Comparative Study Between the Diagnostic Performance of Point and 2-D Shear-Wave Elastography for the Non-invasive Assessment of Liver Fibrosis in Patients With Chronic Hepatitis C Using Transient Elastography as Reference

The study compared the diagnostic performance of two shear-wave elastography techniques, elastography point quantification (ElastPQ) and 2-D shear-wave elastography by General Electric (2-D-SWE.GE), for the non-invasive assessment of liver fibrosis in a cohort of patients with chronic hepatitis C virus (HCV) infection, using transient elastography (TE) as the reference method. There was no significant difference between the feasibility rates of TE, ElastPQ and 2-D-SWE.GE (p = 0.507). A good correlation was found between the liver stiffness (LS) values obtained using the two elastographic methods (r = 0.78). The mean LS values obtained using the ElastPQ technique were significantly higher than those obtained using 2-D-SWE.GE (12.1 ± 7.3 kPa vs. 10.4 ± 4.0 kPa, p < 0.0001). Pairwise comparisons of receiver operator characteristics curves between 2-D-SWE.GE and ElastPQ have shown that there are no significant differences in their performance for staging F ≥ 2 fibrosis (p = 0.89), F ≥ 3 fibrosis (p = 0.76) and F = 4 fibrosis (p = 0.86) in patients with chronic HCV infection.     

Prospective Comparison of the Diagnostic Performance of Magnetic Resonance Elastography with Acoustic Radiation Force Impulse Elastography for Pre-operative Staging of Hepatic Fibrosis in Patients with Hepatocellular Carcinoma

The purpose of this study was to compare the diagnostic accuracy of magnetic resonance (MR) elastography with that of acoustic radiation force impulse (ARFI) elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. We prospectively enrolled 77 patients who were scheduled to undergo hepatectomy for hepatocellular carcinoma. Pre-operative MRE and ARFI elastography examinations were performed on the same day, and liver stiffness/velocity values were determined. Fibrosis stage and necro-inflammatory activity of resected specimens were determined histopathologically using the METAVIR scoring system. Correlations between MRE and ARFI elastography findings and histologic findings were determined by receiver operating characteristic (ROC) analysis. Correlation of MRE was excellent and correlation of ARFI elastography was good with fibrosis stage. MRE had better diagnostic performance than ARFI elastography in estimating substantial fibrosis (F2), severe fibrosis (F3) and cirrhosis (F4). The optimal cutoff value and the area under the ROC curve (AUROC) were determined using ROC curve analysis. The highest Youden index was used as a criterion for selecting the optimal cutoff value. ROC analysis revealed that MRE discriminated advanced stages of fibrosis (F?≥?2) well in patients with hepatocellular carcinoma at a cutoff value of 3.0?kPa with an AUROC value of 0.93, and ARFI elastography did so at a cutoff value of 1.77?m/s with an AUROC value of 0.81 for predicting advanced stages of fibrosis (F?≥?2). In conclusion, MRE is a more accurate imaging modality than ARFI elastography in estimating advanced stages of fibrosis and cirrhosis.     

Non-invasive Assessment of Liver Fibrosis with ElastPQ: Comparison with Transient Elastography and Serologic Fibrosis Marker Tests,and Correlation with Liver Pathology Results

We investigated the feasibility of using ultrasound shear wave elastography point quantification (ElastPQ) for liver fibrosis staging and compared it with other non-invasive tools with respect to efficacy in liver stiffness measurement. A total of 106 patients who underwent liver stiffness measurements, using ElastPQ and biochemical investigations, before parenchymal liver biopsy or surgery were included. Among these, 51 also underwent transient elastography (TE). Correlations of ElastPQ, TE and aspartate aminotransferase-to-platelet ratio index (APRI) with histopathological findings (as the reference standard) were determined using Spearman's correlation coefficient. The diagnostic performance of ElastPQ, TE and APRI was evaluated using receiver operating characteristic (ROC) curve analysis. ElastPQ had good diagnostic accuracy in identifying each liver fibrosis stage, with an area under the ROC curve (AUC) of 0.810 to 0.864. Stiffness values obtained using ElastPQ, TE and APRI were significantly positively correlated (r = 0.686, r = 0.732 and r = 0.454, respectively) with histologic fibrosis staging (p < 0.001). According to the AUC for the diagnosis of significant fibrosis (≥F2) and cirrhosis (=F4), ElastPQ had better diagnostic accuracy (AUC = 0.929 and 0.834, respectively) than APRI (AUC = 0.656 and 0.618, respectively) (p < 0.05), and was similar to TE (AUC = 0.915 and 0.879, respectively). ElastPQ is a promising ultrasound-based imaging technique for evaluation of liver fibrosis, with a diagnostic accuracy comparable to that of TE.     

