Acoustic radiation force impulse elastography, FibroScan®, Forns' index and their combination in the assessment of liver fibrosis in patients with chronic hepatitis B, and the impact of inflammatory activity and steatosis on these diagnostic methods

Dong,Dao‑Ran; Hao,Mei‑Na; Li,Cheng; Peng,Ze; Liu,Xia; Wang,Gui‑Ping; Ma,An‑Lin

doi:10.3892/mmr.2015.3299

Acoustic radiation force impulse elastography, FibroScan®, Forns' index and their combination in the assessment of liver fibrosis in patients with chronic hepatitis B, and the impact of inflammatory activity and steatosis on these diagnostic methods

Authors:
- Dao‑Ran Dong
- Mei‑Na Hao
- Cheng Li
- Ze Peng
- Xia Liu
- Gui‑Ping Wang
- An‑Lin Ma
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Affiliations: Department of Infectious Disease, China‑Japan Friendship Hospital, Beijing 100029, P.R. China, Department of Ultrasound, China‑Japan Friendship Hospital, Beijing 100029, P.R. China, Department of Ultrasound, Beijing University First Hospital, Beijing 100034, P.R. China, Department of Pathology, China‑Japan Friendship Hospital, Beijing 100029, P.R. China
Published online on: February 4, 2015 https://doi.org/10.3892/mmr.2015.3299
Pages: 4174-4182
Copyright: © Dong et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

The aim of the present study was to investigate the combination of certain serological markers (Forns' index; FI), FibroScan® and acoustic radiation force impulse elastography (ARFI) in the assessment of liver fibrosis in patients with hepatitis B, and to explore the impact of inflammatory activity and steatosis on the accuracy of these diagnostic methods. Eighty‑one patients who had been diagnosed with hepatitis B were recruited and the stage of fibrosis was determined by biopsy. The diagnostic accuracy of FI, FibroScan and ARFI, as well as that of the combination of these methods, was evaluated based on the conformity of the results from these tests with those of biopsies. The effect of concomitant inflammation on diagnostic accuracy was also investigated by dividing the patients into two groups based on the grade of inflammation (G<2 and G≥2). The overall univariate correlation between steatosis and the diagnostic value of the three methods was also evaluated. There was a significant association between the stage of fibrosis and the results obtained using ARFI and FibroScan (Kruskal‑Wallis; P<0.001 for all patients), and FI (t-test, P<0.001 for all patients). The combination of FI with ARFI/FibroScan increased the predictive accuracy with a fibrosis stage of S≥2 or cirrhosis. There was a significant correlation between the grade of inflammation and the results obtained using ARFI and FibroScan (Kruskal‑Wallis, P<0.001 for all patients), and FI (t-test; P<0.001 for all patients). No significant correlation was detected between the measurements obtained using ARFI, FibroScan and FI, and steatosis (r=‑0.100, P=0.407; r=0.170, P=0.163; and r=0.154, P=0.216, respectively). ARFI was shown to be as effective in the diagnosis of liver fibrosis as FibroScan or FI, and the combination of ARFI or FibroScan with FI may improve the accuracy of diagnosis. The presence of inflammatory activity, but not that of steatosis, may affect the diagnostic accuracy of these methods.

