Transient versus two-dimensional shear-wave elastography in a multistep strategy to detect advanced fibrosis in NAFLD
Abstract
BACKGROUND AND AIMS: The combination of laboratory and elastography tests allows the accurate diagnosis of advanced liver fibrosis in patients with NAFLD. In this study, we compared the diagnostic performances of a two-step strategy (laboratory tests and vibration-controlled transient elastography [VCTE] or two-dimensional shear-wave elastography with SuperSonic Imagine [2D-SWE-SSI]) and the added value of a three-step strategy (laboratory tests and two elastography methods). APPROACH AND RESULTS: From a prospective registry, we retrospectively selected 577 consecutive patients with suspicion of NAFLD who underwent laboratory tests to calculate the Fibrosis-4 (FIB-4) score, liver stiffness evaluation by VCTE (M and XL probes) and 2D-SWE-SSI, and liver biopsy. The diagnostic performances and need for liver biopsy in unclassified patients for the diagnosis of advanced fibrosis (F ≥ 3) in multistep strategies were compared. The area under the curve of FIB-4, VCTE, and 2D-SWE-SSI was 0.74, 0.82, and 0.88, respectively. Using the same thresholds, the FIB-4/2D-SWE-SSI and FIB-4/VCTE diagnostic performances were comparable (sensitivity, 71.4% and 66%; specificity, 91.4% and 91.5%; and accuracy, 83.7% and 81.4%; all P = not significant). Conversely, more patients required liver biopsy after 2D-SWE-SSI (24.6% versus 15.3%, P < 0.001). Performing a second elastography technique in patients with unreliable or gray zone (between 8 and 10 kPa) results greatly decreased the need for liver biopsy (42/577, 7.3%). The diagnostic performances (accuracy, sensitivity, and specificity) of FIB-4/2D-SWE-SSI/VCTE and FIB-4/VCTE/2D-SWE-SSI were comparable (81.1%, 71.5%, and 87.9% versus 81.3%, 69.7%, and 89.5%, respectively; all P = not significant). CONCLUSIONS: Using the same cutoff values, 2D-SWE-SSI is as accurate as VCTE for advanced liver fibrosis diagnosis in NAFLD. The three-step strategy in selected patients strongly decreased the need for liver biopsy while maintaining excellent accuracy.
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Two-dimensional shear wave elastography and point shear wave elastography show a similar ability to assess the degree of fibrosis as VCTE.
“They show a similar ability to assess the degree of fi brosis as VCTE.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [155]
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- Authors
- Cassinotto, C., Boursier, J., Paisant, A., Guiu, B., Irles‐Depe, M., Canivet, C., Aube, C., & de Ledinghen, V.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Department of Hepatology,University Hospital of Angers,Angers,France
- Université d'Angers (FR)
- Centre Hospitalier Universitaire de Montpellier (FR)
- Centre d’Investigation de la Fibrose Hépatique,Hôpital Haut‐Lévêque,University Hospital of Bordeaux,Pessac,France
- Université Nantes Angers Le Mans (FR)
- Laboratory HIFIH, UPRES 3859,LUNAM University,Angers,France
- Corresponding author
- Cassinotto, Christophe
- Venue
- Hepatology
- Published
- 2021-05-19
- Volume
- 73
- Issue
- 6
- Pages
- 2196-2205
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W3107306127
- Cited by
- 55
- References
- 24
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 16 · 2023: 9 · 2022: 11 · 2021: 5 · 2020: 1
- FWCI
- 4.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Ultrasound Imaging and Elastography
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- non-alcoholic fatty liver disease, advanced liver fibrosis, vibration-controlled transient elastography, two-dimensional shear wave elastography, Fibrosis-4 score, liver stiffness, liver biopsy, diagnostic accuracy, noninvasive fibrosis assessment, liver cirrhosis
- MeSH terms
- Adult, Aged, Biopsy, Female, Humans, Liver Cirrhosis, Male, Middle Aged, Registries, Retrospective Studies, Sensitivity and Specificity, Patient Selection, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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