Liver stiffness measurements by 2-dimensional shear wave elastography compared to histological and ultrasound parameters in primary biliary cholangitis

Abstract

Background and aims

Liver stiffness measurements (LSMs) by 2-dimensional-shear-wave elastography (LSM_2D-SWE) are now widely used in hepatology. However, relevant information for primary biliary cholangitis (PBC) is scant. We compare LSM_2D-SWE with liver biopsy (LB) in a cohort of PBC patients in Greece.

Methods

Data of 68 LBs from 53 PBC patients were retrospectively analyzed and fibrosis stage was compared to LSM_2D-SWE. Forty-six patients (86.8%) were females and at the time of LBx median (IQR) age was 62.6 (53.2–72.1). Demographic, UDCA treatment, histological and B-mode ultrasound data were tested for their influence on LSM_2D-SWE estimates.

Results

Liver fibrosis stages F0–F4 were found in 4, 19, 19, 16 and 10 cases, respectively. Across stages F0–F4, the LSM_2D-SWE was 5.6 (5.1–6.1), 7.0 (5.8–7.7), 9.1 (7.3–11.5), 10.8 (9.9–12.2) and 14.5 (11.9–25.7) kPa, respectively, with highly significant difference (p<.001). The LSM_2D-SWE differed also significantly between F0 vs. F1 (p=.027), F1 vs. F2 (p=.005) and F3 vs. F4 (p=.017). The discriminatory ability of LSM_2D-SWE for mild, significant, severe fibrosis and cirrhosis was highly significant in all comparisons (p<.001), with AUC_2D-SWE 95.3%, 87.4%, 85.3% and 95.3% and accuracy 89.7%, 85.3%, 80.9% and 86.8%, respectively. Among 21 parameters tested, significant predictors of LSM_2D-SWE by multiple linear regression were fibrosis stage, portal inflammation and parenchymal heterogeneity. The portal inflammation grade accounted for 32.2% of LSM variation with adjusted R² 0.428.

Conclusions

In patients with PBC, LSM measurements by 2D-SWE can reliably discriminate between mild, significant, severe fibrosis and cirrhosis. Measurements are significantly affected by portal inflammation grade.

Keywords:

• PBC
• 2D-shear wave elastography
• liver stiffness measurements
• SSI Aixplorer^® apparatus
• estimation of liver fibrosis
• non-invasive methods

Acknowledgements

Clinical trial number: Observational retrospective study.

Disclosure statement

No potential conflict of interest was reported by the author(s).