Performance of Acoustic Radiation Force Impulse Elastography for Staging Liver Fibrosis in Patients With Chronic Hepatitis C After Viral Eradication

Abstract

Background Data on noninvasive liver fibrosis staging after viral eradication are unclear. This histology-based study validated the performance of liver stiffness (LS) measurements after viral eradication. Methods Consecutive participants with chronic hepatitis C (CHC) who received concomitant LS measurements through acoustic radiation force impulse (ARFI) elastography and percutaneous liver biopsy were prospectively screened and analyzed. Results Of the 644 patients, 521 (80.9%) underwent a biopsy at treatment baseline, and the remaining 123 (19.1%) underwent a biopsy at 3 years (median; interquartile range, 0.1) after the sustained virological response (SVR) to pegylated interferon–based and direct-acting antiviral treatments. The proportions of histological fibrosis stages did not differ significantly between the pretreatment and post-SVR groups (P = .0615). However, the LS values differed significantly (P < .0001). The median LS values (presented as shear wave velocities in meters per second) were 1.51 (0.92) for the pretreatment group and 1.22 (0.77) for the post-SVR group. The cutoffs (areas under the receiver operating characteristic curve, obtained using the bootstrap method) to dichotomize between METAVIR fibrosis stage F1 versus stages F2–F4, F1–F2 versus F3–F4, and F1–F3 versus F4 were 1.47 (0.8333, 95% confidence interval [CI] 0.7981–0.8663), 1.81 (0.8763, 95% CI 0.8376–0.9107), and 1.86 (0.8811, 95% CI 0.8378–0.9179) in the pretreatment group, respectively, and 1.22 (0.7872, 95% CI 0.7001–0.8624), 1.59 (0.8808, 95% CI 0.8034–0.9422), and 1.75 (0.9018, 95% CI 0.8201–0.9644) in the post-SVR group, respectively. Conclusions The performance of LS measurements through ARFI elastography is promising to determine the liver fibrosis stage on necroinflammation-resolved histology in CHC after viral eradication.

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

“…84 Another issue is the significant variations in LSM using TE over time reported in untreated patients with chronic liver disease. 85 Similarly, post-SVR LSM decrease has been reported using other devices such as pSWE (Virtual Touch) [86][87][88] and MRE. 89 Along this line, post-SVR decreases have been reported with non-invasive serum biomarkers like APRI, FIB-4 or ELF TM .…”

“…89 Along this line, post-SVR decreases have been reported with non-invasive serum biomarkers like APRI, FIB-4 or ELF TM . 84,86,88,90 These studies, despite contrasting results, 90 also showed a good diagnostic accuracy of LSM by pSWE (AUROC from 0.88 and 0.91) 87,88 and of APRI, FIB-4 and ELF TM84,86 for the diagnosis of advanced fibrosis after SVR, using liver biopsy as a reference. It should be kept in mind, however, that thresholds for LSM and NITs used in untreated viral hepatitis have proven inaccurate after SVR, 83,84,86,87 and it is necessary to validate the newer (lower) cut-offs in larger studies.…”

Liver fibrosis assessments using FibroScan, virtual-touch tissue quantification, the FIB-4 index, and mac-2 binding protein glycosylation isomer levels compared with pathological findings of liver resection specimens in patients with hepatitis C infection

“…However, Nagata et al and Chen et al reported that FibroScan, VTQ, FIB4-Index and M2BPGi levels are significantly decreased regardless of degree of fibrosis in patients with Sustained Viral Response (SVR) [20][21][22][23]. In addition, Bachofner et al reported that FIB-4 index levels are also lower in patients with SVR after treatment [24].…”

The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

“…This imaging technique quantifies the mechanical properties of tissues, without manual compression, by measuring the shear wave velocity induced by acoustic radiation and propagation in the liver tissue (29). Compared to TE, the elastography technique currently used in clinical practice, ARFI showed promising results in the assessment of liver fibrosis staging in CHC and HIV/hepatitis C co-infected patients (13,30). Similar to other studies on patients with SVR after DAAs, the ARFI evaluation found that LS improves in patients with cirrhosis.…”