Fig 1.
Flow diagram of the study population.
Fig 2.
Applicability of 2D comb-push shear wave elastography (SWE) measurements.
(A) Applicable SWE examination with technical success and reliable measurement in a 43-year-old male liver donor with a body mass index (BMI) of 25.73 kg/m2. The region of interest (ROI) was placed in the right upper lobe, avoiding large vessels and areas with artifacts, and 17.7mm away from the Glisson capsule. Sufficient color maps covering more than 50% of the sampling area for all acquisitions were obtained, which was regarded as a technical success. The interquartile range/median ratio was 6.51%, which was lower than 30% and was considered as a reliable measurement. The median liver stiffness (LS) value was 4.15kPa, and the histologic fibrosis was proven to be stage F0. Note that the distance between the transducer and Glisson capsule was 17.5mm. (B) Non-applicable SWE examination with technical failure in a 68-year-old female patient with a BMI of 21.26kg/m2,who was awaiting liver transplantation. The ROI was placed in the right upper lobe, devoid of large vessels and areas of artifacts, and 15.4mm away from the Glisson capsule. Despite 12 trials, color filling of the elastography map was insufficient, which was regarded as a technical failure. Note that this was the only case of technical failure in our study, and the distance between the transducer and Glisson capsule was 34.0mm.
Table 1.
Comparison between patients with applicable 2D CP-SWE and patients with non-applicable 2D CP-SWE.
Table 2.
Clinical characteristics and METAVIR scorings of 105 patients with applicable 2D CP-SWE and histologic diagnosis.
Fig 3.
Box-and-whisker plot shows the liver stiffness (LS) values at each fibrosis staging.
The boxes represent LS values from the 25th to 75th quartile, and the lines at the center of the boxes indicate the median. The whiskers represent the 9th and 91st percentiles. LS values are expressed in kilopascals.
Fig 4.
Scatterplots show good intra-and interobserver correlations for 2D comb-push shear wave elastography.
The Pearson correlation, r and the intra-class correlation, ICC are shown in the plot.
Table 3.
The predictors for high LS value (>5.33kPa) which is the cutoff value for differentiating advanced fibrosis (≥F2) from non-advanced fibrosis.
Fig 5.
When applying the cutoff values from our study, the live stiffness (LS) values obtained by the 2D comb-push shear wave elastography (2D CP-SWE) could predict histologic fibrosis staging.
A)The median LS value of 5.98kPa was achieved by the 2D CP-SWE in a 64-year-old man, which was greater than the cutoff value of F2 (5.33kPa) and less than the cutoff value of F3 (6.84kPa). The patient underwent surgical resection for hepatocellular carcinoma (HCC), after which the fibrosis staging was histologically confirmed to be F2. B) The median LS value of 7.38kPa was measured by the 2D CP-SWE in a 66-year-old man, which was greater than the cutoff value of F3 (6.84kPa) and less than the cutoff value of F4 (7.59kPa). The patient underwent surgical resection for HCC, after which the fibrosis stage was histologically confirmed as F3. C) Despite massive ascites, reliable LS values were successfully measured by 2D CP-SWE in a 57-year-old woman. The median LS value of 13.45kPa was greater than the cutoff value of F4 (7.59kPa). The patient underwent liver transplantation. The fibrosis stage was histologically proven to be F4, and the macronodular cirrhosis was associated with alcohol consumption. D) Reliable LS values were successfully measured by 2D CP-SWE in a 49-year-old obese man with a body mass index of 31.33kg/m2. The median LS value of 8.14kPa was greater than the value of F4 (7.59kPa). The patient underwent liver transplantation. The fibrosis stage was histologically proven to be F4, and macronodular cirrhosis was associated with hepatitis B virus infection and alcohol consumption.
Table 4.
Diagnostic performance of 2D CP-SWE for fibrosis staging (n = 105).