Ultrasound-Based Quantification of Fibrosis and Steatosis with a New Software Considering Transient Elastography as Reference in Patients with Chronic Liver Diseases

The goal of this study was to evaluate the performance of two new ultrasound-based techniques (ShearWave PLUS elastography [2-D-SWE PLUS], SSp PLUS Imaging [SSp PLUS]) implemented on the Aixplorer Mach 30 ultrasound system (Supersonic Imagine, Aix-en-Provence, France) for the non-invasive assessment of liver steatosis and fibrosis, using transient elastography (TE) with the controlled attenuation parameter (CAP) as reference. This monocentric cross-sectional study included 133 consecutive adult patients with chronic hepatopathies. Liver stiffness and steatosis were evaluated in the same session using the techniques mentioned above. An excellent correlation was observed between liver stiffness measurements obtained with 2-D-SWE PLUS and TE (r = 0.92, p < 0.0001). The best cutoff value of 2-D-SWE PLUS for predicting F≥2 was 6.8 kPa; for F≥3, 8.4 kPa; and for F4, 11 kPa. With respect to steatosis evaluation, a strong negative correlation between CAP and SSp PLUS values (r = –0.70, p < 0.0001) was obtained. The best SSp PLUS cutoff value for predicting steatosis was 1537 m/s.     

Intra-Individual Comparison between 2-D Shear Wave Elastography (GE System) and Virtual Touch Tissue Quantification (Siemens System) in Grading Liver Fibrosis

Ultrasound-based shear wave elastography (SWE) has recently gained substantial attention for non-invasive assessment of liver fibrosis. The purpose of this study was to perform an intra-individual comparison between 2-D shear wave elastography (2-D-SWE with a GE system) and Virtual Touch Tissue Quantification (VTTQ with a Siemens system) to assess whether these can be used interchangeably to grade fibrosis. Ninety-three patients (51 men, 42 women; mean age, 54 y) with liver disease of various etiologies (hepatitis B virus?=?47, hepatitis C virus?=?22; alcohol?=?6, non-alcoholic steatohepatitis?=?5, other?=?13) were included. Using published system-specific shear wave speed cutoff values, liver fibrosis was classified into clinically non-significant (F0/F1) and significant (≥F2) fibrosis. Results indicated that intra-modality repeatability was excellent for both techniques (GE 2-D-SWE: intra-class correlation coefficient?=?0.89 [0.84–0.93]; VTTQ: intra-class correlation coefficient?=?0.90 [0.86–0.93]). Intra-modality classification agreement for fibrosis grading was good to excellent (GE 2-D-SWE: κ?=?0.65, VTTQ: κ?=?0.82). However, inter-modality agreement for fibrosis grading was only fair (κ?=?0.31) using published system-specific shear wave speed cutoff values of fibrosis. In conclusion, although both GE 2-D-SWE and Siemens VTTQ exhibit good to excellent intra-modality repeatability, inter-modality agreement is only fair, suggesting that these should not be used interchangeably.     

Could Ultrasound Elastography Reflect Liver Function?

