Comparison between 2D-Real Time Shear Wave-Elastography (2D-SWE) and simple serological scores for liver fibrosis assessment for clinical routine, considering Transient Elastography (TE) as reference method

Background and aim: 2D-SWE is a new method for non-invasive assessment of liver fibrosis. Our aim was to assess the performance of 2D-SWE and simple serological scores for liver fibrosis assessment, considering TE as reference method.

Methods: 88 patients with chronic liver disease undergoing both by TE and 2D-SWE were consecutively included. Biochemical parameters were recorded to calculate the noninvasive fibrosis scores. TE reliability criteriay defined as: median of 10 valid LS measurements with a SR≥60% and IQR6kPa, F2> 7.2kPa, F3> 9.6kPa and F4> 14.5kPa.

Results: Reliable LS measurements by TE and 2D-SWE were obtained in 70.4% and 98.8% of patients (p < 0.0001), respectively. The following noninvasive fibrosis scores were correlated in univariate analysis with fibrosis estimated by TE: 2D-SWE (r = 0.660; p < 0.0001), Forns (r = 0.486; p = 0.0006), King's (r = 0.398; p = 0.005), FIB-4 (r = 0.293; p = 0.03) and Fibrosis Index score (r = 0.279; p = 0.04), while APRI and Lok score were not correlated. In multivariate analysis only LS by SWE was significantly correlated with fibrosis estimated by means of TE.

The best 2D-SWE cut-off for predicting significant fibrosis F≥2, F≥3 and cirrhosis F4 were 8.6kPa (AUC = 0.719, accuracy = 70.4%), 9.2kPa (AUC = 0.899, PPV = 90.5%, accuracy = 90.5%) and 13.5kPa (AUC = 0.910, NPV = 100%, accuracy = 95.1%).

Conclusions: 2D-SWE results in a higher rate of successful liver stiffness measurements than TE and is superior to simple serological scores.