CONTRIBUTION OF SHEARWAVE ELASTOGRAPHY IN THE EVALUATION OF HEPATIC FIBROSIS: PERFORMANCES IN HEPATITIS B E ANTIGEN NEGATIVE CHRONIC INFECTION
Rahma Ayadi*, Kchir Hela, Frikha Wassim, Thebti Kais, Mizouni Habiba, Maamouri Nadia
Background: The assessment of liver fibrosis represents a crucial step in the diagnosis and monitoring of patients with hepatitis B e antigen (Hbe Ag) negative chronic infection. The accurate assessment of the stage of fibrosis has seen the development of new ultrasound elastography methods in recent years. Among these methods, 2D-Shear Wave Elastography (2D-SWE) represents a technological revolution in the field of elastography. Aim: The aim of this work was to evaluate the performance and diagnostic value of 2D-SWE, compared to transient elastography (FibroScan) and the Fibrosis-4 (Fib-4) index in the accurate assessment of liver fibrosis in Hbe Ag negative chronic infection. Methods: A prospective, analytic study was carried out at the gastroenterology department B of La Rabta hospital in Tunisia during the period between July 2019 and June 2020. In order to carry out this study, patients followed up for HBe Ag negative chronic infection during the study period had a blood test. Hepatic elasticity had been measured by Transient elastography (Fibroscan) and abdomino-pelvic ultrasound coupled with a two-dimensional Shear wave elastography in the radiology department of La Rabta hospital. The investigations were performed less than two weeks apart. The various data were recorded on pre-established individual data sheets. The data were entered on computer using IBM® SPSS Statistics® version 22 statistical analysis software. At the end of this work, descriptive and analytical statistics were generated from these data. A comparison between the results of SWE and those of Fibroscan was carried out. Results: Our population included 30 patients. The mean age of the patients was 45.47 years (31-70 years). The sex ratio (M/F) was 0.66. Clinical and biological examinations of all patients revealed no evidence of hepatocellular failure or portal hypertension. The upper endoscopy showed no signs of portal hypertension. A dysmorphic liver was found on abdominal ultrasound in a single patient whose origin was hepatic steatosis. The mean value of hepatic elasticity measured by Fibroscan was 5.4 Kpa with extremes ranging from 3.4 to 7.1 Kpa. No significant fibrosis was noted. The mean value of liver elasticity measured by Shearwave elastography was 6.3 Kpa with extremes ranging from 4.59 to 7.19 Kpa. We noted a statistically significant correlation between hepatic elasticity measured by Fibroscan and that measured by Shearwave elastography (r = 0.428, p=0.018) with an estimated concordance rate of 43.7%. Conclusion: 2D-SWE is a powerful, simple and accessible means of assessing liver elasticity in patients with Hbe Ag negative chronic infection. Its integration into our clinical practice could contribute to the diagnosis, management and follow-up of these patients.
Keywords: Hepatitis B, Elastography, Fibrosis, Elasticity imaging techniques.
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