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Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery

1
Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
2
Italian Liver Foundation, 34149 Trieste, Italy
3
General Surgery Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, 34149 Trieste, Italy
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Department of Pathology, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy
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Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy
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Department of Medical Surgical Sciences and Advanced Technologies G.F. Ingrassia University of Catania, 95124 Catania, Italy
*
Author to whom correspondence should be addressed.
ElastPQ-XL-Group: Mauro Giuffrè, Michela Giuricin, Deborah Bonazza, Natalia Rosso, Pablo José Giraudi, Flora Masutti, Stefano Palmucci, Antonio Basile, Fabrizio Zanconati, Nicolò de Manzini, Claudio Tiribelli, Silvia Palmisano, Lory Saveria Crocè, Francesca Dottor, Daniele Macor, Matteo Rossano Buonocore, Michele Campigotto, Anna Colombo, Alessia Visintin, Cristiana Abazia, Fabio Tinè.
Diagnostics 2020, 10(10), 795; https://doi.org/10.3390/diagnostics10100795
Received: 7 September 2020 / Revised: 1 October 2020 / Accepted: 3 October 2020 / Published: 7 October 2020
(This article belongs to the Section Medical Imaging)
Background: Obesity is a primary limiting factor in liver stiffness measurement (LSM). The impact of obesity has always been evaluated in terms of body mass index (BMI), without studying the effects of skin-to-liver distance (SLD) on LSM. We studied the impact of SLD on LSM in a cohort of obese patients undergoing bariatric surgery and intra-operatory liver biopsy. Materials and Methods: 299 patients underwent LSM by point-shear wave elastography (ElastPQ protocol), with two different ultrasound machines. SLD was measured as the distance between the skin and the liver capsule, perpendicular to where the region of interest (ROI) was positioned. We used the following arbitrary cut-offs: <5.7 kPa, F0–1; 5.7–7.99 kPa, F2; ≥8 kPa, F3–4. Results: We developed two logistic regression models using elastography–histology agreement (EHA) as the dependent variable and SLD as the independent variable. The model based on the second machine showed strongly more performant discriminative and calibration metrics (AIC 38.5, BIC 44.2, Nagelkerke Pseudo-R2 0.894, AUROC 0.90). The SLD cut-off value of 34.5 mm allowed a correct EHA with a sensitivity of 100%, a specificity of 93%, negative predictive value of 100%, positive predictive value of 87%, an accuracy of 96%, and positive likelihood ratio of 3.56. Conclusion: The impact of SLD is machine-dependent and should be taken into consideration when interpreting LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in obese patients. View Full-Text
Keywords: liver elastography; liver fibrosis; bariatric surgery; non-alcoholic fatty liver disease; abdominal wall thickness; abdominal wall; NAFLD; liver biopsy; liver histology; non-alcoholic steatohepatitis liver elastography; liver fibrosis; bariatric surgery; non-alcoholic fatty liver disease; abdominal wall thickness; abdominal wall; NAFLD; liver biopsy; liver histology; non-alcoholic steatohepatitis
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MDPI and ACS Style

Giuffrè, M.; Giuricin, M.; Bonazza, D.; Rosso, N.; Giraudi, P.J.; Masutti, F.; Palmucci, S.; Basile, A.; Zanconati, F.; de Manzini, N.; Tiribelli, C.; Palmisano, S.; Crocè, L.S., for the ElastPQ-XL-Group. Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery. Diagnostics 2020, 10, 795. https://doi.org/10.3390/diagnostics10100795

AMA Style

Giuffrè M, Giuricin M, Bonazza D, Rosso N, Giraudi PJ, Masutti F, Palmucci S, Basile A, Zanconati F, de Manzini N, Tiribelli C, Palmisano S, Crocè LS for the ElastPQ-XL-Group. Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery. Diagnostics. 2020; 10(10):795. https://doi.org/10.3390/diagnostics10100795

Chicago/Turabian Style

Giuffrè, Mauro; Giuricin, Michela; Bonazza, Deborah; Rosso, Natalia; Giraudi, Pablo J.; Masutti, Flora; Palmucci, Stefano; Basile, Antonio; Zanconati, Fabrizio; de Manzini, Nicolò; Tiribelli, Claudio; Palmisano, Silvia; Crocè, Lory S. for the ElastPQ-XL-Group 2020. "Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery" Diagnostics 10, no. 10: 795. https://doi.org/10.3390/diagnostics10100795

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