Real-Time Tissue Elastograhy For Assessing Hepatic Fibrosis In Chronic Hepatitis B Patients

AIM:Liver biopsy is widely recognized as the gold standard for staging disease progression. Limitations associated with liver biopsies include its invasiveness, the risk for complication,so clinical workers hope to find some noninvasive methods for the evaluation of hepatic fibrosis. noninvasive methods for the evaluation of hepatic fibrosis have been fast developed over the past few years,especially ultrasound of elastography.The aim of this work was to assess the value of real-time tissue elastography (RTE) parameters in measuring hepatic fibrosis in patients with chronic hepatitis B (CHB), meanwhile, comparing it with RTE scores,APRI.Methods:A standard ultrasound unit (HI VISION Preirus, Hitachi Medical, Japan) and an EUP-L52linear probe (3-7MHz, Hitachi Medical, Japan) were used to conduct all RTE examinations of80patients, RTE images were described as parameters (mean, area, standard deviation, and complexity) and scored according to the proportion of each color in the RTE images. Liver biopsy or operation, and routine laboratory analyses were performed three days afte RTE examinations,In addition, the aspartate transaminase-to-platelet ratio index (APRI) was calculated. The relationship between RTE parameters, RTE scores, histologic grade of fibrosis and steatosis, as well as APRI, were calculated.Results:RTE parameters mean, area and RTE scores were significantly correlated with liver fibrosis,APRI was medium correlated with liver fibrosis. Of all the parameters,mean and area had highest sensitivity,specificities and AUC.Compared with the RTE scores and APRI, mean and area performed better in staging liver fibrosis.In discriminating patients with severe liver fibrosis, the sensitivities for mean, area, RTE scores, and APRI were86.2%、86.4%、86.4%、80.8%respectively, the sensitivities were90.9%、86.2%、82.8%.81.8%respectively, The areas under the receiver operating characteristic curves were0.938、0.933、0.846、0.808,80.3%,85.7%respectively.In discriminating patients with cirrhosis, the sensitivities for mean, area, RTE scores, and APRI were80.3%,85.7%,57.1%, and85.7%, respectively. The specificities were78.6%,77.3%,89.4%, and66.7%, respectively. The areas under the receiver operating characteristic curves were0.894for mean,0.897for area,0.840for elastic scores, and0.803for APRI.Conclusions:RTE appears to be a promising technique for noninvasively assessing hepatic fibrosis in patients with CHB. Its performance compared favorably with APRI and RTE scores for staging liver fibrosis,having high sensitivity,specificities and AUC.