Liver stiffness measurements by 2-dimensional shear wave elastography compared to histological and ultrasound parameters in primary biliary cholangitis.

Background And Aims: Liver stiffness measurements (LSMs) by 2-dimensional-shear-wave elastography (LSM) are now widely used in hepatology. However, relevant information for primary biliary cholangitis (PBC) is scant. We compare LSM with liver biopsy (LB) in a cohort of PBC patients in Greece.

Methods: Data of 68 LBs from 53 PBC patients were retrospectively analyzed and fibrosis stage was compared to LSM. Forty-six patients (86.8%) were females and at the time of LBx median (IQR) age was 62.6 (53.2-72.1). Demographic, UDCA treatment, histological and B-mode ultrasound data were tested for their influence on LSM estimates.

Results: Liver fibrosis stages F0-F4 were found in 4, 19, 19, 16 and 10 cases, respectively. Across stages F0-F4, the LSM was 5.6 (5.1-6.1), 7.0 (5.8-7.7), 9.1 (7.3-11.5), 10.8 (9.9-12.2) and 14.5 (11.9-25.7) kPa, respectively, with highly significant difference (<.001). The LSM differed also significantly between F0 vs. F1 (=.027), F1 vs. F2 (=.005) and F3 vs. F4 (=.017). The discriminatory ability of LSM for mild, significant, severe fibrosis and cirrhosis was highly significant in all comparisons (<.001), with AUC 95.3%, 87.4%, 85.3% and 95.3% and accuracy 89.7%, 85.3%, 80.9% and 86.8%, respectively. Among 21 parameters tested, significant predictors of LSM by multiple linear regression were fibrosis stage, portal inflammation and parenchymal heterogeneity. The portal inflammation grade accounted for 32.2% of LSM variation with adjusted 0.428.

Conclusions: In patients with PBC, LSM measurements by 2D-SWE can reliably discriminate between mild, significant, severe fibrosis and cirrhosis. Measurements are significantly affected by portal inflammation grade.