Ultrasonography.  2019 Jul;38(3):246-254. 10.14366/usg.18046.

Reproducibility of liver stiffness measurements made with two different 2-dimensional shear wave elastography systems using the comb-push technique

• Ryu H
• Ahn SJ
• Yoon JH
• Lee JM

• KMID: 2452551
• DOI: http://doi.org/10.14366/usg.18046

Abstract

PURPOSE
The purpose of this study was to retrospectively compare the technical success and reliability of the measurements made using two 2-dimensional (2D) shear wave elastography (SWE) systems using the comb-push technique from the same manufacturer and to assess the intersystem reproducibility of the resultant liver stiffness (LS) measurements.
METHODS
Ninety-four patients with suspected chronic liver diseases were included in this retrospective study. LS measurements were obtained using two 2D-SWE systems (LOGIQ E9 and LOGIQ S8) from the same manufacturer, with transient elastography (TE) serving as the reference standard, on the same day. The technical success rates and reliability of the measurements of the two 2D-SWE systems were compared. LS values measured using the two 2D-SWE systems and TE were correlated using Spearman correlation coefficients and 95% Bland-Altman limits of agreement. Thereafter, Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs) were used to analyze the intersystem reproducibility of LS measurements.
RESULTS
The two 2D-SWE systems showed similar technical success rates (98.9% for both) and reliability of LS measurements (92.3% for the LOGIQ E9, 91.2% for the LOGIQ S8; P=0.185). Despite the excellent correlation (ICC=0.92), the mean LS measurements obtained by the two 2D-SWE systems were significantly different (LOGIQ E9, 6.57±2.33 kPa; LOGIQ S8, 6.90±6.64 kPa; P=0.018).
CONCLUSION
Significant intersystem variability was observed in the LS measurements made using the two 2D-SWE systems. Therefore, even 2D-SWE systems from the same manufacturer should not be used interchangeably in longitudinal follow-up.

Keyword

Ultrasonography; Sonoelastography; Reproducibility of results; Liver cirrhosis

MeSH Terms

Elasticity Imaging Techniques*
Follow-Up Studies
Humans
Liver Cirrhosis
Liver Diseases
Liver*
Reproducibility of Results
Retrospective Studies
Ultrasonography

Figure

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  Fig. 1. Study design.Unreliable data were obtained from both the LOGIQ E9 and LOGIQ S8 in one patient who experienced technical failure with transient elastography (TE) (n=1), both the LOGIQ E9 and LOGIQ S8 (n=2), and both the LOGIQ E9 and TE (n=1).

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  Fig. 2. Liver stiffness (LS) measurements of the two different 2-dimensional shear wave elastography systems and transient elastography (TE): LOGIQ E9 (A), LOGIQ S8 (B), and TE (C).A, B. For LS measurements, the regions of interest were placed in the right anterior segment of the liver, avoiding vascular structures. The blue color in the SWE boxes is related to the speed of the shear waves. C. The slope of the line at the right panel of TE measurements indicates shear wave speed.

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  Fig. 3. Correlations between liver stiffness (LS) measurements obtained with two different 2-dimensional shear wave elastography systems and transient elastography (TE).Scatter diagrams (A, LOGIQ E9 vs. LOGIQ S8; B, LOGIQ E9 vs. TE; and C, LOGIQ S8 vs. TE) show strong correlations in all combinations of the three systems used in this study.

• 

  Fig. 4. Bland-Altman plot comparing liver stiffness (LS) values obtained from two different 2-dimensional shear wave elastography systems and transient elastography (TE).The solid blue line in the middle represents the mean LS values obtained from each pair of the three systems (A, LOGIQ E9 vs. LOGIQ S8; B, LOGIQ E9 vs. TE; and C, LOGIQ S8 vs. TE), and the dotted purple line define ±1.96 standard deviations (SD).

• 

  Fig. 5. Comparison of receiver operating characteristic (ROC) curves for the two different 2-dimensional shear wave elastography (2D-SWE) systems for the detection of significant fibrosis (F≥2).The blue line delineates the ROC curve of the LOGIQ E9 with an area under the ROC curve (AUROC) of 0.921 (P<0.001), and the green line delineates the ROC curve of the LOGIQ S8, with an AUROC of 0.938 (P<0.001). In the pairwise ROC curve comparison, the AUROCs of the two 2D-SWE systems were not significantly different (P=0.436).

Reference

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