Transient Elastography and Ultrasonography: Optimal Evaluation of Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease

Abstract

Background and Aims. Concordance between transient elastography (TE) and ultrasonography (US) in assessing liver fibrosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD) has been rarely studied. This study aimed to evaluate the individual and combined performances of TE and US in assessing liver fibrosis and cirrhosis. Patients and Methods. Consecutive CHB patients with NAFLD were prospectively enrolled. TE and US examinations were performed, with liver biopsy as a reference standard. Receiver operating characteristic (ROC) curves were obtained to evaluate the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared using DeLong’s test. Results. TE and US scores correlated significantly with the histological fibrosis staging scores. TE was significantly superior to US in the diagnosis of significant fibrosis (AUC, 0.84 vs 0.73; P=0.02), advanced fibrosis (AUC, 0.95 vs 0.76; P<0.001), and cirrhosis (AUC, 0.96 vs 0.71; P<0.001). Combining TE with US did not increase the accuracy of detecting significant fibrosis, advanced cirrhosis, or cirrhosis (P=0.62, P=0.69, and P=0.38, respectively) compared to TE alone. However, TE combined with US significantly increased the positive predictive value for significant fibrosis when compared to TE alone. The optimal cut-off values of TE for predicting advanced fibrosis and cirrhosis were 8.7 kPa and 10.9 kPa, with negative predictive values of 92.4% and 98.7%, respectively. Conclusions. TE is useful for predicting hepatic fibrosis and excluding cirrhosis in CHB patients with NAFLD. A combination of TE and US does not improve the accuracy in assessing liver fibrosis or cirrhosis.

Optimizing the Use of the Gamma-Glutamyl Transpeptidase-to-Platelet Ratio and Transient Elastography to Identify Liver Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease

“…Although TE may be affected by several factors, it shows good to excellent performance in CHB patients and decreases the need for LB [13, 27]. Similar to our previous study [28], TE had excellent performance in detecting liver fibrosis and cirrhosis, as revealed by AUCs in the current study. To our knowledge, no comparison between TE and GPR in assessing liver fibrosis and cirrhosis in CHB patients with NAFLD has been previously reported.…”

Assessment of Hepatic Steatosis in Patients with Chronic Hepatitis B Using Fibroscan and its Relation to Insulin Resistance

“…There was no significant difference between the two studied groups regarding the degree of liver fibrosis measured by Fibroscan. This was supported by data revealed by Zhang et al, (2019) who performed liver biopsy, Transient Elastography (TE) and Ultrasound for the assessment of steatosis and fibrosis, and concluded that there was no significant correlation between fibrosis and steatosis, and they added that Fibroscan is more accurate than other two methods in the assessment of steatosis and fibrosis [31]. Several previous studies had concluded the same results [9, 32 -36].…”

Combination of FIB-4 with ultrasound surface nodularity or elastography as predictors of histologic advanced liver fibrosis in chronic liver disease

“…In a prior study by Zhang et al used a specific US scoring system including scores for liver contour, liver parenchyma echotexture, hepatic vein contour and spleen size, for assessment of fibrosis in chronic hepatitis B patients with NAFLD, combining US and transient elastography. They showed the combination of the two methods significantly increased the PPV for detection of advanced fibrosis or cirrhosis compared to transient elastography alone; however, the accuracy of diagnosis was not significantly increased 28 . In our cohort combined SN and VCTE resulted in higher specificity and PPV compared to either test alone.…”