Establishing Reliability Criteria for Liver ElastPQ Shear Wave Elastography (ElastPQ-SWE): Comparison Between 10, 5 and 3 Measurements

Abstract

Purpose ElastPQ is a new elastography technique for non-invasive liver fibrosis staging. However, it does not have validated reliability criteria. We tested the reliability of a different number of measurements in patients with chronic liver disease and explored whether the application of quality criteria improves the diagnostic performance.

Materials and Methods All patients underwent liver stiffness assessment (LSM) with ElastPQ and Fibroscan (F-TE). The mean, median, standard deviation (SD) and interquartile range (IQR) of 10, 5 and 3 measurements were retrospectively collected for each patient and compared to each other. Liver histology was available in a subset of patients.

Results Overall, 400 patients met the inclusion criteria. Non-alcoholic fatty liver disease (NAFLD) was the most represented etiology (75 %), followed by primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH). The correlation of medians was significantly better between 10 and 5 measurements than between 10 and 3. The difference of medians was significant only in the comparison between 10 and 3 measurements. The correlation between ElastPQ and F-TE was equally good for 10 and 5 measurements and significantly improved after an IQR/median ≤ 30 % was applied. The diagnostic performance of ElastPQ was better with the median value of 10 and 5 measurements and improved if LSM values were obtained with IQR/M ≤ 30 %.

Conclusion The median value of 5 valid LSMs suffices for the reliable estimation of liver stiffness using ElastPQ. The quality criterion of IQR/M ≤ 30 % should also be followed when using this technique.

Zusammenfassung

Ziel ElastPQ ist ein neues elastografisches Verfahren für das nichtinvasive Staging der Leberfibrose, hat aber keine validierten Reliabilitätskriterien. Wir haben die Verlässlichkeit der verschiedenen Messungen bei Patienten mit chronischer Lebererkrankung getestet und untersucht, ob die Anwendung von Qualitätskriterien die diagnostische Leistung verbessert.

Material und Methoden Bei allen Patienten wurde eine Lebersteifigkeitsuntersuchung (LSM) mit ElastPQ und Fibroscan (F-TE) durchgeführt. Mittelwert, Median, Standardabweichung (SD) und Interquartilsabstand (IQR) von 10, 5 und 3 Messungen wurden retrospektiv für jeden Patienten erhoben und miteinander verglichen. Bei einer Untergruppe der Patienten war eine Leberhistologie verfügbar.

Ergebnisse Insgesamt erfüllten 400 Patienten die Einschlusskriterien. Die nichtalkoholische Fettleberkrankheit (NAFLD) war die am häufigsten vertretene Ätiologie (75 %), gefolgt von primärer sklerosierender Cholangitis (PSC), primärer biliärer Cholangitis (PBC) und Autoimmunhepatitis (AIH). Die Korrelation der Mediane war signifikant besser zwischen 10 und 5 Messungen als zwischen 10 und 3. Eine Differenz der Mediane war nur signifikant beim Vergleich von 10 und 3 Messungen. Die Korrelation zwischen ElastPQ und F-TE war für 10 und 5 Messungen gleichermaßen gut und verbesserte sich signifikant, wenn IQR/median ≤ 30 % angewendet wurde. Die diagnostische Leistung von ElastPQ war besser mit dem Medianwert von 10 und 5 Messungen und verbesserte sich, wenn LSM-Werte mit IQR/M ≤ 30 % erreicht wurden.

Schlussfolgerung Der Medianwert von 5 gültigen LSMs ist ausreichend für die zuverlässige Abschätzung der Lebersteifigkeit mittels ElastPQ. Auch bei dieser Methode sollte das Qualitätskriterium IQR/M ≤ 30 % eingehalten werden.

Key words

transient elastography - liver stiffness - non-alcoholic fatty liver disease - autoimmune liver disease - point shear wave elastography

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