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Messung der Lebersteifigkeit mittels der 2D-Scherwellen-Elastographie mit dem Sonographiegerät LOGIQ E9 (Firma GE Healthcare) bei gesunden Probanden, Leber-gesunden Patienten sowie Patienten mit Leberzirrhose zur Generierung von Normwerten

Measurement of liver stiffness using 2D shear wave elastography with the sonography device LOGIQ E9 (GE Healthcare) in healthy subjects, liver-healthy patients and patients with cirrhosis to generate normal values

Johannes Albertus Hofer
Doctoral thesis
Date of Examination: 2020-06-16
Date of issue: 2020-06-11
Advisor: Neeße, Albrecht Prof Dr.
Referee: Neeße, Albrecht Prof Dr.
Referee: Lorf, Thomas PD Dr.

Persistent Address: http://hdl.handle.net/21.11130/00-1735-0000-0005-13D2-8

 

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Abstract

English

This work aims at generating standard values for liver stiffness of liver-healthy people for the sonography device LOGIQ E9 (GE Healthcare), which is used in the clinic for Gastroenterology, gastrointestinal Oncology, and Endocrinology at the University Medical center Göttingen. Furthermore, a cut-off value should be defined, which seeks to mark the border to liver cirrhosis. The work should contribute to the early diagnosis of chronic liver diseases, which are generally associated with increased stiffness, and thus to improve the treatment options. A total of 175 participants were included in the clinical prospective study. Among them were 68 healthy volunteers (group 1), 57 patients with non-hepatic morbidities (group 2), and 50 patients with histologically confirmed cirrhosis (group 3). The measurement process was implemented according to the recommendations of the EFSUMB guideline on liver elastography. The 2D-SWE method showed an excellent agreement of the results (ICC = 0.87) between two examiners of different experience levels. The mean liver stiffness between group 1 and group 2 did not differ significantly, hence they were merged into a new group of liver-healthy people. The consideration of possible influencing factors showed no significant effect of gender, age or BMI, whereby a trend towards higher values could be seen among male participants.  A reference range for normal liver stiffness was calculated from the measurement values of 122 liver-healthy people and was determined from 3.62 kPa to 7.02 kPa with a mean value of 5.07 kPa.  The mean stiffness value calculated for 45 cirrhosis patients was 13.29 kPa (SD ± 3.26). The rate of incorrect measurements was significantly higher in patients with histologically confirmed cirrhosis than in the 122 liver-healthy people. The results from the elastographic measurement should always be evaluated in the clinical context and against the background of possible influencing factors such as laboratory values, period of fasting, alcohol consumption, etc. This work demonstrates that liver cirrhosis can be ruled out with high diagnostic accuracy in patients with normal range liver stiffness using 2D-SWE with the device LOGIQ E9.
Keywords: 2-dimensional shear wave elastography; GE LOGIQ E9; liver cirrhosis; liver stiffness; normal values
Schlagwörter: 2-dimensionale Scherwellen-Elastographie; GE LOGIQ E9; Leberzirrhose; Lebersteifigkeit; Normwerte
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