Diagnostic Accuracy of Shear Wave Elastography in Detection of Liver Fibrosis in Patients with Hepatitis C Infection by Taking Histopathology as Gold Standard
DOI:
https://doi.org/10.70749/ijbr.v3i7.2610Keywords:
Hepatitis C, Liver Fibrosis, Shear Wave Elastography, Diagnostic Accuracy, Liver BiopsyAbstract
Background and aim: Chronic hepatitis C infection leads to progressive liver fibrosis and cirrhosis, creating significant long-term health burdens. Liver biopsy remains the definitive method for staging fibrosis, but its invasive nature, procedural discomfort, and risk of complications limit its routine use. Shear wave elastography (SWE) offers a non-invasive technique for measuring liver stiffness and may provide a reliable alternative for assessing fibrosis severity. This study was conducted to determine the diagnostic accuracy of 2D-SWE in detecting advanced fibrosis in patients with chronic hepatitis C, using histopathology as the reference standard. Methodology: A cross-sectional diagnostic accuracy study was performed on 150 adults with confirmed hepatitis C infection. All participants underwent 2D-SWE followed by ultrasound-guided liver biopsy. A stiffness value of ≥9.3 kPa on SWE was considered indicative of advanced fibrosis. Histopathology was interpreted by a blinded pathologist using the METAVIR scoring system, with F3–F4 categorized as fibrosis positive. Sensitivity, specificity, predictive values, and overall accuracy of SWE were calculated against biopsy findings. Stratified analysis was performed for age, gender, duration of disease, and BMI. Results: Among the 150 patients, 72 (48%) had advanced fibrosis on biopsy. SWE identified 75 patients as fibrosis positive. The test yielded 65 true positives, 10 false positives, 68 true negatives, and 7 false negatives. This corresponded to a sensitivity of 90.3%, specificity of 87.2%, positive predictive value of 86.7%, negative predictive value of 90.7%, and an overall diagnostic accuracy of 88.7%. No meaningful differences in accuracy were observed across demographic subgroups. Conclusion: Shear wave elastography demonstrates high diagnostic accuracy for identifying advanced fibrosis in chronic hepatitis C. Its non-invasive nature and strong performance make it a practical tool for routine clinical assessment and for reducing reliance on liver biopsy.
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1. El-Shater Bosaty E, El-Sayed M, Abd El Aziz A, et al. Diagnostic value of shear wave elastography compared to APRI and FIB-4 in chronic hepatitis C patients. Egypt J Radiol Nucl Med. 2021;52(1):196. doi:10.1186/s43066-021-00196-3
2. Sepanlou, S. G., Safiri, S., Bisignano, C., Ikuta, K. S., Merat, S., Saberifiroozi, M., ... & Padubidri, J. R. (2020). The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet gastroenterology & hepatology, 5(3), 245-266.
3. European Association for Study of Liver. (2015). Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J hepatol, 63(1), 237-264.
4. Ioannou, G. N., Green, P. K., & Berry, K. (2018). HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma. Journal of Hepatology, 68(1), 25-32.
https://doi.org/10.1016/j.jhep.2017.08.030
5. Friedrich‐Rust, M., Nierhoff, J., Lupsor, M., Sporea, I., Fierbinteanu‐Braticevici, C., Strobel, D., Takahashi, H., Yoneda, M., Suda, T., Zeuzem, S., & Herrmann, E. (2011). Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: A pooled meta‐analysis. Journal of Viral Hepatitis, 19(2).
https://doi.org/10.1111/j.1365-2893.2011.01537.x
6. Omata, M., Cheng, A. L., Kokudo, N., Kudo, M., Lee, J. M., Jia, J., ... & Sarin, S. K. (2017). Asia–Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatology international, 11(4), 317-370.
https://doi.org/10.1007/s12072-017-9799-9
7. Cosgrove, D., Piscaglia, F., Bamber, J., Bojunga, J., Correas, J., Gilja, O., Klauser, A., Sporea, I., Calliada, F., Cantisani, V., D'Onofrio, M., Drakonaki, E., Fink, M., Friedrich-Rust, M., Fromageau, J., Havre, R., Jenssen, C., Ohlinger, R., Săftoiu, A., … Dietrich, C. (2013). EFSUMB guidelines and recommendations on the clinical use of ultrasound Elastography.Part 2: Clinical applications. Ultraschall in der Medizin - European Journal of Ultrasound, 34(03), 238-253.
