Effects of patient factors on noninvasive liver stiffness measurement using acoustic radiation force impulse elastography in patients with chronic hepatitis C

Abstract

BackgroundPrevious research has shown variation in the effects of patient factors, including hepatic necroinflammatory activity, on liver stiffness measurement (LSM). This prospective study attempts to identify explanatory factors for LSM in patients with chronic hepatitis C (CHC) using acoustic radiation force impulse (ARFI) technology.MethodsA cohort of 127 Taiwanese patients with CHC underwent ARFI LSM and immediate percutaneous liver biopsy. This study compares the concurrent diagnostic performances of LSM and FibroTest using receiver operating characteristic (ROC) curves. Three multiple linear regression models were used to evaluate the significance of concurrent patient factors in explaining LSM.ResultsTo classify METAVIR fibrosis (F) stages, the areas under ROC curves (AUCs) were ARFI LSM, 0.847 (95% confidence interval (CI), 0.779-0.914) and FibroTest, 0.823 (95% CI, 0.748-0.898), for F1 versus F2-4; ARFI LSM, 0.902 (95% CI, 0.835-0.970) and FibroTest, 0.812 (95% CI, 0.735-0.888), for F1-2 versus F3-4; ARFI LSM, 0.831 (95% CI, 0.723-0.939) and FibroTest, 0.757 (95% CI, 0.648-0.865), for F1-3 versus F4. After adjusting for other demographic and biological covariates, biochemical and histological necroinflammatory factors consistently explained LSM. Factors included serum alanine aminotransferase (ALT)/upper limit of normal (ULN) categories (model R2 = 0.661, adjusted R2 = 0.629), ActiTest A scores (R2 = 0.662, adjusted R2 = 0.636), and METAVIR activity (A) grades (R2 = 0.651, adjusted R2 = 0.620). METAVIR F stages, body mass index, and platelet count were also independently associated with LSM. Necroinflammatory degrees, including ALT/ULN, ActiTest A scores, and METAVIR A grades, explained the false positivity of liver fibrosis staging using ARFI LSM.ConclusionsThe degree of hepatic necroinflammatory activity independently and significantly exaggerated liver fibrosis evaluation using ARFI LSM. However, comparisons with concurrent FibroTest indicate that ARFI LSM may be a promising alternative, or adjunctive single indicator, for liver fibrosis evaluation in patients with CHC.

Acoustic Radiation Force Impulse (ARFI) Elastography for non‑invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis

“…To combine sensitivity, specificity, and AUROC, 21 articles with 22 studies and 2,691 patients were included in the diagnosis analysis. Of the 21 articles, 11 [15,18,20,22,[26][27][28][29][30]33,35] articles provided ARFI values that were combined in the analysis. Details are present in figure 1.…”

Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy

“…In a meta-analysis study, ARFI demonstrated a satisfactory ability to predict higher-stage liver fibrosis (F = 3) and liver cirrhosis (F = 4) [15]. However, inflammation, variation, and other factors have significant impacts on the interpretation [16][17][18][19][20][21][22]. In our previous study as well as in others, ARFI had a poorer performance in the measurement of liver fibrosis in chronic hepatitis B than in chronic hepatitis C [16].…”

Reply

“…Even if some inaccurate terms were used in our article 1 and in the others, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] there is no consequence on the clinical conclusions, which remain the most important. Indeed, our article permitted us to demonstrate that SWV measurement by ARFI in liver tumors could not allow the differentiation between benign and malignant tumors.…”

“…We found more than 12 articles with the similar error in referring to the SWV in meters per second by all the preceding terms, for which the units are different. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] This "mixture" of terms and units reported in numerous clinically oriented journals was probably used by authors to simplify the understanding in clinical practice, where evaluation of tissue elasticity remains the most important point for the management of patients, especially for the evaluation of liver fibrosis for chronic hepatopathy.…”