Test-retest repeatability of ultrasonographic shear wave elastography in a rat liver fibrosis model: toward a quantitative biomarker for preclinical trials
Youngbin Shin1,2 , Jimi Huh1,3 , Su Jung Ham4 , Young Chul Cho4 , Yoonseok Choi4 , Dong-Cheol Woo4 , Jeongjin Lee2 , Kyung Won Kim1,4
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2School of Computer Science and Engineering, Soongsil University, Seoul, Korea
3Department of Radiology, Ajou University Hospital, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Korea
4Bioimaging Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
Corresponding Author: Jimi Huh ,Tel: +82-31-219-4369, Fax: +82-31-219-5862, Email: jimihuh.rad@gmail.com
Received: December 16, 2019;  Accepted: April 23, 2020.  Published online: April 23, 2020.
This study evaluated the test-retest repeatability and measurement variability of ultrasonographic shear wave elastography (SWE) for liver stiffness in a rat liver fibrosis model.
In 31 Sprague-Dawley rats divided into three groups (high-dose, low-dose, and control), liver fibrosis was induced by intraperitoneal administration of thioacetamide for 8 weeks. A dedicated radiographer performed SWE to measure liver stiffness in kilopascals in two sessions at a 3-day interval. We calculated correlations between liver stiffness and histopathologic results, measurement variability in each session using coefficients of variation (CoVs) and interquartile/median (IQR/M), and test-retest repeatability between both sessions using the repeatability coefficient.
Different levels of liver fibrosis in each group were successfully induced in the animal model. The mean liver stiffness values were 8.88±1.48 kPa in the control group, 11.62±1.70 kPa in the low-dose group, and 11.91±1.73 kPa in the high-dose group. The correlation between collagen areas and liver stiffness values was moderate (r=0.6). In all groups, the second session yielded lower CoVs (i.e., more reliable results) for liver stiffness than the first session, suggesting a training effect for the operator. The mean IQR/M values were also lower in the second session than in the first session, which had four outliers (0.21 vs. 0.12, P<0.001). The test-retest repeatability coefficient was 3.75 kPa and decreased to 2.82 kPa after removing the four outliers.
The use of ultrasonographic SWE was confirmed to be feasible and repeatable for evaluating liver fibrosis in preclinical trials. Operator training might reduce variability in liver stiffness measurements.
Keywords: Shear wave elastography; Ultrasound; Liver fibrosis; Liver stiffness; Repeatability
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