Switching Between VCTE and 2D-SWE Reclassifies Fibrosis Risk in Metabolic Dysfunction-Associated Steatotic Liver Disease
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Background and Aims
Vibration-controlled transient elastography (VCTE) and two-dimensional shear-wave elastography (2D-SWE) are used to assess liver stiffness in metabolic dysfunction-associated steatotic liver disease (MASLD); patients may be assessed by different methods over time. Because 2D-SWE fibrosis cut-offs are not uniformly validated and no biopsy or magnetic resonance elastography reference is available, we asked whether switching methods moves patients across decision thresholds. We evaluated agreement and decision-threshold interchangeability between VCTE and 2D-SWE in MASLD with obesity.
Methods
In a retrospective cross-sectional agreement study at a tertiary-care center, 317 consecutive adults with MASLD underwent same-day VCTE (FibroScan) and GE LOGIQ E9/E10 2D-SWE. Continuous agreement was assessed by Bland–Altman analysis; the categorical analysis compared binary clinical decision thresholds (VCTE ≥8.0/≥10.0 kPa; 2D-SWE ≥7.204/≥8.060 kPa) using Cohen κ and McNemar tests. Prespecified sensitivity analyses and a post-hoc recalibration were performed; VCTE served as operational reference.
Results
VCTE yielded higher values (geometric mean VCTE/2D-SWE ratio, 1.23; ratio limits of agreement, 0.64–2.40; intraclass correlation coefficient, 0.41). At the lower threshold, 71 of 117 VCTE-positive patients (61%) were below the 2D-SWE threshold versus 5 of 200 (2.5%) reclassified upward (agreement 76.0%; κ 0.417; P<.001); the upper threshold was similar (38 of 63, 60%, vs 8 of 254, 3.1%). Discordance persisted across cut-offs; agreement worsened descriptively across BMI strata. Recalibration removed the directional asymmetry but not the discordance (agreement unchanged, 76.0%).
Conclusions
In MASLD patients, switching from VCTE to 2D-SWE reclassified decision-threshold status in ∼60% of VCTE-positive patients; recalibration removed the directional bias but not the disagreement. Follow-up should use the same elastography modality and, when possible, the same platform.
