Korean J Radiol.  2017 Dec;18(6):926-935. 10.3348/kjr.2017.18.6.926.

Prospective Validation of Intra- and Interobserver Reproducibility of a New Point Shear Wave Elastographic Technique for Assessing Liver Stiffness in Patients with Chronic Liver Disease

• Ahn SJ
• Lee JM
• Chang W
• Lee SM
• Kang HJ
• Yang H
• Yoon JH
• Park SJ
• Han JK

• KMID: 2427202
• DOI: http://doi.org/10.3348/kjr.2017.18.6.926

Abstract

OBJECTIVE
To assess intra- and inter-observer reproducibility of a new point shear wave elastography technique (pSWE, S-Shearwave, Samsung Medison) and compare its accuracy in assessing liver stiffness (LS) with an established pSWE technique (Virtual Touch Quantification, VTQ).
MATERIALS AND METHODS
Thirty-three patients were enrolled in this Institutional Review Board-approved prospective study. LS values were measured by VTQ on an Acuson S2000 system (Siemens Healthineer) and S-Shearwave on an RS-80A (Samsung Medison) in the same session, followed by two further S-Shearwave sessions for inter- and intra-observer variation at 8-hour intervals. The technical success rate (SR) and reliability of the measurements of both pSWE techniques were compared. The intra- and inter-observer reproducibility of S-Shearwave was determined by intraclass correlation coefficients (ICCs). LS values were measured by both methods of pSWE. The diagnostic performance in severe fibrosis (F ≥ 3) and cirrhosis (F = 4) was evaluated using the receiver operating characteristics curve analysis and the Obuchowski measure with the LS values of transient elastography as the referenced standard.
RESULTS
The VTQ (100%, 33/33) and S-Shearwave (96.9%, 32/33) techniques did not display a significant difference in technical SR (p = 0.63) or reliability of LS measurements (96.9%, 32/33; 93.9%, 30/32, respectively, p = 0.61). The inter- and intra-observer agreement for LS measurements using the S-Shearwave technique was excellent (ICC = 0.98 and 0.99, respectively). The mean LS values of both pSWE techniques were not significantly different and exhibited a good correlation (r = 0.78). To detect F ≥ 3 and F = 4, VTQ and S-Shearwave showed comparable diagnostic accuracy as indicated by the following outcomes: areas under receiver operating characteristics curve (AUROC) = 0.87 (95% confidence intervals [CI] 0.70-0.96), 0.89 for VTQ (95% CI 0.74-0.97), respectively; and AUROC = 0.84 (95% CI 0.67-0.94), 0.94 (95% CI 0.80-0.99) for S-Shearwave (p > 0.48), respectively. The Obuchowski measures were similarly high for S-Shearwave and VTQ (0.94 vs. 0.95).
CONCLUSION
S-Shearwave shows excellent inter- and intra-observer agreement and diagnostic effectiveness comparable to VTQ in detecting LS.

Keyword

Liver fibrosis; Liver stiffness; Ultrasound elastography; Shear wave elastography

MeSH Terms

Adult
Aged
Aged, 80 and over
Area Under Curve
Chronic Disease
*Elasticity Imaging Techniques
Female
Humans
Liver/diagnostic imaging/*physiopathology
Liver Cirrhosis/diagnosis/pathology
Liver Diseases/*diagnosis/diagnostic imaging
Male
Middle Aged
Prospective Studies
ROC Curve
Reproducibility of Results
Severity of Illness Index

Figure

• 

  Fig. 1 Flow diagram of study population. *One population with unreliable measurements for S-Shearwave also had unreliable measurements for VTQ. LS = liver stiffness, S-Shearwave = S-Shearwave elastography, TE = transient elastography, VTQ = virtual touch quantification

• 

  Fig. 2 LS measurement by two pSWE techniques, VTQ (A) and S-Shearwave (B). For both measurements, operator sited predefined measurement box in liver. pSWE = point shear wave elastography

• 

  Fig. 3 Correlation between VTQ and S-Shearwave in same individuals. Linear correlation analysis of LS values seen with VTQ and S-Shearwave in same individuals indicates significant correlation between two techniques.

• 

  Fig. 4 Bland–Altman plot showing inter- (A) and intraobserver agreement (B) in S-Shearwave measurement. X-axis shows means of repeated LS measurements, and y-axis displays difference between repeat S-Shearwave LS measurements. Red line = mean difference, green line = 95% limit of agreement

• 

  Fig. 5 Comparison of ROC curves for VTQ and S-Shearwave for different fibrosis thresholds. (A) F0–1 vs. F2–4, (B) F0–F2 vs. F3–F4, (C) F0–F3 vs. F4. In parentheses, 95% CI are shown. p values of differences between AUROCs are given. AUROC = areas under receiver operating characteristics curve, CI = confidence intervals, ROC = receiver operating characteristics

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