The purpose of this study was to investigate whether ultrasound elastography reflects liver function reserve relative to liver fibrosis histology. Sixty-five New Zealand rabbits were divided into an experimental group (n?=?45) and a control group (n?=?20). In the experimental group, liver fibrosis (F1–F4) was induced by subcutaneous injection of carbon tetrachloride. Point shear wave elastography and the indocyanine green (ICG) elimination test were performed for the two groups at 4-wk intervals for 56?wk. The liver stiffness value (LSV) and the ICG retention rate at 15?min (ICGR15) were obtained, and the correlation between them was investigated. The median LSVs of stages F0–F4 were 3.92?kPa (1.91–8.53?kPa), 5.02?kPa (2.39–8.91?kPa), 7.87?kPa (5.21–12.26?kPa), 12.83?kPa (5.92–16.79?kPa) and 16.64?kPa (9.76–29.50?kPa), respectively. The median ICGR15 values of stages F0–F4 were 8.7% (4.8%–15.6%), 10.8% (5.6%–20.3%), 19.2% (12.3%–26.7%), 31.0% (20.9%–41.0%) and 45.6% (22.1%–60.9%). There were significant differences in LSVs and ICGR15 values among the different stages of liver fibrosis (p?<0.01). A positive correlation was observed between LSV and ICGR15 (r?=?0.7497, p?<?0.0001). A strong correlation was observed between liver stiffness and liver function reserve, indicating ultrasound elastography may reflect liver function reserve in different degrees of liver fibrosis.     

实时双幅联合弹性成像在慢性肝病肝纤维化与炎症分层诊断中的价值

目的评估联合弹性成像技术的纤维化相关F指数和炎症活动度相关A指数在分层诊断肝纤维化和炎症程度中的应用价值。 方法收集2019年9月至2021年4月在复旦大学附属华山医院就诊并接受经皮肝穿刺活检或肝部分切除术并获得病理结果的202例慢性肝病患者,其中49例因肝占位性病变而行肝部分切除术,153例因弥漫性肝病行肝穿刺活检。所有患者在术前进行联合弹性成像检查,获得肝纤维化相关F指数和炎症活动度相关A指数;以病理诊断肝纤维化分期（S0~S4期）和炎症活动分级（G0~G4级）为金标准,使用Kruskal-Wallis秩和检验和Bonferroni校正比较不同纤维化分期的F指数以及不同炎症活动分级的A指数的差异,绘制受试者操作特征曲线,使用DeLong检验比较F指数与剪切波速度、实时组织弹性成像的肝纤维化指数（LFI）、天冬氨酸转氨酶与血小板的比率指数（APRI）在肝纤维化无创诊断中的效能。 结果肝纤维化分期S0（40例）、S1（42例）、S2（41例）、S3（34例）和S4期（45例）患者的F指数中位数分别为0.89、1.17、1.45、1.75和2.30,相邻纤维化分期之间的F指数中位数比较,差异均具有统计学意义（P＜0.05）。F指数在诊断纤维化分期≥S1、≥S2、≥S3和≥S4的临界值分别为1.14、1.45、1.50和1.63,受试者操作特征曲线下面积（AUC）分别为0.91、0.89、0.90和0.91,均高于LFI（AUC=0.66、0.68、0.69、0.69）与APRI（AUC=0.71、0.68、0.72、0.77）,差异均具有统计学意义（P均＜0.05）;F指数诊断纤维化分期≥S1、≥S2期的AUC高于剪切波速度（AUC=0.84、0.85）,差异具有统计学意义（P均＜0.05）。炎症活动度分级G0（26例）、G1（86例）、G2（68例）和G3-4（22例）级患者的A指数中位数分别为0.83、0.99、1.29和1.69。相邻等级间的A指数中位数比较,差异均具有统计学意义（P均＜0.05）。A指数区分≥G1、≥G2和≥G3-4的临界值分别为0.87、1.15和1.41,AUC分别为0.86、0.87和0.92。 结论联合弹性成像技术获得的A指数能很好地评估肝炎症活动度;F指数则校正了肝细胞炎症活动对肝组织硬度测量的影响,能更准确地诊断肝纤维化分期。     

Comparison of Acoustic Structure Quantification,Transient Elastography (FibroScan) and Histology in Patients with Chronic Hepatitis B and without Moderate to Severe Hepatic Steatosis

