Liver and Spleen Stiffness Measured by Acoustic Radiation Force Impulse Elastography for Noninvasive Assessment of Liver Fibrosis and Esophageal Varices in Patients With Chronic Hepatitis B

Abstract

epatitis B, which is caused by the hepatitis B virus (HBV), is a potential life-threatening liver infection and the most serious type of viral hepatitis. As the World Health Organization reported, 1 approximately 2 billion people have been infected with HBV worldwide, and more than 350 million people have chronic hepatitis B. In China, the most common viral hepatitis is type B. The final evolutionary stage of chronic hepatitis B is liver cirrhosis. Portal hypertension is a major cause of esophageal varices, which have been reported to occur in up to 90% of patients with cirrhosis. 2 -Ping Ye, MM, Hai-Tao Ran, MD, Juan Cheng, MM, Ye-Feng Zhu, MM, Da-Zhi Zhang, MD, Ping Zhang, MD, Yuan-Yi Zheng, MD Received November 14, 2011, Methods-Two hundred sixty-four participants, of whom 60 were healthy volunteers (classified as stage 0), 66 were patients with chronic hepatitis B who had undergone liver biopsy, and 138 were patients with hepatitis B-related cirrhosis, were enrolled in this study. Median liver and spleen stiffness values (meters per second) from 10 successful measurements per participant were obtained. Patients with cirrhosis were examined by upper endoscopy. XiaoResults-Significant linear correlations were found between liver (Spearman ρ = 0.87; P < .001) and spleen (Spearman ρ = 0.76; P < .001) stiffness and the fibrosis stage.Liver and spleen stiffness values increased as fibrosis progressed; however, overlaps in liver stiffness were detected in stages 0 and 1 and 1 and 2, and overlaps in spleen stiffness were observed in stages 0 and 1, 1 and 2, and 2 and 3. Liver stiffness cutoff values were 1.69 m/s for predicting stage 3 or greater (area under the receiver operating characteristic curve [AUROC] = 0.99) and 1.88 m/s for stage 4 (AUROC = 0.97). The spleen stiffness cutoff value was 2.72 m/s for stage 4 (AUROC = 0.96). Liver stiffness was not correlated with the varix grade, whereas a significant linear correlation (Spearman ρ = 0.65; P < .001) between spleen stiffness and the varix grade was found. The optimal spleen stiffness cutoff value for predicting varices was 3.16 m/s (AUROC = 0.83).Conclusions-Liver and spleen stiffness values measured by ARFI elastography are reliable predictors of liver fibrosis. Spleen stiffness measured by ARFI can be used as a noninvasive method for determining the presence and severity of esophageal varices; however, evidence to support a similar role for liver stiffness is lacking.

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.…”

Is the spleen stiffness value acquired using acoustic radiation force impulse (ARFI) technology predictive of the presence of esophageal varices in patients with cirrhosis of various etiologies?

“…Ye et al have reported a significant correlation between spleen elastography and EVs in patients with chronic HBV (sensitivity 84.1%, specificity 81%) [10]. Colecchia et al found significant correlation between spleen elastography and EV in patients with chronic hepatitis C related liver cirrhosis (sensitivity 98.5%, specificity 60.1%, negative predictive value 98.4%) [11].…”

“…The ability to measure spleen stiffness by ARFI elastography in patients with chronic liver disease has also been recently reported. However, these stud-ies focused primarily on the simple correlation between spleen stiffness and EVs without consideration of cirrhosis etiology [10][11][12].…”

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

“…213 Using the Batts and Ludwig scoring system, 214 ARFI had a sensitivity of 68% and specificity of 66% for fibrosis stage ≥2 and a sensitivity of 95% and specificity of 86% for fibrosis stage ≥3 in patients with diverse chronic liver diseases. 215 Spleen stiffness by ARFI has correlated with the grade of oesophageal varices (whereas liver stiffness has not), 216,217 and ARFI, like magnetic resonance elastography, 183 may evolve into a non-invasive method for assessing manifestations of portal hypertension. 216,217 The confounding factors that can affect the performance of ARFI are similar to those affecting tissue elastography (Table 3).…”

“…215 Spleen stiffness by ARFI has correlated with the grade of oesophageal varices (whereas liver stiffness has not), 216,217 and ARFI, like magnetic resonance elastography, 183 may evolve into a non-invasive method for assessing manifestations of portal hypertension. 216,217 The confounding factors that can affect the performance of ARFI are similar to those affecting tissue elastography (Table 3). Hepatic inflammation, but not hepatic steatosis, 218 increases the ARFI measurements when the fibrosis stage is low.…”