Evaluation of Inter-System Variability in Liver Stiffness Measurements

Aim  The primary aim of this study was to determine the inter-system variability of liver stiffness measurements (LSMs) in patients with varying degrees of liver stiffness. The secondary aim was to determine the inter-observer variability of measurements. Materials and Methods  21 individuals affected by chronic hepatitis C and 5 healthy individuals were prospectively enrolled. The assessment of LSMs was performed using six ultrasound (US) systems, four of which with point shear wave elastography (p-SWE) and two with 2 D shear wave elastography (2D-SWE) systems. The Fibroscan (Echosens, France) was used as the reference standard. Four observers performed the measurements in pairs (A-B, C-D). The agreement between different observers or methods was calculated using Lin’s concordance correlation coefficient. The Bland-Altman limits of agreement (LOA) were calculated as well. Results  There was agreement above 0.80 for all pairs of systems. The mean difference between the values of the systems with 2D-SWE technique was 1.54 kPa, whereas the maximum mean difference between the values of three out of four systems with the pSWE technique was 0.79 kPa. The intra-patient concordance for all systems was 0.89 (95 % CI: 0.83 – 0.94). Inter-observer agreement was 0.96 (95 % CI: 0.94 – 0.98) for the pair of observers A-B and 0.93 (95 % CI: 0.89 – 0.96) for the pair of observers C-D. Conclusion  The results of this study show that the agreement between LSMs performed with different US systems is good to excellent and the overall inter-observer agreement in “ideal conditions” is above 0.90 in expert hands.