Liver stiffness quantification in patients with non-alcoholic steatohepatitis: comparison of shear wave elastography and transient elastography with liver biopsy correlation

Purpose: To assess the accuracy of liver stiffness quantification in patients with non-alcoholic steatohepatitis (NASH) using shear wave elastography (SWE) in comparison with transient elastography (TE). Methods and Materials: This is a prospective study performed in a single institution, including 49 patients with histological diagnosis of NASH. The stiffness of the right liver lobe was measured on the same day with two techniques: TE (FibroScan, Echosens), and SWE (RS80A ultrasound system, Samsung Medison). In the SWE evaluation, 11 patients were excluded due to more than 75% measurements fails. Receiver operating curves (ROC), areas under the ROC (AUROC) and 95% confidence intervals (CI) were calculated to assess the accuracy of TE and SWE for the diagnosis of significant fibrosis (F2-F4) and advanced fibrosis (F3-F4). Spearman’s rank coefficient (rho) was used for correlation of TE with SWE. A p<0.05 was considered for statistical significance. Results: 38 patients were included in the final population. Overall 24 (63%) patients had significant fibrosis and 17 (45%) had advanced fibrosis. TE and SWE showed an AUROC of 0.711 (95% CI: 0.545-0.877, p=0.032) and 0.729 (95% CI: 0.562-0.896, p=0.020) for the diagnosis of significant fibrosis. The AUROC for the diagnosis of advanced fibrosis were 0.803 (95% CI: 0.648- 0.9580, p=0.002) and 0.811 (95% CI: 0.667-0.955, p=0.001) for TE and SWE, respectively. There was a significant correlation between TE and SWE measurements (rho=0.455, p = 0.004). Conclusion: SWE and TE have both a good accuracy, with a significant correlation, for the diagnosis of advanced fibrosis in NASH-patients