The purpose of this study was to compare acoustic structure quantification (ASQ) with transient elastography for staging liver fibrosis. One hundred eighty-two patients with chronic hepatitis B and without moderate to severe hepatic steatosis scheduled for liver biopsy underwent ASQ and transient elastography examinations. All ASQ parameters, including total mode, total average, red mode, red average, red standard deviation, blue mode, blue average, blue standard deviation and focal disturbance (FD) ratio and liver stiffness obtained via transient elastography were found to correlate with fibrosis stage (Spearman's r?=?0.783, 0.791, 0.750, 0.771, 0.544, 0.718, 0.691, 0.439, 0.815 and 0.814, respectively; all p values < 0.001). Among the ASQ parameters, the FD ratio had the highest correlation with the stage of fibrosis. The areas under the receiver operating characteristic curves (AUCs) of FD ratio and liver stiffness were 0.911 and 0.906 for F ≥ F1, 0.918 and 0.882 for F ≥ F2, 0.911 and 0.914 for F ≥ F3 and 0.926 and 0.978 for F?=?F4, respectively. There was no significant difference in AUCs between FD ratio and liver stiffness in predicting different stages of fibrosis (p?=?0.062–0.912). ASQ is a promising technique for assessing liver fibrosis in the absence of moderate to severe hepatic steatosis.     

Comparative study concerning the value of acoustic radiation force impulse elastography (ARFI) in comparison with transient elastography (TE) for the assessment of liver fibrosis in patients with chronic hepatitis B and C

Our aim was to compare liver stiffness (LS) measurements by means of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in patients with chronic hepatitis B and C, according to the severity of fibrosis. We also compared the correlation strength of ARFI and TE measurements with liver fibrosis. We included 53 patients with hepatitis B and 107 with hepatitis C in which liver biopsy, ARFI and TE measurements were performed in the same session. The mean LS values measured with ARFI were similar in patients with chronic hepatitis B and C and depended on the stage of fibrosis. The correlation strength of LS measurements by ARFI and by TE with fibrosis was similar in chronic hepatitis B and C patients. In conclusion, for the same stage of fibrosis, the mean LS values by ARFI were similar in patients with chronic hepatitis B and C. ARFI had similar predictive value with TE in both chronic viral hepatitis.     

剪切波点定量弹性成像技术对慢性乙型肝炎肝纤维化分期的诊断价值

目的 探讨剪切波点定量弹性成像（ElastPQ）技术测量肝组织硬度对诊断慢性乙型肝炎（CHB）肝纤维化分期的价值。方法 选取68例CHB患者为观察对象，24名健康体检者为对照，应用ElastPQ技术进行肝组织硬度检测，获得所有受试者的肝硬度值（ElastPQ值）。以肝穿刺活组织病理结果为金标准，绘制ElastPQ值诊断各肝纤维化分期的ROC曲线，分析其诊断效能。结果 不同分期肝纤维化ElastPQ值差异具有统计学意义（F=9.45，P<0.05），且ElastPQ值与肝纤维化程度呈正相关（r=0.672，P<0.001）。ElastPQ值诊断肝纤维化分期>S0期、>S1-2期、>S3期的界值分别为6.24 kPa、9.20 kPa、15.96 kPa，相应的AUC分别为0.904、0.855、0.772，敏感度分别为93.2%、78.0%、76.3%，特异度分别为100%、89.7%、76.9%。结论 ElastPQ技术可有效评估肝组织弹性硬度，对诊断肝纤维化分期具有重要的临床价值。     

Hepatic Elastometry and Glissonian Line in the Assessment of Liver Fibrosis

The aim of this study was to identify a method for staging hepatic fibrosis using a non-invasive, rapid and inexpensive technique based on ultrasound morphologic hepatic features. A total of 215 patients with different liver diseases underwent B-mode (2-D brightness mode) ultrasonography, vibration-controlled transient elastography, 2-D shear wave elastography and measurement of the controlled attenuation parameter with transient elastography. B-Mode images of the anterior margin of the left lobe were obtained and processed with automatic Genoa Line Quantification (GLQ) software based on a neural network for staging liver fibrosis. The accuracy of GLQ was 90.6% during model training and 78.9% in 38 different patients with concordant elastometric measures. Receiver operating characteristic curve analysis of GLQ performance using vibration-controlled transient elastography as a reference yielded areas under the curves of 0.851 for F ≥ F1, 0.793 for F ≥ F2, 0.784 for F ≥ F3 and 0.789 for F ≥ F4. GLQ has the potential to be a rapid, easy-to-perform and tolerable method in the staging of liver fibrosis.     

