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SSI, transient elastography useful for detecting fibrosis in obese patients with liver disease

Supersonic shear imaging and transient elastography accurately measured liver fibrosis in obese patients with chronic liver disease, according to data published in Clinical Gastroenterology and Hepatology.

“Supersonic shear imaging, also named ShearWave (SuperSonic Imagine, Aix-en-Provence, France) elastography, is based on the measurement of the velocity of a local shear wave through soft tissue,” the researchers wrote. “Several studies have reported on the usefulness of [supersonic shear imaging] for assessing liver fibrosis in patients with chronic hepatitis. … [We sought] to specifically investigate the diagnostic accuracy and reliability of [supersonic shear imaging] when compared with assessment of liver fibrosis using [transient elastography] with the XL probe in overweight or obese patients with chronic liver disease.”

Researchers conducted a prospective study of 258 patients evaluated at the University of Miami between October 2013 and December 2014. All patients had a BMI greater than 25 and had underlying liver conditions such as HCV (n = 168), nonalcoholic fatty liver disease (n = 35), chronic HBV (n = 20), primary biliary cirrhosis (n = 11), primary sclerosing cholangitis (n = 10), autoimmune hepatitis (n = 4) and other liver diseases (n = 10).

The liver stiffness was measured using the transient elastography (TE) -XL probe and supersonic shear imaging (SSI) of the right and left lobes to determine stage of fibrosis and compared with 124 patients who had histologic determination of fibrosis stage, according to the research. Analyses were also conducted on a subgroup of 102 patients with chronic HCV.

Overall, reliable liver stiffness measurements were obtained from 96.1% of patients using the TE-XL probe, 94.6% of patients using SSI of the right lobe and 72.1% of patients using SSI of the left lobe.

Among the 124 patients with biopsy-proven fibrosis, severe fibrosis was detected with an area under the receiver operating characteristic curve (AUROC) value of 0.955 using the TE-XL, AUROC value of 0.954 using SSI of the right lobe and AUROC value of 0.91 using SSI of the left lobe. Among the 102 biopsy-proven patients with HCV infection, severe fibrosis was measured with the TE-XL with an AUROC value of 0.952, SSI of the right lobe had an AUROC value of 0.949 and SSI of the left lobe had an AUROC value of 0.917.

In all 124-biopsy proven patients, stage 4 fibrosis was detected using the TE-XL with an AUROC value of 0.92, SSI of the right lobe had an AUROC value of 0.93 and SSI of the left lobe had an AUROC value of 0.91, compared with histologic analysis. In the 102 patients with chronic HCV, stage 4 fibrosis was measured as having an AUROC value of 0.907 with TE-XL, AUROC value of 0.914 with SSI of the right lobe and AUROC value of 0.887 with SSI of the left lobe.

“We showed that both SSI and TE-XL are valuable diagnostic tools for the diagnosis of severe fibrosis and cirrhosis with AUROCs greater than 0.9 even in overweight or obese patients,” the researchers wrote. “Furthermore, both types of elastography showed higher accuracy than several clinical scoring systems in the diagnosis of severe fibrosis and cirrhosis. … Because SSI requires a well-trained sonographer, these findings could be used to determine if the accuracy of SSI is indeed susceptible to operator variation. Larger prospective multicenter studies may be necessary to further ensure that SSI is indeed a reliable diagnostic tool in overweight patients.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.