Real-Time Shear Wave versus Transient Elastography for Predicting Fibrosis: Applicability, and Impact of Inflammation and Steatosis. A Non-Invasive Comparison.

BACKGROUND AND AIMS: Real-time shear wave elastography (2D-SWE) is a two-dimensional transient elastography and a competitor as a biomarker of liver fibrosis in comparison with the standard reference transient elastography by M probe (TE-M). The aims were to compare several criteria of applicability, and to assess inflammation and steatosis impact on elasticity values, two unmet needs. METHODS: We took FibroTest as the fibrosis reference and ActiTest and SteatoTest as quantitative estimates of inflammation and steatosis. After standardization of estimates, analyses used curve fitting, quantitative Lin concordance coefficient [LCC], and multivariate logistic regression. RESULTS: A total of 2,251 consecutive patients were included. We validated the predetermined 0.2 kPa cut-off as a too low minimal elasticity value identifying not-reliable 2D-SWE results (LCC with FibroTest = 0.0281[-0.119;0.175]. Other criteria, elasticity CV, body mass index and depth of measures were not sufficiently discriminant. The applicability of 2D-SWE (95%CI) 89.6%(88.2-90.8), was significantly higher than that of TE, 85.6%(84.0-87.0; P<0.0001). In patients with non-advanced fibrosis (METAVIR F0F1F2), elasticity values estimated by 2D-SWE was less impacted by inflammation and steatosis than elasticity value estimated by TE-M: LCC (95%CI) 0.039 (0.021;0.058) vs 0.090 (0.068;0.112;P<0.01) and 0.105 (0.068;0.141) vs 0.192 (0.153;0.230; P<0.01) respectively. The three analyses methods gave similar results. CONCLUSIONS: Elasticity results including very low minimal signal in the region of interest should be considered not reliable. 2D-SWE had a higher applicability than TE, the reference elastography, with less impact of inflammation and steatosis especially in patients with non-advanced fibrosis, as presumed by blood tests. TRIAL REGISTRATION: ClinicalTrials.gov NCT01927133.

Laboratory Tests for Diagnosis of Alcoholic Liver Disease.

Alcohol is considered one of the most common hepatotoxin, and chronic alcoholic liver disease is affecting millions of subjects worldwide. The three most frequently manifestations of alcoholic liver disease are steatosis, acute alcoholic hepatitis and liver cirrhosis. The diagnosis of Alcoholic Liver Diseases (ALD) is made by clinical and laboratory analysis. Actually do not exist a single laboratory test able to confirm the diagnosis of ALD, but in the last years several serum markers and laboratory abnormalities have been discovered in these patients. In particular the combination of tests and markers can increase the diagnostic accuracy, for this reason the last studies are focusing on the development of serum biomarkers panel able to diagnose alcohol-related liver damage.