Ultraschall Med 2019; 40(01): 64-75
DOI: 10.1055/s-0043-124184
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of Inter-System Variability in Liver Stiffness Measurements

Bewertung der Intersystem-Variabilität bei Lebersteifigkeitsmessungen
Giovanna Ferraioli
1   Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Italy
,
Annalisa De Silvestri
2   Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
,
Raffaella Lissandrin
1   Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Italy
,
Laura Maiocchi
1   Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Italy
,
Carmine Tinelli
2   Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
,
Carlo Filice
1   Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Italy
,
Richard G. Barr
3   Radiology, Northeastern Ohio Medical University, Rootstown, United States
› Institutsangaben
Weitere Informationen

Publikationsverlauf

02. Juli 2017

16. November 2017

Publikationsdatum:
22. März 2018 (online)

Abstract

Aim The primary aim of this study was to determine the inter-system variability of liver stiffness measurements (LSMs) in patients with varying degrees of liver stiffness. The secondary aim was to determine the inter-observer variability of measurements.

Materials and Methods 21 individuals affected by chronic hepatitis C and 5 healthy individuals were prospectively enrolled. The assessment of LSMs was performed using six ultrasound (US) systems, four of which with point shear wave elastography (p-SWE) and two with 2 D shear wave elastography (2D-SWE) systems. The Fibroscan (Echosens, France) was used as the reference standard. Four observers performed the measurements in pairs (A-B, C-D). The agreement between different observers or methods was calculated using Lin’s concordance correlation coefficient. The Bland-Altman limits of agreement (LOA) were calculated as well.

Results There was agreement above 0.80 for all pairs of systems. The mean difference between the values of the systems with 2D-SWE technique was 1.54 kPa, whereas the maximum mean difference between the values of three out of four systems with the pSWE technique was 0.79 kPa. The intra-patient concordance for all systems was 0.89 (95 % CI: 0.83 – 0.94). Inter-observer agreement was 0.96 (95 % CI: 0.94 – 0.98) for the pair of observers A-B and 0.93 (95 % CI: 0.89 – 0.96) for the pair of observers C-D.

Conclusion The results of this study show that the agreement between LSMs performed with different US systems is good to excellent and the overall inter-observer agreement in “ideal conditions” is above 0.90 in expert hands.

Zusammenfassung

Ziel Das Primärziel dieser Studie war es, die Intersystem-Variabilität von Lebersteifigkeitsmessungen (LSM) bei Patienten mit unterschiedlichen Lebersteifigkeiten zu bestimmen. Das Sekundärziel bestand in der Bestimmung der Inter-Beobachter-Variabilität der Messungen.

Material und Methoden Einundzwanzig Personen mit chronischer Hepatitis C und fünf gesunde Personen wurden prospektiv aufgenommen. Die Bewertung der LSM erfolgte mit sechs Ultraschallsystemen (US), vier davon verwendeten Punkt-Scherwellen-Elastografie (p-SWE) und zwei 2D-Scherwellen-Elastografie (2D-SWE). Der Fibroscan (Echosens, Frankreich) wurde als Referenzstandard verwendet. Vier Beobachter führten jeweils in Paaren die Messungen durch (A-B, C-D). Die Übereinstimmung zwischen verschiedenen Beobachtern oder Methoden wurde unter Verwendung des Konkordanz-Korrelationskoeffizienten nach Lin berechnet. Die Bland-Altman Übereinstimmungsgrenzen (LOA) wurden ebenfalls bestimmt.

Ergebnisse Die Übereinstimmung betrug mehr als 0,80 für alle Systempaare. Der mittlere Unterschied zwischen den Werten der Systeme mit 2D-SWE-Technik betrug 1,54 kPa, während der maximale mittlere Unterschied zwischen den Werten von drei der vier Systeme mit pSWE-Technik 0,79 kPa betrug. Die Intra-Patienten-Konkordanz für alle Systeme war 0,89 (95 % CI: 0,83 – 0,94). Die Interobserver-Übereinstimmung betrug 0,96 (95 % CI: 0,94 – 0,98) für das Paar der Beobachter A-B und 0,93 (95 % CI: 0,89 – 0,96) für das Paar der Beobachter C-D.

Schlussfolgerung Die Ergebnisse dieser Studie zeigen, dass die Übereinstimmung zwischen LSMs, die mit unterschiedlichen US-Systemen durchgeführt wurden, gut bis hervorragend ist und die globale Übereinstimmung zwischen den Beobachtern, sofern diese Expertise besitzen, unter „idealen Bedingungen“ über 0,90 liegt.

 
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