Diagnostic Performance of 2-D Shear-Wave Elastography with Propagation Maps and Attenuation Imaging in Patients with Non-Alcoholic Fatty Liver Disease

We aimed to investigate the diagnostic performance of new 2-D shear-wave elastography (SWE) with propagation maps and attenuation imaging (ATI) for quantification of fibrosis and steatosis in non-alcoholic fatty liver disease (NAFLD). Consecutive patients with NAFLD and healthy volunteers underwent liver stiffness measurement and steatosis quantification by means of vibration-controlled transient elastography coupled with the controlled attenuation parameter as the reference and by 2-D shear-wave elastography (2-D-SWE) with propagation maps and ATI as the investigational methods. We included 232 participants (164 in the NAFLD group and 68 in the healthy control group): 51.7%/49.3% women/men; mean age, 54.2 ± 15.2 y; mean body mass index, 29.4 ± 6.5 kg/m². Significant correlations were found between 2-D-SWE and vibration-controlled transient elastography (r = 0.71, p < 0.0001) and between ATI and the controlled attenuation parameter (r = 0.72, p < 0.0001). NAFLD-specific 2-D-SWE liver stiffness measurement cutoffs were as follows—F ≥ 2: 7.9 kPa (area under the curve [AUC] = 0.91); F ≥ 3: 10 kPa (AUC = 0.92); and F = 4: 11.4 kPa (AUC = 0.95). For steatosis, the best cutoffs by ATI were as follows—S1 = 0.73 dB/cm/MHz (AUC = 0.86); S2 = 0.76 dB/cm/MHz (AUC = 0.86); and S3 = 0.80 dB/cm/MHz (AUC = 0.83). According to Baveno VI criteria, the optimal 2-D-SWE liver stiffness measurement for diagnosing liver cirrhosis is 15.5 kPa (AUC = 0.94), and for ruling out compensated advanced chronic liver disease it is 9.2 kPa (AUC = 0.92). To conclude, 2-D-SWE with propagation maps and ATI is reliable for quantification of liver fibrosis and steatosis in patients with NAFLD.     

Noninvasive in vivo liver fibrosis evaluation using supersonic shear imaging: a clinical study on 113 hepatitis C virus patients

Supersonic shear imaging (SSI) has recently been demonstrated to be a repeatable and reproducible transient bidimensional elastography technique. We report a prospective clinical evaluation of the performances of SSI for liver fibrosis evaluation in 113 patients with hepatitis C virus (HCV) and a comparison with FibroScan (FS). Liver elasticity values using SSI and FS ranged from 4.50 kPa to 33.96 kPa and from 2.60 kPa to 46.50 kPa, respectively. Analysis of variance (ANOVA) shows a good agreement between fibrosis staging and elasticity assessment using SSI and FS (p < 10⁻⁵). The areas under receiver operating characteristic (ROC) curves for elasticity values assessed from SSI were 0.948, 0.962 and 0.968 for patients with predicted fibrosis levels F ≥ 2, F ≥ 3 and F = 4, respectively. These values are compared with FS area under the receiver operating characteristic curve (AUROC) of 0.846, 0.857 and 0.940, respectively. This comparison between ROC curves is particularly significant for mild and intermediate fibrosis levels. SSI appears to be a fast, simple and reliable method for noninvasive liver fibrosis evaluation.     

