Acoustic radiation force impulse in the diagnosis of liver fibrosis in patients with chronic hepatitis B

Application of acoustic radiation force impulse elastography combined with serum markers in Child-Pugh grading

OBJECTIVES

Acoustic radiation force impulse (ARFI) elastography, the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 (FIB-4) index are widely used to assess liver fibrosis. However, efficacies of these methods in the evaluation of hepatic functional reserve remain unclear. In this study, we investigated the relationship between ARFI elastography combined with either AAR, APRI, or FIB-4 index and Child-Pugh (CP) class for the evaluation of hepatic functional reserve in patients with chronic hepatitis B (CHB)-related cirrhosis.

METHODS

The shear wave velocities of 104 patients with clinically confirmed CHB-related cirrhosis were determined using the ARFI; and clinical serum markers (e.g. ALT, AST, PLT) were used to calculate the AAR, APRI, and FIB-4 index. Cirrhosis patients were scored according to their CP class. The ARFI, AAR, APRI, and FIB-4 index were compared with the CP class. The efficacy of each indicator in diagnosis was analyzed using the receiver operating characteristic (ROC) curve and the ARFI combined with either the AAR, APRI, or FIB-4 index, which is used to predict decompensated cirrhosis.

RESULTS

No significant differences were observed in gender and age among CP classes A, B, and C patients (p>0.05). The ARFI values and the AAR, APRI, and FIB-4 index of patients with CP classes A, B, and C were significantly different (p<0.05). With an increasing CP class, the ARFI, AAR, APRI, and FIB-4 values increased. The correlation between the ARFI and the CP class was stronger than that between the AAR, APRI, and FIB-4 index and the CP class. The area under the ROC curve for the diagnosis of decompensated cirrhosis using the ARFI was 0.841, which was higher than that for the AAR, APRI, and FIB-4 index. According to the area under the curve results, no significant differences were found when the ARFI was combined with either the AAR, APRI, or FIB-4 index and when the ARFI alone was used.

CONCLUSIONS

The ARFI value has a strong correlation with the CP class. Therefore, ARFI elastography complements CP class in the assessment of the hepatic functional reserve in patients with CHB-related cirrhosis.

Value of real-time shear wave elastography in assessing liver fibrosis in patients with chronic hepatitis B

AIM

To evaluate the value of real-time shear wave elastography (SWE) and routine ultrasonography in the assessment of liver fibrosis in patients with chronic hepatitis B.

METHODS

A retrospective analysis was performed of 87 patients with chronic hepatitis B treated in Tangshan Infectious Disease Hospital from August 2015 to June 2017. All patients underwent routine ultrasound and SWE examinations. Using the pathological biopsy results as the gold standard, the results of routine ultrasound and SWE in staging and diagnosing liver fibrosis were compared by ROC curve analysis.

RESULTS

There was no significant difference in conventional ultrasound scores between adjacent stages of liver fibrosis (S0-S1 vs S2, S2 vs S3, and S3 vs S4), but there were significant differences between non-adjacent stages (S0-S1 vs S3, S0-S1 vs S4, and S2 vs S4; P = 0.001, 0.000, and 0.000, respectively). The elastic modulus values of SWE in different stages of liver fibrosis were 5.625 kPa ± 1.221 kPa (S0), 7.172 kPa ± 1.818 kPa (S1), 10.295 kPa ± 3.122 kPa (S2), 15.541 kPa ± 4.340 kPa (S3), and 23.918 kPa ± 5.697 kPa (S4). There was a significant difference in the elastic modulus values between both adjacent and non-adjacent stages (P < 0.05 for all). Spearman correlation analysis showed that there was a positive correlation between conventional ultrasound score or SWE elastic modulus and liver fibrosis stage (r = 0.529, 0.798, P < 0.001). The areas under the ROC curve of conventional ultrasound score in diagnosing liver fibrosis S ≥ 2, S ≥ 3, and S4 were 0.766, 0.891, and 0.764, respectively; the corresponding values of SWE were 0.941, 0.948, and 0.952, respectively. The diagnostic efficiency of SWE was higher than that of conventional ultrasound (P < 0.05).

CONCLUSION

Compared with conventional ultrasound, SWE has higher value in assessing the degree of liver fibrosis in patients with chronic hepatitis B, with better reproducibility.