Shear wave elastography: How well does it perform in chronic hepatitis D virus infection?

Hepatitis delta virus (HDV) infection is associated with accelerated progression of liver disease to cirrhosis. Shear wave elastography (SWE) is a non‐invasive evaluation method of liver fibrosis. Its performance in accurately characterizing HDV fibrosis compared to other noninvasive markers remains unknown. We assessed the performance of SWE in patients with chronic HDV, Hepatitis B (HBV) and Hepatitis C (HCV) infection. Cirrhosis was determined by histology or clinical data. Area under receiver operator characteristics (AUROC) was used to assess diagnostic performance in identifying cirrhosis by SWE in comparison with Fibroscan® (VCTE) and serologic tests of fibrosis. 158 patients with chronic hepatitis (HDV:44%, HBV: 46% and HCV: 29%) were evaluated. Cirrhosis was diagnosed in 28 (17.7%) patients. Mean noninvasive fibrosis measurements for the HBV/HCV and HDV groups, respectively, were as follows: APRI: 0.73 ± 1.08 and 1.3 ± 1.38; FIB‐4: 1.90 ± 2.24 and 2.33 ± 2.24; VCTE: 8.9 ± 6.7 kPa vs 10.4 ± 5.3 kPa; SWE: 1.5 ± 0.2 m/s and 1.6 ± 0.2 m/s. The performance of SWE in detecting HDV‐induced cirrhosis (AUROC 0.84, 95% CI 0.71–0.97) was slightly lower than in HBV/HCV induced disease (AUROC 0.88, 95% CI 0.81–0.96). For HDV patients, the performance of SWE was comparable to VCTE and slightly better than APRI and FIB‐4 especially in APRI and FIB‐4 indeterminate zones. The overall less accurate performance of noninvasive markers in HDV in comparison with HBV and HCV may be a result of significant hepatic inflammation in HDV.

[1]  D. Kleiner,et al.  Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis , 2021, World journal of gastrointestinal pathophysiology.

[2]  M. Manns,et al.  Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity. , 2020, Journal of hepatology.

[3]  S. Devaraj,et al.  A Liver Biopsy Validation Pilot Study of Shear Wave Elastography, APRI, FIB-4, and Novel Serum Biomarkers for Liver Fibrosis Staging in Children With Chronic Viral Hepatitis , 2020, Global pediatric health.

[4]  M. Manns,et al.  DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: Real-world experience from HCV-TARGET cohort. , 2020, Journal of hepatology.

[5]  D. Rockey,et al.  The utility of liver biopsy in 2020. , 2020, Current opinion in gastroenterology.

[6]  Ilias Gatos,et al.  Comparison of Sound Touch Elastography, Shear Wave Elastography and Vibration-Controlled Transient Elastography in Chronic Liver Disease Assessment using Liver Biopsy as the "Reference Standard". , 2020, Ultrasound in medicine & biology.

[7]  V. Suvannarerg,et al.  Prospective comparison of transient elastography, point shear wave elastography, APRI and FIB‐4 for staging liver fibrosis in chronic viral hepatitis , 2019, Journal of viral hepatitis.

[8]  D. Kleiner,et al.  Vibration‐controlled transient elastography for the detection of cirrhosis in chronic hepatitis D infection , 2019, Journal of viral hepatitis.

[9]  N. Afdhal,et al.  Liver Fibrosis Determination. , 2019, Gastroenterology clinics of North America.

[10]  B. McMahon,et al.  Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance , 2018, Hepatology.

[11]  Richard G. Barr,et al.  Shear wave liver elastography , 2018, Abdominal Radiology.

[12]  Ioan Sporea,et al.  Assessment of biopsy‐proven liver fibrosis by two‐dimensional shear wave elastography: An individual patient data‐based meta‐analysis , 2017, Hepatology.

[13]  J. Hoofnagle,et al.  Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience , 2017, Alimentary pharmacology & therapeutics.

[14]  J. Hoofnagle,et al.  Noninvasive markers for staging fibrosis in chronic delta hepatitis , 2017, Alimentary pharmacology & therapeutics.

[15]  R. Gish,et al.  Hepatitis Delta: Epidemiology, Diagnosis and Management 36 Years After Discovery , 2013, Current Gastroenterology Reports.

[16]  M. Albannan,et al.  Noninvasive Diagnosis of Liver Fibrosis and Cirrhosis in Chronic Hepatitis C Patients , 2013, Journal of clinical laboratory analysis.

[17]  D. Scott,et al.  Liver Transient Elastography (Fibroscan®): A Place in the Management Algorithms of Chronic Viral Hepatitis , 2010, Antiviral therapy.

[18]  D. Capron,et al.  Noninvasive diagnosis of liver fibrosis by ultrasonic transient elastography (Fibroscan) , 2006, European journal of gastroenterology & hepatology.

[19]  J. Montaner,et al.  Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection , 2006, Hepatology.

[20]  V. Paradis,et al.  Sampling variability of liver fibrosis in chronic hepatitis C , 2003, Hepatology.

[21]  J. Kalbfleisch,et al.  A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C , 2003, Hepatology.

[22]  J. Glenn,et al.  Pathogenesis of and New Therapies for Hepatitis D. , 2019, Gastroenterology.