Abstract
Purpose
To investigate the diagnostic usefulness of real-time elastography (RTE) for liver fibrosis in chronic hepatitis B (CHB).
Methods
89 CHB patients were enrolled in the cross-sectional study. Ultrasound-guided percutaneous liver biopsies, RTE, and blood testing were performed in all patients. Areas under receiver operating characteristic curves (AUROC) were used to examine the diagnostic performance of liver fibrosis index (LFI) for the assessment of liver fibrosis.
Results
LFI differed significantly across histologic fibrosis stages (P < 0.05), except the comparison between S0 and S1 (P = 0.298). There was a strong positive correlation between LFI and histologic liver fibrosis stage (Spearman r = 0.831, P < 0.001). The cutoff LFI value of >2.74 indicated a sensitivity of 0.766 and a specificity of 0.872 for predicting significant liver fibrosis (S ≥ 2), and the cutoff LFI value of >3.61 indicated a sensitivity of 0.833 and a specificity of 0.878 for predicting early liver cirrhosis (S = 4). LFI showed higher AUROC for discriminating significant liver fibrosis (0.873 vs. 0.614) and early liver cirrhosis (0.923 vs. 0.769) than aspartate aminotransferase-to-platelet ratio index (APRI).
Conclusions
RTE is a valuable sonography-based non-invasive method for assessment of liver fibrosis and has better discrimination power for significant liver fibrosis and early liver cirrhosis than APRI in CHB.
Similar content being viewed by others
References
Ganem D, Prince AM (2004) Hepatitis B virus infection–natural history and clinical consequences. N Engl J Med 350:1118–1129
He J, Gu D, Wu X, et al. (2005) Major causes of death among men and women in China. N Engl J Med 353:1124–1134
Liang X, Bi S, Yang W, et al. (2009) Epidemiological serosurvey of hepatitis B in China—declining HBV prevalence due to hepatitis B vaccination. Vaccine 27:6550–6557
Liang X, Bi S, Yang W, et al. (2009) Evaluation of the impact of hepatitis B vaccination among children born during 1992–2005 in China. J Infect Dis 200:39–47
Lu FM, Zhuang H (2009) Prevention of hepatitis B in China: achievements and challenges. Chin Med J (Engl) 122:2925–2927
EASL clinical practice guidelines (2012) Management of chronic hepatitis B virus infection. J Hepatol 57:167–185
Friedman SL (2008) Hepatic stellate cells: protean, multifunctional, and enigmatic cells of the liver. Physiol Rev 88:125–172
Cadranel JF, Rufat P, Degos F (2000) Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology 32:477–481
Guo Y, Parthasarathy S, Goyal P, et al. (2015) Magnetic resonance elastography and acoustic radiation force impulse for staging hepatic fibrosis: a meta-analysis. Abdom Imaging 40:818–834
Lin SH, Ding H, Mao F, et al. (2013) Non-invasive assessment of liver fibrosis in a rat model: shear wave elasticity imaging versus real-time elastography. Ultrasound Med Biol 39:1215–1222
Friedrich-Rust M, Ong MF, Herrmann E, et al. (2007) Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis. AJR Am J Roentgenol 188:758–764
Kim YW, Kwon JH, Jang JW, et al. (2014) Diagnostic usefulness of real-time elastography for liver fibrosis in chronic viral hepatitis B and C. Gastroenterol Res Pract 2014:210407
Koizumi Y, Hirooka M, Kisaka Y, et al. (2011) Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography–establishment of the method for measurement. Radiology 258:610–617
Wu T, Wang P, Zhang T, et al. (2016) Comparison of two-dimensional shear wave elastography and real-time tissue elastography for assessing liver fibrosis in chronic hepatitis B. Dig Dis 34:640–649
Wu T, Ren J, Cong SZ, et al. (2014) Accuracy of real-time tissue elastography for the evaluation of hepatic fibrosis in patients with chronic hepatitis B: a prospective multicenter study. Dig Dis 32:791–799
Hu Q, Zhu SY, Kang LK, et al. (2014) Non-invasive assessment of liver fibrosis using real-time tissue elastography in patients with chronic hepatitis B. Clin Radiol 69:194–199
[The guideline of prevention and treatment for chronic hepatitis B (2010 version)] (2011). Zhonghua Liu Xing Bing Xue Za Zhi 32:405–415
Hong H, Li J, Jin Y, et al. (2014) Performance of real-time elastography for the staging of hepatic fibrosis: a meta-analysis. PLoS ONE 9:e115702
Tatsumi C, Kudo M, Ueshima K, et al. (2010) Non-invasive evaluation of hepatic fibrosis for type C chronic hepatitis. Intervirology 53:76–81
Snyder N, Gajula L, Xiao SY, et al. (2006) APRI: an easy and validated predictor of hepatic fibrosis in chronic hepatitis C. J Clin Gastroenterol 40:535–542
Gao S, Peng Y, Guo H, et al. (2014) Texture analysis and classification of ultrasound liver images. Biomed Mater Eng 24:1209–1216
Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group (1994). Hepatology 20:15–20.
Regev A, Berho M, Jeffers LJ, et al. (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97:2614–2618
Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1457
Marcellin P, Ziol M, Bedossa P, et al. (2009) Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int 29:242–247
Enomoto M, Morikawa H, Tamori A, Kawada N (2014) Noninvasive assessment of liver fibrosis in patients with chronic hepatitis B. World J Gastroenterol 20:12031–12038
Morikawa H, Fukuda K, Kobayashi S, et al. (2011) Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C. J Gastroenterol 46:350–358
Xie L, Chen X, Guo Q, et al. (2012) Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B. J Ultrasound Med 31:1053–1060
Yada N, Kudo M, Morikawa H, et al. (2013) Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis. Oncology 84(Suppl 1):13–20
Fujimoto K, Kato M, Kudo M, et al. (2013) Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C. Oncology 84(Suppl 1):3–12
Meng F, Zheng Y, Zhang Q, et al. (2015) Noninvasive evaluation of liver fibrosis using real-time tissue elastography and transient elastography (FibroScan). J Ultrasound Med 34:403–410
Friedrich-Rust M, Schwarz A, Ong M, et al. (2009) Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease. Ultraschall Med 30:478–484
Wang J, Guo L, Shi X, et al. (2012) Real-time elastography with a novel quantitative technology for assessment of liver fibrosis in chronic hepatitis B. Eur J Radiol 81:e31–e36
Ochi H, Hirooka M, Koizumi Y, et al. (2012) Real-time tissue elastography for evaluation of hepatic fibrosis and portal hypertension in nonalcoholic fatty liver diseases. Hepatology 56:1271–1278
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was funded by the National Science and Technology Major Project (Grant Number 2013ZX10002004) and the Beijing Municipal Administration of Hospitals Clinical medicine Development of special funding support (Grant Number XM201308).
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Wang, T., Shao, C., Zhang, G. et al. Real-time elastography (RTE): a valuable sonography-based non-invasive method for the assessment of liver fibrosis in chronic hepatitis B. Abdom Radiol 42, 2632–2638 (2017). https://doi.org/10.1007/s00261-017-1186-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-017-1186-4