Accuracy of Controlled Attenuation Parameter and Liver Stiffness Measurement in Patients with Non-alcoholic Fatty Liver Disease

We evaluated the diagnostic accuracy of the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) measured with either an M or XL probe against liver biopsy (LB) in patients with non-alcoholic fatty liver disease (NAFLD). This study was a cross-sectional prospective study that included 179 NAFLD patients. With a cutoff value for CAP ≥345, we can exclude significant steatosis in 87% (79.4%–92.5%) of our population. With respect to the LSM, the highest accuracy was obtained for F ≥ F3 (area under the receiver operating characteristic curve [AUROC] = 0.98) and F = F4 (AUROC = 0.98). In a multivariable linear regression model, significant predictors influencing LSM were fibrosis stage (β = 2.6, p < 0.001) as a positive predictor and lobular inflammation (β = –0.68, p = 0.04) as a negative predictor, without significant influence after adjustment for CAP and probe type. We found that CAP is a satisfactory method for excluding advanced steatosis, while LSM is a good non-invasive marker for the exclusion of fibrosis.     

Assessing Hepatic Fibrosis Using 2-D Shear Wave Elastography in Patients with Liver Tumors: A Prospective Single-Center Study

The purpose of this study was to investigate the diagnostic performance of 2-D shear wave elastography (2-D-SWE) in evaluations of liver stiffness in patients with liver tumors before resection. A total of 121 consecutive patients with hepatocellular carcinoma (HCC) (n = 93), intra-hepatic cholangiocarcinoma (n = 6), mixed hepatocellular carcinoma and intra-hepatic cholangiocarcinoma (n = 6), liver metastases (n = 10) and benign tumors (n = 6) were prospectively enrolled in this study from June 2015 to March 2016. Three valid 2-D-SWE measurements for each patient and median liver stiffness values were calculated. Fibrosis staging was evaluated according to the METAVIR scoring system. A receiver operating characteristic curve analysis was used to assess diagnostic performance. In this study, we found that median liver stiffness values were significantly higher in patients with primary liver tumors than in those with liver metastases and benign tumors (11.80 kPa vs. 5.85 kPa, p < 0.001). In addition, liver stiffness, assessed using 2-D-SWE, was highly correlated with pathologically confirmed liver fibrosis stage. Liver fibrosis stage and liver stiffness values were analyzed using Spearman's correlation (0.708, p < 0.001). The median liver stiffness values were as follows: F1, 6.7 kPa; F2, 6.33 kPa; F3, 9.2 kPa; F4, 13.7 kPa. The area under the receiver operating characteristic curves of the liver stiffness values that predicted significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 83.5%, 91.6% and 88.1%, respectively. According to the Youden index, the optimal cutoff values for predicting significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 7.05 kPa (sensitivity = 74.6%, specificity = 100.0%), 9.45 kPa (sensitivity = 78.8%, specificity = 100.0%) and 11.1 kPa (sensitivity = 83.1%, specificity = 89.3%), respectively. We conclude that 2-D-SWE is a useful, accurate and non-invasive method for evaluating hepatic fibrosis in patients with liver tumors adapted to hepatectomy (ClinicalTrials.gov ID: NCT02958592).     

Evaluation of Non-alcoholic Fatty Liver Disease Using Acoustic Radiation Force Impulse Imaging Elastography in Rat Models

The aim of this study is to evaluate the utility of acoustic radiation force impulse (ARFI) elastography for assessing hepatic fibrosis stage and non-alcoholic fatty liver disease (NAFLD) severity, as well as the relationship among hepatic histologic changes using shear wave velocity (SWV). Animal models with various degrees of NAFLD were established in 110 rats. The right liver lobe was processed and embedded in a fabricated gelatin solution (porcine skin). Liver mechanics were measured using SWV induced by acoustic radiation force. Among the histologic findings, liver elasticity could be used to differentiate normal rats from rats with simple steatosis (SS) as well as distinguish SS from non-alcoholic steatohepatitis (NASH), with areas under the receiver operating characteristic curves (AUROC) of 0.963 (95% confidence interval = 0.871–0.973) and 0.882 (95% confidence interval = 0.807–0.956), respectively. For NAFLD rats, the diagnostic performance of ARFI elastography in predicting significant fibrosis (F ≥ 2) had an AUROC of 0.963. For evaluating steatosis severity, we found a progressive increase in ARFI velocity proportional to steatotic severity in NAFLD rat models, but we observed no significant differences for steatotic severity after excluding the rats with fibrosis. ARFI elastography may be used to differentiate among degrees of severity of NAFLD and hepatic fibrotic stages in NAFLD rat models.     

