Diagnosis of steatohepatitis and fibrosis in biopsy-proven nonalcoholic fatty liver diseases: including two-dimension real-time shear wave elastography and noninvasive fibrotic biomarker scores

Jie Zhou; Feng Yan; Jinshun Xu; Qiang Lu; Xianglan Zhu; Binyang Gao; Huan Zhang; Rui Yang; Yan Luo

doi:10.21037/qims-21-700

Diagnosis of steatohepatitis and fibrosis in biopsy-proven nonalcoholic fatty liver diseases: including two-dimension real-time shear wave elastography and noninvasive fibrotic biomarker scores

Quant Imaging Med Surg. 2022 Mar;12(3):1800-1814. doi: 10.21037/qims-21-700.

Authors

Jie Zhou^{1

2}, Feng Yan^{1

2}, Jinshun Xu^{1

2}, Qiang Lu^{1

2}, Xianglan Zhu³, Binyang Gao^{1

2}, Huan Zhang^{1

2}, Rui Yang^{1

2}, Yan Luo^{1

2}

Affiliations

¹ Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China.
² Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China.
³ Pathology Department of West China Hospital of Sichuan University, Chengdu, China.

Abstract

Background: The aim of this retrospective study was to evaluate the accuracy of two-dimension real-time shear wave elastography (2D-SWE) for the diagnosis of steatohepatitis and fibrosis in a cohort patients confirmed nonalcoholic fatty liver diseases (NAFLD) by liver biopsy, and compare with four noninvasive fibrotic biomarker scores (NFS, FIB-4, BARD and APRI).

Methods: 116 NAFLD patients and 23 normal control group were enrolled. The diagnostic performance of 2D-SWE and four noninvasive fibrotic biomarker scores was evaluated based on histopathological inflammation grades and fibrosis stages (F) according to Kleiner/Brunt et al.'s criteria classification. 5-fold cross validation and receiver operating characteristics curve (ROC) analyses were used to obtain an assessment of 2D-SWE and four noninvasive fibrotic biomarker scores; then cross validated area under the curves (AUCs) were compared using the test of Delong. Meanwhile, influence of steatosis on liver stiffness measurement (LSM) of 2D-SWE was also studied.

Results: Liver stiffness measured by 2D-SWE proved to be an excellent diagnostic indicator for detecting steatohepatitis (AUROC =0.88), and fibrosis: ≥F2 stage (AUROC =0.86), ≥F3 stage (AUROC =0.89) and =F4 stage (AUROC =0.90) with the cutoff values were 7.3, 10.0, 11.6 and 12.6 kPa, respectively. Compared with fibrotic scores, 2D-SWE had the highest AUROC for predicting ≥F2, ≥F3, =F4 by Delong test (all P<0.05). No statistic differences of LSM were found among different steatosis levels (P=0.97).

Conclusions: The stiffness measured by 2D-SWE could be used to noninvasively identify steatohepatitis and stage fibrosis in NAFLD patients. Moreover, the diagnosis efficiency of the stiffness measured by 2D-SWE could not be influenced by steatosis.

Keywords: K-fold-cross-validation; Nonalcoholic fatty liver disease (NAFLD); cirrhosis; nonalcoholic steatohepatitis (NASH); shear wave elastography (SWE).