Quantitative Elastography of Liver Fibrosis and Spleen Stiffness in Chronic Hepatitis B Carriers: Comparison of Shear-Wave Elastography and Transient Elastography with Liver Biopsy Correlation

Published Online:https://doi.org/10.1148/radiol.13130128

Shear-wave elastography enables better biopsy correlated assessment of liver fibrosis compared with transient elastography, especially for early fibrosis, and gives objective assessment of splenic elasticity, correlated with liver fibrosis staging in chronic hepatitis B patients.


To document utility of shear-wave (SW) elastography for assessing liver fibrosis in chronic hepatitis B and to compare its performance with that of transient elastography.

Materials and Methods

Ethics committee approved the study, and informed consent was obtained. Patients with liver biopsy correlation (n = 226) and healthy patients (n = 171) were analyzed. Results of SW elastography of liver, SW elastography of spleen, and transient elastography of liver were compared and correlated according to METAVIR scores. Areas under the receiver operating characteristic curve (AUCs), binary logistic regression, and Delong test were used.


AUC for SW elastography of liver, transient elastography of liver, and SW elastography of spleen was, respectively, 0.86, 0.80, and 0.81 for fibrosis (≥F1 stage); 0.88, 0.78, and 0.82 for moderate fibrosis (≥F2 stage); 0.93, 0.83, and 0.83 for severe fibrosis (≥F3 stage); and 0.98, 0.92, and 0.84 for cirrhosis (F4 stage). SW elastography of liver showed significantly higher accuracy than transient elastography of liver and SW elastography of spleen in all fibrosis stages (P = .01–.04). SW elastography of spleen showed similar accuracy with transient elastography of liver (P = .21–.99). Combination SW elastography of liver and SW elastography of spleen to predict fibrosis staging showed diagnostic accuracy not further improved compared with SW elastography of liver alone (similar AUC; ≥F1, P = .87; ≥F2, P = .81; ≥F3, P = .84; ≥F4, P = .88). SW elastography of liver had higher successful rate than transient elastography of liver (98.9% vs 89.6%). Prevalence of discordance in at least two stages with liver histologic staging was 10.2% (23 of 226) for SW elastography of liver and 28.2% (58 of 206) for SW elastography of spleen.


SW elastography provides more accurate correlation of liver elasticity with liver fibrosis stage compared with transient elastography, especially in identification of stage F2 or greater.

© RSNA, 2013


  • 1. Cobbold JFL, Morin S, Taylor-Robinson SD. Transient elastography for the assessment of chronic liver disease: ready for the clinic? World J Gastroenterol 2007;13(36):4791–4797. Crossref, MedlineGoogle Scholar
  • 2. Rockey DC. Noninvasive assessment of liver fibrosis and portal hypertension with transient elastography. Gastroenterology 2008;134(1):8–14. Crossref, MedlineGoogle Scholar
  • 3. Kim JE, Lee JY, Kim YJ, et al. Acoustic radiation force impulse elastography for chronic liver disease: comparison with ultrasound-based scores of experienced radiologists, Child-Pugh scores and liver function tests. Ultrasound Med Biol 2010;36(10):1637–1643. Crossref, MedlineGoogle Scholar
  • 4. Friedrich-Rust M, Wunder K, Kriener S, et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology 2009;252(2):595–604. LinkGoogle Scholar
  • 5. Yoneda M, Suzuki K, Kato S, et al. Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology 2010;256(2):640–647. LinkGoogle Scholar
  • 6. Muller M, Gennisson JL, Deffieux T, Tanter M, Fink M. Quantitative viscoelasticity mapping of human liver using supersonic shear imaging: preliminary in vivo feasibility study. Ultrasound Med Biol 2009;35(2):219–229. Crossref, MedlineGoogle Scholar
  • 7. Castéra L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology 2010;51(3):828–835. MedlineGoogle Scholar
  • 8. Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL. Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology 2011;259(3):749–756. LinkGoogle Scholar
  • 9. Kim BH, Lee JM, Lee YJ, et al. MR elastography for noninvasive assessment of hepatic fibrosis: experience from a tertiary center in Asia. J Magn Reson Imaging 2011;34(5):1110–1116. Crossref, MedlineGoogle Scholar
  • 10. Asbach P, Klatt D, Schlosser B, et al. Viscoelasticity-based staging of hepatic fibrosis with multifrequency MR elastography. Radiology 2010;257(1):80–86. LinkGoogle Scholar
  • 11. Faria SC, Ganesan K, Mwangi I, et al. MR imaging of liver fibrosis: current state of the art. RadioGraphics 2009;29(6):1615–1635. LinkGoogle Scholar
  • 12. Tanter M, Bercoff J, Athanasiou A, et al. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med Biol 2008;34(9):1373–1386. Crossref, MedlineGoogle Scholar
  • 13. Wong VWS, Vergniol J, Wong GLH, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology 2010;51(2):454–462. Crossref, MedlineGoogle Scholar
  • 14. Stefanescu H, Grigorescu M, Lupsor M, Procopet B, Maniu A, Badea R. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. J Gastroenterol Hepatol 2011;26(1):164–170. Crossref, MedlineGoogle Scholar
  • 15. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996;24(2):289–293. Crossref, MedlineGoogle Scholar
  • 16. Ferraioli G, Tinelli C, Dal Bello B, et al. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology 2012;56(6):2125–2133. Crossref, MedlineGoogle Scholar
  • 17. Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008;134(4):960–974. Crossref, MedlineGoogle Scholar
  • 18. Haque M, Robinson C, Owen D, Yoshida EM, Harris A. Comparison of acoustic radiation force impulse imaging (ARFI) to liver biopsy histologic scores in the evaluation of chronic liver disease: A pilot study. Ann Hepatol 2010;9(3):289–293. Crossref, MedlineGoogle Scholar
  • 19. Karlas T, Pfrepper C, Wiegand J, et al. Acoustic radiation force impulse imaging (ARFI) for non-invasive detection of liver fibrosis: examination standards and evaluation of interlobe differences in healthy subjects and chronic liver disease. Scand J Gastroenterol 2011;46(12):1458–1467. Crossref, MedlineGoogle Scholar
  • 20. Bavu E, Gennisson JL, Couade M, et al. Noninvasive in vivo liver fibrosis evaluation using supersonic shear imaging: a clinical study on 113 hepatitis C virus patients. Ultrasound Med Biol 2011;37(9):1361–1373. Crossref, MedlineGoogle Scholar

Article History

Received January 16, 2013; revision requested February 22; revision received March 20; accepted May 13; final version accepted May 23.
Published online: Dec 2013
Published in print: Dec 2013