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Liver stiffness as measured by two-dimensional shear wave elastography overestimates the stage of fibrosis in patients with chronic hepatitis B and hepatic steatosis - 18/04/20

Doi : 10.1016/j.clinre.2020.03.021 
Xiaoyu Xie a, Yuemin Feng a, Zhuozhen Lyu b, Le Wang c, Yao Yang a, Yuping Bai a, Chenxi Liu a, Hao Wu a, Wanhua Ren b, , Qiang Zhu a,
a Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China 
b Department of Infectious Disease, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China 
c Department of Geriatrics, Department of Geriatric, Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 18 April 2020
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Highlights

The use of 2D-SWE in the measurement of liver stiffness provides an accurate, non-invasive technique for diagnosing stages F2–F4 fibrosis in CHB patients.
Histopathologic HS independently associated with LS values and induced an increase in liver stiffness in the early stages of hepatic fibrosis.
Patients with stages F0-F2 or F0-F3 fibrosis who were at the threshold of significant HS (10%) were overestimated by 2D-SWE as F3 or F=4.
It should be taken into consideration to combine LS results with other noninvasive parameters in patients with CHB and hepatic steatosis.

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Summary

Two-dimensional shear wave elastography (2D-SWE) is a non-invasive technique for measuring liver stiffness (LS) and is used to assess the degree of hepatic fibrosis in patients with chronic hepatitis B (CHB). Despite its usefulness, several factors, other than hepatic fibrosis, can affect its diagnostic accuracy. Hepatic steatosis (HS) is a common lesion in CHB that has increasingly been getting attention in the field of disease development; however, its influence on the measurement of LS remains unclear. We aimed to determine whether HS affects the diagnostic accuracy of 2D-SWE in patients with CHB. Serum parameters and LS values were obtained from 161 patients with CHB. The degrees of hepatic fibrosis and inflammatory activity were estimated based on the METAVIR Cooperative Study Group criteria, and the extent of HS was defined as the percentage of hepatocytes containing fat droplets using oil red staining. We found that LS values were independently correlated with HS in the early stages of hepatic fibrosis (F0-F2 or F0-3). Furthermore, LS values in patients with significant steatosis (S10%) were higher than the counterpart in fibrosis stages F0-2 (6.82±1.57 vs. 7.92±1.99; p=0.010) and F0-3 (7.18±1.84 vs. 8.25±1.91; p=0.007). Therefore, false positive rates (FPRs) in the diagnosis of advanced fibrosis (16.00% vs. 37.04%, p=0.037) and cirrhosis (6.67% vs. 21.62%, p=0.030) were higher in patients with significant steatosis. In conclusion, the use of 2D-SWE in the measurement of LS overestimates the stage of hepatic fibrosis in CHB patients with HS>10%. This should be taken into consideration to combine LS results with other non-invasive parameters to improve its accuracy.

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Keywords : Hepatic fibrosis, Hepatic steatosis, Liver stiffness, Two-dimensional shear wave elastography

Abbreviations : LS, 2D-SWE, CHB, HS, BMI, ALT, AST, γ-GGT, TBIL, ALB, ALP, PT, INR, PLT, TG, TC, GLU, HBeAg, HBeAb, HBsAg, ROC, PPV, NPV, LR, AUC, CI, FPR, FNR


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