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Noninvasive Assessment of Liver Fibrosis Stage Using Ultrasound‐Based Shear Wave Velocity Measurements and Serum Algorithms in Patients With Viral Hepatitis B: A Retrospective Cohort Study
Author(s) -
Liu Jianxue,
Zhao Junzhi,
Zhang Yaoren,
Ji Yonghao,
Lin Shumei,
Dun Guoliang,
Guo Sujuan
Publication year - 2017
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.16.01069
Subject(s) - medicine , receiver operating characteristic , cirrhosis , gastroenterology , fibrosis , stage (stratigraphy) , liver biopsy , area under the curve , alanine transaminase , aspartate transaminase , hepatitis c , biopsy , alkaline phosphatase , paleontology , biochemistry , chemistry , biology , enzyme
Objectives Liver biopsy remains the reference standard for the assessment of liver fibrosis, but this procedure is invasive and can lead to complications. Thus, studies to determine the optimal noninvasive test are warranted. This study compared several noninvasive tests and their combinations for evaluating liver fibrosis stages in patients with chronic hepatitis B. Methods The shear wave velocity (SWV) and laboratory indicators were collected from 174 patients with chronic hepatitis B. Formulas were applied to calculate the serum fibrosis model, including the aspartate aminotransaminase‐to‐platelet ratio index (APRI), fibrosis‐4 index (FIB‐4) and aspartate aminotransferase‐to‐alanine aminotransferase ratio (AAR). The diagnostic performance of all noninvasive tests was assessed in comparison with percutaneous liver biopsy, based on a receiver operating characteristic curve analysis. Results The SWV (area under the receiver operating characteristic curve [AUC], 0.82) and APRI (AUC = 0.77) performed better than the FIB‐4 (AUC = 0.62), and the AAR (AUC = 0.47) was not suitable for evaluating substantial liver fibrosis (stage ≥F2). The SWV (AUC = 0.96) was the best indicator, being superior to the APRI (AUC = 0.75) and FIB‐4 (AUC = 0.74), and the AAR (AUC = 0.45) was not suitable for assessing cirrhosis (F4). Combining the SWV and APRI, the AUC improved to 0.85 for substantial liver fibrosis, and the sensitivity increased to 100% for cirrhosis. Conclusions The SWV, APRI, and FIB‐4 were valid tests for evaluating substantial liver fibrosis and cirrhosis. The combination of these tests with several noninvasive indicators is expected to enhance the assessment of liver fibrosis stages.