Clinical usefulness and performance of acoustic radiation force impulse in patients with chronic hepatitis B

Noninvasive Assessment of Liver Parenchyma Using Gray-Scale Ultrasound-Based Histogram Analysis in Patients With Chronic Hepatitis B Infection

The aims of this study were to examine the alterations of liver echo-intensity histogram parameters in chronic hepatitis B (CHB) patients and to assess the potential role of histogram parameters in the evaluation of hepatic fibrosis. A total of 52 patients with CHB who underwent liver biopsies were included in the study. The control group consisted of 30 healthy individuals. Histogram parameters were obtained from histogram analysis of gray-scale ultrasound images of both groups. The histogram parameters of the groups were compared. The association of histogram parameters with the grading and staging of histological activity index (HAI) in patients with CHB were evaluated. The patient group had statistically significant lower skewness, kurtosis, and higher variance, mean, 50th, and 90th percentile values compared with control group. When patients with CHB were divided into subgroups according to HAI stage, there was the increasing trend in skewness values and decreasing trend in kurtosis values across subgroups. The first percentile values showed negative correlation with HAI staging in patients with CHB. Ultrasound is a fast, inexpensive, and reproducible imaging method; histogram analysis of gray-scale ultrasound images may provide useful information for evaluation of hepatic fibrosis in CHB patients.

Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

BACKGROUND

Noninvasive biomarkers have been developed to predict hepatitis B virus (HBV) related fibrosis owing to the significant limitations of liver biopsy. Both serum biomarkers and imaging techniques have shown promising results and may improve the evaluation of liver fibrosis. However, most of the previous studies focused on the diagnostic effects of various imaging techniques on fibrosis in all chronic liver diseases.

AIM

To compare the performance of common imaging methods and serum biomarkers for prediction of significant fibrosis caused only by HBV infection.

METHODS

A systematic review was conducted on the records available in PubMed, EMBASE, and the Cochrane Library electronic databases until December 2018. We systematically assessed the effectiveness of two serum biomarkers and three imagine techniques in predicting significant fibrosis solely caused by HBV infection. The serum biomarkers included aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4). The three imaging techniques included acoustic radiation force impulse (ARFI), FibroScan, and magnetic resonance elastography (MRE). Three parameters, the area under the summary receiver operating characteristic curve (AUSROC), the summary diagnostic odds ratio, and the summary sensitivity and specificity, were used to examine the accuracy of all tests for liver fibrosis.

RESULTS

Out of 2831 articles evaluated for eligibility, 204 satisfied the predetermined inclusion criteria for this current meta-analysis. Eventually, our final data contained 81 studies. The AUSROCs of serum biomarkers of APRI and FIB-4 were both 0.75. For imaging techniques (ARFI, FibroScan, and MRE), the areas were 0.89, 0.83, and 0.97, respectively. The heterogeneities of ARFI and FibroScan were statistically significant (I² > 50%). The publication bias was not observed in any of the serum biomarkers or imaging methods.

CONCLUSION

These five methods have attained an acceptable level of diagnostic accuracy. Imaging techniques, MRE in particular, demonstrate significant advantages in accurately predicting HBV-related significant fibrosis, while serum biomarkers are admissible methods.