Comparison of Acoustic Radiation Force Impulse Imaging and Transient Elastography for Non-invasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B

The aims of this study were to compare the performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis in patients with chronic hepatitis B and to evaluate the impact of elevated alanine transaminase levels on liver stiffness assessment using ARFI elastography. One hundred eighty consecutive patients with chronic hepatitis B were enrolled in this study and evaluated with respect to histologic and biochemical features. All patients underwent ARFI elastography and TE. ARFI elastography and TE correlated significantly with histologically assessed fibrosis (r = 0.599, p < 0.001, for ARFI elastography; r = 0.628, p < 0.001, for TE) and necro-inflammatory activity (r = 0.591, p < 0.001, for ARFI elastography; r = 0.616, p < 0.001, for TE). Areas under the receiver operating characteristic curves for ARFI elastography and TE were 0.764 and 0.813 (p = 0.302, ≥stage 2), 0.852 and 0.852 (p = 1.000, ≥stage 3) and 0.825 and 0.799 (p = 0.655, S = 4), respectively. The optimum cutoff values for ARFI elastography were 1.63 m/s for stage ≥2, 1.74 m/s for stage ≥3 and 2.00 m/s for stage 4 in patients for whom alanine transaminase levels were evaluated. The cutoff values decreased to 1.24 m/s for ≥ stage 2, 1.32 m/s for ≥ stage 3 and 1.41 m/s for stage 4 in patients with normal alanine transaminase levels. ARFI elastography may be a reliable method for diagnosing the stage of liver fibrosis with diagnostic performance similar to that of TE in patients with chronic hepatitis B. In addition, liver stiffness values obtained with ARFI elastography, like those obtained with TE, may be influenced by alanine transaminase levels.     

Image Processing Pipeline for Liver Fibrosis Classification Using Ultrasound Shear Wave Elastography

The purpose of this study was to develop an automated method for classifying liver fibrosis stage ≥F2 based on ultrasound shear wave elastography (SWE) and to assess the system's performance in comparison with a reference manual approach. The reference approach consists of manually selecting a region of interest from each of eight or more SWE images, computing the mean tissue stiffness within each of the regions of interest and computing a resulting stiffness value as the median of the means. The 527-subject database consisted of 5526 SWE images and pathologist-scored biopsies, with data collected from a single system at a single site. The automated method integrates three modules that assess SWE image quality, select a region of interest from each SWE measurement and perform machine learning-based, multi-image SWE classification for fibrosis stage ≥F2. Several classification methods were developed and tested using fivefold cross-validation with training, validation and test sets partitioned by subject. Performance metrics were area under receiver operating characteristic curve (AUROC), specificity at 95% sensitivity and number of SWE images required. The final automated method yielded an AUROC of 0.93 (95% confidence interval: 0.90–0.94) versus 0.69 (95% confidence interval: 0.65–0.72) for the reference method, 71% specificity with 95% sensitivity versus 5% and four images per decision versus eight or more. In conclusion, the automated method reported in this study significantly improved the accuracy for ≥F2 classification of SWE measurements as well as reduced the number of measurements needed, which has the potential to reduce clinical workflow.     