https://doi.org/10.1055/s-0033-1335375
8. Ferraioli, G., Wong, V. W., Castera, L., Berzigotti, A., Sporea, I., Dietrich, C. F., Choi, B. I., Wilson, S. R., Kudo, M., & Barr, R. G. (2018). Liver ultrasound Elastography: An update to the world Federation for ultrasound in medicine and biology guidelines and recommendations. Ultrasound in Medicine & Biology, 44(12), 2419-2440.
https://doi.org/10.1016/j.ultrasmedbio.2018.07.008
9. Barr, R. G., Ferraioli, G., Palmeri, M. L., Goodman, Z. D., Garcia-Tsao, G., Rubin, J., Garra, B., Myers, R. P., Wilson, S. R., Rubens, D., & Levine, D. (2015). Elastography assessment of liver fibrosis: Society of radiologists in ultrasound consensus conference statement. Radiology, 276(3), 845-861.
https://doi.org/10.1148/radiol.2015150619
10. Jiang, T., Tian, G., Zhao, Q., Kong, D., Cheng, C., Zhong, L., & Li, L. (2016). Diagnostic accuracy of 2D-Shear wave Elastography for liver fibrosis severity: A meta-analysis. PLOS ONE, 11(6), e0157219.
https://doi.org/10.1371/journal.pone.0157219
11. Li, C., Zhang, C., Li, J., Huo, H., & Song, D. (2016). Diagnostic accuracy of real-time shear wave Elastography for staging of liver fibrosis: A meta-analysis. Medical Science Monitor, 22, 1349-1359.
https://doi.org/10.12659/msm.895662
12. Ferraioli G, et al. Performance of SWE versus transient elastography in staging liver fibrosis. Egypt Liver J. 2020;10:15. doi:10.1186/s43066-020-00096-4
13. Barr RG, et al. Elastography in clinical practice: liver. J Ultrasound Med. 2015;34(1):3–20. doi:10.7863/ultra.34.1.3
14. Wong VW, et al. Obesity and reliability of elastography. Clin Gastroenterol Hepatol. 2011;9(2):189–196. doi:10.1016/j.cgh.2010.09.040
15. Myers RP, et al. Failure rates of transient elastography in high BMI populations. Eur J Radiol. 2012;81(3):e325–e330. doi:10.1016/j.ejrad.2011.09.016
16. Barr RG. 2D SWE in clinical practice. J Clin Ultrasound. 2019;47(1):1–10. doi:10.1002/jcu.22734
17. Castéra L, et al. Prospective comparison of transient elastography, SWE and biopsy in chronic hepatitis C. Eur Radiol. 2010;20(10):2525–2535. doi:10.1007/s00330-010-1787-0
18. Boursier J, et al. Two cutoff strategy for elastography in cirrhosis detection. BMJ Open Gastroenterol. 2014;1(1):e000007. doi:10.1136/bmjgast-2014-000007
19. EASL–EASD–EASO Clinical Practice Guidelines. Non-invasive tests in liver disease. J Hepatol. 2021;75(3):659–689. doi:10.1016/j.jhep.2021.04.008
20. Petta S, et al. SWE and transient elastography in NAFLD vs HCV. Diagnostics. 2020;10(10):800. doi:10.3390/diagnostics10100800
21. Sporea I, et al. SWE in autoimmune hepatitis: diagnostic performance. Cureus. 2023;15(2):e34789. doi:10.7759/cureus.34789
22. Indré L, et al. SWE in NAFLD: meta-analysis. Liver Int. 2025;45(1):102–112. doi:10.1111/liv.15879
23. Esposto C, et al. SWE values predict HCC after HCV cure. World J Gastroenterol. 2024;30(5):455–464. doi:10.3748/wjg.v30.i5.455
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