Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis

To investigate the performance of real-time 2D shear wave elastography (RT 2D-SWE) for non-invasive staging of liver disease in patients with chronic viral hepatitis (CVH). Naive CVH patients underwent liver (LS) and spleen stiffness (SS) measurements by an intercostal approach. Patients with ALT > 3x upper limit of normal, cholestasis as revealed by dilated intrahepatic biliary tree, and liver congestion were excluded. Results were expressed in kPa and compared to histological stage (Ishak) of liver fibrosis (LF). Patients with decompensated liver cirrhosis (LC) were diagnosed using standard clinical, ultrasound, and endoscopic criteria. Of 123 patients, LS was successfully measured in 79.7 % and SS in 53.7 %. LS accurately differentiated between liver disease stages, with cut-off values of 8.1 (AUC 0.991) for F a parts per thousand yenaEuro parts per thousand 3, 10.8 kPa (AUC 0.954) for F a parts per thousand yenaEuro parts per thousand 5, and 27 kPa (AUC 0.961) for decompensated LC. SS was significantly different between non-cirrhotic stages (F0-4) and LC (cut-off 24 kPa; AUC 0.821). While both LS and SS increased with liver disease progression, the difference between them decreased, as reflected by the stiffness ratio index. RT 2D-SWE can accurately differentiate between the stages of LF, and can distinguish LF from LC and compensated from decompensated LC. aEuro cent RT 2D-SWE is an accurate method for assessment of liver fibrosis. aEuro cent RT 2D-SWE is applicable in 80 % of patients with chronic viral hepatitis. aEuro cent RT 2D-SWE accurately differentiates compensated from decompensated liver cirrhosis. aEuro cent Both liver and spleen stiffness increase with progression of liver fibrosis. aEuro cent In cirrhosis, the difference between liver and spleen stiffness decreases.