Replacement of hystological findings: serum hyaluronic acid for fibrosis, high-sensitive C-reactive protein for necroinflamation in chronic viral hepatitis

Because of limitations in biopsy procedure, several non-invasive tests have been developed for predicting the histological findings in chronic hepatitis. A fibrosis (F) score 1 or above and necroinflammation [histological activity index (HAI)] score 4 or above are required to initiate the treatment in chronic viral hepatitis. Literature includes many studies on hyaluronic acid (HA) as a non-invasive procedure in predicting histological findings but lacks on high-sensitive-C-reactive protein (hsCRP). We evaluated the diagnostic value of HA and hsCRP in patients with chronic viral hepatitis. Ninety-eight subjects (42 chronic viral hepatitis, 28 cirrhosis and 28 healthy controls) were included in the study. Liver biopsies were performed on 42 chronic hepatitis patients and assessed by Ishak scoring system. All sera were stored at -70 degrees C until assay. Many laboratory parameters related to viral hepatitis, HA and hsCRP were studied following the instructions. We tried to determine a cut-off value for HA to represent > or =F1 score and that for hsCRP to represent > or =4 HAI score. Hepatitis B virus was the predominant aetiology of chronic hepatitis in our study. Mean HA levels were 113, 754 and 24 ng/ml in patients with chronic hepatitis, cirrhosis and controls, respectively (anova, p < 0.001). A HA level >64.7 ng/ml had a 100% specificity for diagnosing chronic hepatitis. A value > or =154 ng/ml had a 100% specificity, 100% positive predictive value and 90% negative predictive value for diagnosing liver cirrhosis (Area 1.00; p < 0.0001). A cut-off value of 63 ng/ml for HA had a 100% specificity for diagnosing fibrosis score > or =1 in chronic hepatitis (Area 0.86; p < 0.001). An hsCRP level >0.56 mg/dl had a 100% specificity and 12% sensitivity for diagnosing chronic hepatitis (Area 0.71; p = 0.002), while cut-off of 0.53 mg/dl had 75% specificity for diagnosing HAI > or = 4 in chronic hepatitis (Area 0.32; p = 0.132). This study supported the HA level in predicting fibrosis score > or =1 with a cut-off value of 63 ng/ml. Cut-off of 154 ng/ml had a strong worth for cirrhosis. A cut-off of hsCRP for predicting HAI score > or =4 warrants further evaluation in wider study populations. We concluded that we are a bit closer to the strategy for guiding therapy in patients with chronic hepatitis, without a liver biopsy.     

声脉冲辐射力成像联合瞬时弹性成像对炎性肝纤维化的诊断价值

目的评估声脉冲辐射力成像（ARFI）技术联合瞬时弹性成像（TE）技术对慢性乙型肝炎（CHB）肝纤维化的诊断价值。 方法选取2015年10月至2017年6月在哈尔滨医科大学附属第四医院就诊的121例CHB患者，进行肝脏穿刺活检、常规生化检查、ARFI及TE检查。采用方差分析比较肝纤维化各组的年龄、AST、ALT、ARFI值及TE值，进一步比较采用SNK-q检验，并与病理结果做相关性分析。以肝纤维化病理学分期为"金标准"，采用工作特征曲线（ROC）对比分析ARFI及TE技术对CHB肝纤维化分期的准确性，并应用Logistic回归进行联合诊断的风险预测，并通过预测值绘制ROC曲线，比较ARFI、TE及两者联合对肝纤维化S≥1期及S≥2期的诊断价值。 结果ARFI及TE值均与肝纤维化分期具有较好的正相关性（r=0.789、0.845，P均<0.0001）。ARFI及TE技术诊断肝纤维化S≥1期的AUROC分别为0.849及0.903（P=0.424）；S≥2期的AUROC分别为0.874及0.923（P=0.191）；S≥3期的AUROC分别为0.938及0.954（P=0.526）；S=4期的AUROC分别为0.913及0.926 （P=0.842）。ARFI及TE技术联合诊断肝纤维化S≥1期的AUROC为0.925，与两者单独诊断相比，差异均无统计学意义（P均>0.05），但联合后的敏感度、特异度及准确性均提高；联合诊断S≥2期的AUROC为0.949，与两者单独诊断相比，仅优于ARFI的单独诊断，差异有统计学意义（P=0.009），但联合后的敏感度及准确性均有所提高。 结论ARFI技术联合TE技术有助于提高肝纤维化S≥1期及S≥2期的诊断。