Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy

Lee, Cheng‐Han; Wan, Yung-Liang; Hsu, Tse-Hwa; Huang, Shiu-Feng; Yu, Ming–Chin; Lee, Wei‐Chen; Tsui, Po-Hsiang; Chen, Yi-Cheng; Lin, Chun‐Yen; Tai, Dar‐In

doi:10.3390/app7111164

Cited by 7 publications

(8 citation statements)

References 39 publications

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“…Liver steatosis was measured by the control attenuation parameter (CAP) value during the TE study. ARFI (Acuson S2000; Siemens Healthcare, Erlangen, Germany) imaging was conducted according to the published guidelines by obtaining measurements in two locations [25], with slight modification [7,18]. Briefly, two locations from the right intercostal space were selected for assessment; one was at the right upper liver and the other was at the right lower liver based on optimal 2D imaging.…”

Section: Methodsmentioning

confidence: 99%

“…Hemogram blood testing, liver biochemistry, and serology tests were performed for all patients, as described in our previous reports [7,18]. The patients were divided into three groups according to the presence or absence of viral markers: patients seronegative for hepatitis B surface antigen (HBsAg) and HCV antibodies (anti-HCV) were classified into the non-B/non-C liver cirrhosis (NBNC) group; while patients seropositive for either HBsAg or anti-HCV were classified into the chronic hepatitis B (CHB) or chronic hepatitis C (CHC) group, respectively.…”

Section: Patientsmentioning

confidence: 99%

“…FIB4 is calculated from routine laboratory data in addition to age [6]. It is inexpensive but has a relatively low area under the receiver operating characteristic curve (AUROC) values [7]. TE measurement by FibroScan (Echosens, Paris, France) is a well-standardized modality for the measurement of both liver fibrosis and steatosis [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Hepatic Steatosis on Non-Invasive Liver Fibrosis Measurements Between Hepatitis B and Other Etiologies

et al. 2019

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Fibrosis-4 (FIB4), transient elastography (TE), and acoustic radiation force impulse (ARFI) are popular modalities to assess liver fibrosis. Their cutoff values for degrees of fibrosis vary between studies. The influence of hepatic steatosis on fibrosis measurements for different etiologies was evaluated. Data from a consecutive series of patients who received fibrosis measurement were included for the training group. An additional series with histology served as the validation group. A standardized protocol was performed for both TE and ARFI, mostly by a single technician. Patients with alcoholism, autoimmune disease, active inflammation, or who were receiving therapy were excluded. The training group included 215 patients and the validation group included 221. The correlation of liver stiffness between TE and ARFI was good (R2 linear = 0.798; p < 0.001). Different correlations between ARFI and TE were noted between high and low control attenuation parameter (CAP) values (cutoff: 290 dB/m), especially in the non-hepatitis B subgroups. Relatively lower FIB4 and TE values were seen in the high CAP versus low CAP in patients with histology-proven non-alcoholic fatty liver disease and chronic hepatitis C. FIB4 cutoff values were >25% lower among F2-F4 stages and the TE cutoff value for F4 was 8.5% lower in the high versus low CAP group. Such findings were not observed in chronic hepatitis B. Different fibrogenesis mechanisms between hepatitis B and non-B are discussed. We conclude that hepatic steatosis significantly impacts FIB4 and TE fibrosis measurements in non-hepatitis B-related liver diseases. Fibrosis grade should be interpreted with caution in severe steatosis.

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Section: Methodsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Hepatic Steatosis on Non-Invasive Liver Fibrosis Measurements Between Hepatitis B and Other Etiologies

et al. 2019

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“…The mean data from two locations will decrease the variation and make the ARFI assessment more objective. [1112] In this ARFI two-location measurements study, we would like to establish its cutoff values according to histology fibrosis score in different etiologies.…”

Section: Introductionmentioning

confidence: 99%

Cutoff values of acoustic radiation force impulse two-location measurements in different etiologies of liver fibrosis

Hsu

Tsui

et al. 2019

J Med Ultrasound

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Background:Acoustic radiation force impulse (ARFI) imaging is a popular modality to measure liver fibrosis. ARFI selects optimal locations for measurement under imaging guiding. However, there are concerns on study locations and observers bias. To decrease the variations, ARFI at two locations was measured with standardized protocol. This study attempted to establish its cutoff values according to Metavir fibrosis score in different etiologies.Methods:A consecutive series of patients who received liver histology study were prospectively enrolled. All cases had hemogram, liver biochemistry, viral markers, and ARFI two-location measurements within 4 weeks of histology study. A standardized protocol was performed by single technologist. We excluded patients with alanine aminotransferase >5x upper limit normal.Results:Five hundred and ten patients that included 153 seronegative for both HBsAg and anti-HCV Non-B non-C (NBNC), 33 autoimmune liver diseases (AILD), 261 chronic hepatitis B (CHB), and 63 chronic hepatitis C (CHC) were enrolled. About 83% of NBNC patients had fat cell >5%. For diagnosis of liver cirrhosis, the area under receiver operating characteristic curve of NBNC, AILD, CHB, and CHC groups was 0.937, 0.929, 0.784, and 0.937; the cutoff values for mean ARFI were 1.788, 2.095, 1.455, and 1.710 m/s, respectively. The sensitivity and specificity are both over 0.818 for patients with nonalcoholic fatty liver diseases, CHC, and AILD, but the corresponding data are only 0.727–0.756 in CHB. The Fibrosis-4 Score is as good as ARFI on fibrosis assessment in NBNC.Conclusion:The performance of ARFI two-location measurement is excellent in NBNC, AILD, and CHC, but is only satisfactory in CHB.

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“…The paper "Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy" concludes that 2D-SWE (regrettably referred to as ARFI) is a reliable tool for the measurement of liver fibrosis in chronic hepatitis B patients with alanine aminotransferase <5× the upper limit of normal. For those patients under anti-HBV therapy, the optimal timing for SWE analysis will be over 1 to 2.5 years of nucleos(t)ide analogue therapy [50].…”

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confidence: 99%

Editorial on the Special Issue of Applied Sciences on the Topic of Elastography

Dietrich

Bamber

2018

Applied Sciences

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Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy

Cited by 7 publications

References 39 publications

Effects of Hepatic Steatosis on Non-Invasive Liver Fibrosis Measurements Between Hepatitis B and Other Etiologies

Effects of Hepatic Steatosis on Non-Invasive Liver Fibrosis Measurements Between Hepatitis B and Other Etiologies

Cutoff values of acoustic radiation force impulse two-location measurements in different etiologies of liver fibrosis

Editorial on the Special Issue of Applied Sciences on the Topic of Elastography

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