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

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 pati...

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Autores principales: Giuffrè, Mauro, Giuricin, Michela, Bonazza, Deborah, Rosso, Natalia, Giraudi, Pablo José, Masutti, Flora, Palmucci, Stefano, Basile, Antonio, Zanconati, Fabrizio, de Manzini, Nicolò, Tiribelli, Claudio, Palmisano, Silvia, Crocè, Lory Saveria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601552/
https://www.ncbi.nlm.nih.gov/pubmed/33036418
http://dx.doi.org/10.3390/diagnostics10100795
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author Giuffrè, Mauro
Giuricin, Michela
Bonazza, Deborah
Rosso, Natalia
Giraudi, Pablo José
Masutti, Flora
Palmucci, Stefano
Basile, Antonio
Zanconati, Fabrizio
de Manzini, Nicolò
Tiribelli, Claudio
Palmisano, Silvia
Crocè, Lory Saveria
author_facet Giuffrè, Mauro
Giuricin, Michela
Bonazza, Deborah
Rosso, Natalia
Giraudi, Pablo José
Masutti, Flora
Palmucci, Stefano
Basile, Antonio
Zanconati, Fabrizio
de Manzini, Nicolò
Tiribelli, Claudio
Palmisano, Silvia
Crocè, Lory Saveria
author_sort Giuffrè, Mauro
collection PubMed
description 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.
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spelling pubmed-76015522020-11-01 Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery Giuffrè, Mauro Giuricin, Michela Bonazza, Deborah Rosso, Natalia Giraudi, Pablo José Masutti, Flora Palmucci, Stefano Basile, Antonio Zanconati, Fabrizio de Manzini, Nicolò Tiribelli, Claudio Palmisano, Silvia Crocè, Lory Saveria Diagnostics (Basel) Article 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. MDPI 2020-10-07 /pmc/articles/PMC7601552/ /pubmed/33036418 http://dx.doi.org/10.3390/diagnostics10100795 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Giuffrè, Mauro
Giuricin, Michela
Bonazza, Deborah
Rosso, Natalia
Giraudi, Pablo José
Masutti, Flora
Palmucci, Stefano
Basile, Antonio
Zanconati, Fabrizio
de Manzini, Nicolò
Tiribelli, Claudio
Palmisano, Silvia
Crocè, Lory Saveria
Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery
title Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery
title_full Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery
title_fullStr Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery
title_full_unstemmed Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery
title_short Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery
title_sort optimization of point-shear wave elastography by skin-to-liver distance to assess liver fibrosis in patients undergoing bariatric surgery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601552/
https://www.ncbi.nlm.nih.gov/pubmed/33036418
http://dx.doi.org/10.3390/diagnostics10100795
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