Stiffness Value and Serum Biomarkers in Liver Fibrosis Staging: Study in Large Surgical Specimens in Patients with Chronic Hepatitis B

Abstract

Purpose To investigate the capabilities of stiffness value and serum biomarkers in the staging of liver fibrosis in patients with chronic hepatitis B (CHB), with pathologic findings in large surgical specimens serving as the reference standard. Materials and Methods This study was approved by the institutional review board, and informed consent was obtained from all patients. Liver stiffness (determined by means of ultrasonography-based elastography point quantification), aspartate aminotransferase-platelet ratio index (APRI), and fibrosis index (based on the four-factor Fibrosis-4 [FIB-4] calculation) were obtained in 386 patients with CHB. With pathologic fibrosis stages in large surgical specimens as the reference standard, capabilities and cutoffs of stiffness and serum biomarkers were first investigated in a cohort of 284 patients and then validated in an independent cohort of 102 patients by means of area under the receiver operating characteristic curve (AUC) analysis. Results Liver stiffness demonstrated significantly stronger correlation with fibrosis stages than did APRI and FIB-4 (r = 0.738 vs r = 0.477 vs r = 0.427, respectively; P < .05 for all). In the development cohort, liver stiffness had significantly higher AUCs in identifying fibrosis of stage 1 or higher, stage 2 or higher, stage 3 or higher, and stage 4 or higher (0.97, 0.96, 0.91, and 0.87, respectively) than APRI (0.89, 0.84, 0.73, and 0.74, respectively) and FIB-4 (0.82, 0.79, 0.70, and 0.72, respectively). In the validation cohort, liver stiffness was validated as showing significantly higher AUCs in identifying fibrosis of stage 1 or higher, stage 2 or higher, stage 3 or higher, and stage 4 or higher (0.99, 0.95, 0.89, and 0.88, respectively) than APRI (0.83, 0.76, 0.78, and 0.68, respectively) and FIB-4 (0.76, 0.69, 0.75, and 0.67, respectively). Conclusion Liver stiffness demonstrated considerable capability in identifying each stage of liver fibrosis in patients with CHB, whereas serum biomarkers showed limited capabilities. (©) RSNA, 2016 Online supplemental material is available for this article.

Detection of liver fibrosis using qualitative and quantitative MR elastography compared to liver surface nodularity measurement, gadoxetic acid uptake, and serum markers

“…13,25 In our study, we found the same moderate sensitivity and accuracy of APRI and FIB-4 in diagnosing advanced liver fibrosis and cirrhosis as shown in a prior meta-analysis. Lu et al, 28 in a large cohort of chronic HBV patients, reported significantly higher AUCs for liver stiffness (measured by point shear wave ultrasound elastography) than for APRI and FIB-4 in identification of all stages of liver fibrosis. Lu et al, 28 in a large cohort of chronic HBV patients, reported significantly higher AUCs for liver stiffness (measured by point shear wave ultrasound elastography) than for APRI and FIB-4 in identification of all stages of liver fibrosis.…”

“…26 Also, as reported previously by Huwart et al, 27 we showed that MRE was superior to blood tests (APRI and FIB-4) in our study. Lu et al, 28 in a large cohort of chronic HBV patients, reported significantly higher AUCs for liver stiffness (measured by point shear wave ultrasound elastography) than for APRI and FIB-4 in identification of all stages of liver fibrosis. Our results are in concordance with extensive literature showing that serum biomarkers are less reliable for discriminating between intermediate fibrosis stages and can be influenced by the presence of extrahepatic disease.…”

Staging liver fibrosis in chronic hepatitis B with T1 relaxation time index on gadoxetic acid‐enhanced MRI: Comparison with aspartate aminotransferase‐to‐platelet ratio index and FIB‐4

“…Great strides in imaging technique have been made for staging hepatic fibrosis. Noninvasive measurement of liver stiffness with elastometry, such as transient elastography, shear‐wave elastography, and MR elastography, has shown high accuracy for staging hepatic fibrosis, but the dedicated device is costly and its availability is limited.…”

“…Wang et al reported low positive predictive value of APRI and FIB‐4 index for significant fibrosis in CHB patients with persistently normal and mildly elevated ALT, indicating that liver biopsy was still needed for those patients who have FIB‐4 >1.45 or APRI >0.5 . In the latest study of Lu et al, APRI and FIB‐4 showed relatively poor diagnostic accuracy in discriminating fibrosis of stage 4 (AUCs, 0.68 and 0.67, respectively) …”

Nomograms to predict prognosis of hepatocelluar carcinoma without major vascular invasion after primary liver transplantation

“…According the previous studies, the 5-year survival could reach up to 78.3% for the Milan criteria, 72.4% for the UCSF, 71.2% for the up-to-seven and 72.3% for the Hangzhou criteria [4][5][6]. Recently, large sample size studies from eastern and western liver transplantation centers had reported the superiority of transplantation over resection for HCC beyond the Milan criteria without major vascular invasion [3,7]. Moreover, study from Bruix, et al and Volk et al suggested that transplantation for HCC without dropping to 50% of 5-year overall survival was acceptable [8,9].…”