLUSION
MRE and SWE show moderate correlation in their LSMs, although SWE shows higher incidence of unreliable LSMs in cirrhotic liver.

Keyword

Hepatic fibrosis; Elastography; Ultrasound-based elastography; Shear wave elastography; Magnetic resonance elastography; Cross-validation

MeSH Terms

Adolescent
Adult
Elasticity Imaging Techniques/*methods
Female
Humans
Linear Models
Liver Cirrhosis/*diagnosis/ultrasonography
*Liver Transplantation
*Living Donors
*Magnetic Resonance Imaging
Male
Middle Aged
ROC Curve
Sensitivity and Specificity

Figure

• 

  Fig. 1 Flow diagram of study population. MRE and SWE = patient population that underwent both examinations. *Study population defining technical failure of each examination, †Study population used for cross-validation. MRE = magnetic resonance elastography, SWE = shear wave elastography

• 

  Fig. 2 Shear wave elastography (SWE) and magnetic resonance elastography (MRE) images in of 39-year-old liver donor. Liver stiffness map on SWE (A) was color-coded with blue, which suggested lower liver stiffness value. Liver stiffness value on SWE was 2.9 kPa. On MRE wave image (B) and elastogram (C), liver showed narrow wavelength over liver, as well as lower stiffness value, which was color-coded with violet and blue.

• 

  Fig. 3 Shear wave elastography (SWE) and magnetic resonance elastography (MRE) images in 40-year-old liver recipient due to liver cirrhosis. Elastogram of SWE (A) was coded with red and liver stiffness value was 50.7 kPa. On MRE wave image (B), wavelength over liver was markedly wider than that of donor (Fig. 2B), and which suggested faster shear wave speed. On MRE elastogram (C), liver was color-coded with red and liver stiffness of MRE was 10.61 kPa.

• 

  Fig. 4 Correlation between MRE and SWE in same individuals. Linear correlation analysis of liver stiffness values seen on MRE and SWE in same individuals, including all donors and recipients (A), indicates correlation between two techniques. Bland-Altman analysis of same data is shown in (B). X-axis is average value of logarithmic transformation of liver stiffness values seen on MRE and SWE, and y-axis is difference between logarithmic transformations of liver stiffness values seen on two examinations. SWE = shear wave elastography, MRE = magnetic resonance elastography, SD = standard deviation

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