Acoustic Radiation Force Impulse US Imaging: Liver Stiffness in Patients with Chronic Hepatitis B with and without Antiviral Therapy

Abstract

Purpose To investigate the clinical utility and longitudinal change of acoustic radiation force impulse (ARFI) ultrasonographic (US) imaging in patients with chronic hepatitis B. Materials and Methods A retrospective cohort study of patients with chronic hepatitis B who underwent serial ARFI examinations in a tertiary referral center in Taiwan between 2012 and 2016 was conducted. The clinical information and noninvasive liver stiffness measurement tests (ARFI, Fibrosis-4 index [FIB-4], and FibroScan) were collected. Serial ARFI measurements were compared in patients without antiviral therapy (nontreatment group) and during antiviral therapy (treatment group). The linear mixed-effects model with random coefficients was used to compare longitudinal repeated measurements. Results A total of 559 patients undergoing serial ARFI examinations were included. The ARFI value correlated with FIB-4 (correlation coefficient = 0.55, P < .001) and FibroScan (correlation coefficient = 0.69, P < .001) results. There were 314 patients with five or more ARFI measurements in more than 3 years of follow-up. The ARFI value remained unchanged in the nontreatment group (n = 189, from 1.11 to 1.11 m/sec, time trend P = .911). However, the ARFI value declined significantly in the treatment group (n = 125, from 1.63 to 1.37 m/sec, time trend P < .001), both in patients with cirrhosis (n = 51, from 2.15 to 1.75 m/sec, time trend P < .001) and in those without (n = 74, from 1.27 to 1.11 m/sec, time trend P < .001). Conclusion ARFI US imaging is an important clinical noninvasive test for liver stiffness measurement and can be used for serial measurements in the management of chronic hepatitis B. Antiviral therapy significantly reduces liver stiffness during longitudinal follow-up.

Performance of spleen stiffness measurement by 2D-shear wave elastography in evaluating the presence of high-risk varices: comparative analysis of idiopathic portal hypertension versus hepatitis B virus

“…Additionally, the volume of hepatocytes accounts for more than 90% of the total volume of the liver, with liver function being more severely affected in HBV-infected patients than in those with IPH. In the liver, there is mostly inflammation, thick fibrous septa, and small nodules, which are the most important factors for the LS increase [ 19 ], as found in our study (Table 2 ). However, at the later stages, with the progression of hepatocytes death, extracellular matrix deposition, and vascular reorganization, the pathological hallmark of the liver is pseudolobule formation, which includes regenerative nodules, fibrous septa, and microvascular clotting [ 16 ].…”

Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations

“…The performance of transient elastography in chronic hepatitis B was described in the last WFUMB guidelines (Ferraioli et al 2015). Since then, 2-D SWE (Leung et al 2013;Zeng et al 2017) and p-SWE (Hu et al 2017;Kim et al 2016;Su et al 2018) have also been evaluated against liver histology in patients with chronic hepatitis B. Overall, studies have indicated similar diagnostic accuracy across different machines.…”

ARFI Elastography in Chronic Hepatitis B Virus Infection—The Sources of Variations

“…Longitudinal follow-up studies have shown a significant decrease in shear wave velocity measurements both in patients with significant fibrosis and cirrhosis. 8 We should however note that this change was noted only after 32 months of antiviral therapy. 9 …”