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1	Iroezindu MO, Agbaji OO, Daniyam CA, Isiguzo GC, Isichei C and Akanbi MO: Liver function test abnormalities in Nigerian patients with human immunodeficiency virus and hepatitis B virus co-infection. Int J STD AIDS. 24:461–467. 2013. View Article : Google Scholar : PubMed/NCBI
2	Wang J, Guo L, Shi X, Pan W, Bai Y and Ai H: Real-time elastography with a novel quantitative technology for assessment of liver fibrosis in chronic hepatitis B. Eur J Radiol. 81:e31–e36. 2012. View Article : Google Scholar
3	Frieser M, Lindner A, Meyer S, et al: Spectrum and bleeding complications of sonographically guided interventions of the liver and pancreas. Ultraschall Med. 30:168–174. 2009.In German. View Article : Google Scholar : PubMed/NCBI
4	Tatsumi C, Kudo M, Ueshima K, et al: Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan®), and real-time tissue elastography. Intervirology. 51(Suppl 1): 27–33. 2008. View Article : Google Scholar
5	Friedrich-Rust M, Ong MF, Martens S, et al: Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 134:960–974. 2008. View Article : Google Scholar : PubMed/NCBI
6	Satio H, Tada S, Nakamoto N, et al: Efficacy of non-invasive elastometry on staging of hepatic fibrosis. Hepatol Res. 29:97–103. 2004. View Article : Google Scholar
7	Friedrich-Rust M, Nierhoff J, Lupsor M, et al: Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat. 19:e212–e219. 2012. View Article : Google Scholar : PubMed/NCBI
8	Boursier J, Isselin G, Fouchard-Hubert I, et al: Acoustic radiation force impulse: a new ultrasonographic technology for the widespread non-invasive diagnosis of liver fibrosis. Eur J Gastroenterol Hepatol. 22:1074–1084. 2010. View Article : Google Scholar : PubMed/NCBI
9	Haque M, Robinson C, Owen D, Yoshida EM and Harris A: Comparison of acoustic radiation force impulse imaging (ARFI) to liver biopsy histologic scores in the evaluation of chronic liver disease: a pilot study. Ann Hepatol. 9:289–293. 2010.PubMed/NCBI
10	Kim JE, Lee JY, Kim YJ, et al: Acoustic radiation force impulse elastography for chronic liver disease: comparison with ultrasoundbased scores of experienced radiologists, Child-Pugh scores and liver function tests. Ultrasound Med Biol. 36:1637–1643. 2010. View Article : Google Scholar : PubMed/NCBI
11	Kuroda H, Kakisaka K, Tatemichi Y, et al: Non-invasive evaluation of liver fibrosis using acoustic radiation force impulse imaging in chronic hepatitis patients with hepatitis C virus infection. Hepatogastroenterology. 57:1203–1207. 2010.
12	Palmeri ML, Wang MH, Rouze NC, et al: Non-invasive evaluation of hepatic fibrosis using acoustic radiation forcebased shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol. 55:666–672. 2011. View Article : Google Scholar : PubMed/NCBI
13	Rizzo L, Calvaruso V, Cacopardo B, et al: Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic hepatitis C. Am J Gastroenterol. 106:2112–2120. 2011. View Article : Google Scholar : PubMed/NCBI
14	Fierbinteanu-Braticevici C, Andronescu D, Usvat R, Cretoiu D, Baicus C and Marinoschi G: Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis. World J Gastroenterol. 15:5525–5532. 2009. View Article : Google Scholar : PubMed/NCBI
15	Boursier J and Cales P: Combination of fibrosis tests: sequential or synchronous? Hepatology. 50:656–657. 2009. View Article : Google Scholar : PubMed/NCBI
16	Castéra L, Vergniol J, Foucher J, et al: Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 128:343–350. 2005. View Article : Google Scholar : PubMed/NCBI
17	Castéra L, LeBail B, Roudot-Thoraval F, et al: Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol. 50:59–68. 2009. View Article : Google Scholar
18	Chinese Society of Hepatology and Chinese Society of Infectious Diseases Chinese Medical Association: The guideline of prevention and treatment for chronic hepatitis B (2010 version). Chin J Hepatology. 19:13–24. 2011.In Chinese.
19	Chinese Society of Hepatology and Chinese Society of Infectious Diseases Chinese Medical Association: Chinese program of prevention and cure for viral hepatitis. Chin J Intern Med. 40:62–68. 2001.In Chinese.
20	Forns X, Ampurdanès S, Llovet JM, et al: Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 36:986–992. 2002. View Article : Google Scholar : PubMed/NCBI
21	Boursier J, de Ledinghen V, Zarski JP, et al: Comparison of eight diagnostic algorithms for liver fibrosis in hepatitis C: new algorithms are more precise and entirely non-invasive. Hepatology. 55:58–67. 2012. View Article : Google Scholar
22	DeLong ER, DeLong DM and Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 44:837–845. 1988. View Article : Google Scholar : PubMed/NCBI
23	Joka D, Wahl K, Moeller S, et al: Prospective biopsy-controlled evaluation of cell death biomarkers for prediction of liver fibrosis and nonalcoholic steatohepatitis. Hepatology. 55:455–464. 2012. View Article : Google Scholar
24	Verveer C, Zondervan PE, ten Kate FJ, et al: Evaluation of transient elastography for fibrosisassessment compared with large biopsies in chronic hepatitis B and C. Liver Int. 32:622–628. 2012. View Article : Google Scholar
25	Myers RP, Pomier-Layrargues G, Kirsch R, et al: Discordance in fibrosis staging between liver biopsy and transient elastography using the fibroscan XL probe. J Hepatol. 56:564–570. 2012. View Article : Google Scholar
26	Gaia S, Carenzi S, Barilli AL, et al: Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol. 54:64–71. 2011. View Article : Google Scholar
27	Harata M, Hashimoto S, Kawabe N, et al: Liver stiffness in extrahepatic cholestasis correlates positively with bilirubin and negatively with alanine aminotransferase. Hepatol Res. 41:423–429. 2011. View Article : Google Scholar : PubMed/NCBI
28	Millonig G, Reimann FM, Friedrich S, et al: Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 48:1718–1723. 2008. View Article : Google Scholar : PubMed/NCBI
29	Boursier J, Vergniol J, Sawadogo A, et al: The combination of a blood test and Fibroscan improves the non-invasive diagnosis of liver fibrosis. Liver Int. 29:1507–1515. 2009. View Article : Google Scholar : PubMed/NCBI
30	Coco B, Oliveri F, Maina AM, et al: Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat. 14:360–369. 2007. View Article : Google Scholar : PubMed/NCBI
31	Arena U, Vizzutti F, Corti G, et al: Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 47:380–384. 2008. View Article : Google Scholar
32	Scheuer PJ, Ashrafzdeh P, Sherlock S, Brown D and Dusheiko GM: The pathology of hepatitis C. Hepatology. 15:567–571. 1992. View Article : Google Scholar : PubMed/NCBI
33	Sandrin L, Fourquet B, Hasquenoph JM, et al: Transient elastograhpy: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 29:1705–1713. 2003. View Article : Google Scholar : PubMed/NCBI