A Comparative Study Of Acoustic Radiation Force Pulse Elastography (ARFI) And Instantaneous Elastography (FibroScan) In Noninvasive Diagnosis Of Hepatic Fibrosis

Objective:1.To explore the diagnostic value of acoustic radiation force impulse imaging(ARFI)and instantaneous elastography(Fibro Scan)in staging liver fibrosis in patients with chronic hepatitis B.2.To explore the diagnostic value of the combination of two elastography techniques in the staging of liver fibrosis in patients with chronic hepatitis B.3.To explore the correlation between routine ultrasonography and liver function detection.Method:1.Subject investigated: From January 2017 to December 2018,the outpatients and inpatients in the Department of Gastroenterology,First Affiliated Hospital of Henan University of Traditional Chinese Medicine were screened out.A total of 90 patients with chronic hepatitis B were diagnosed by medical history,laboratory examination or routine ultrasonography.2.Operating methods:Siemens ACUSON S2000 ultrasound imaging system was selected,ARFI imaging software was installed,abdominal 4C1 convex array probe was selected with a frequency of 4.0MHz.Acoustic radiation force impulse(VTQ)was used to detect the patients.At the same position,VTQ was measured several times during a breath holding period(10-15S),and the most stable VTQ value(m/s)was selected for statistics.Using Echosens Fibro Scan detector and standard M-probe,liver stiffness measurement(LSM)was performed in 10 consecutive successful tests,and the median value(k Pa)of 10 effective measurements was obtained.SPSS22.0statistical software was used to analyze the accuracy of VTQ value and LSM value in the diagnosis of liver fibrosis staging in patients with chronic hepatitis B.Thecorrelation between VTQ value,LSM value and pathological staging and general data was expressed by Spearman correlation coefficient R.P < 0.05 was statistically significant.Result:1.Detection results of VTQ values in patients with chronic hepatitis B at various stages of pathological fibrosis: stage S0(1.19±0.08)m/s,stage S1(1.21±0.16)m/s,stage S2(1.39±0.18)m/s,stage S3(1.68±0.36 m/s),stage S4(2.00±0.24)m/s.The results of LSM measurements in patients with chronic hepatitis B at various stages of pathological fibrosis were as follows: stage S0(5.09±1.17)k Pa,stage S1(5.91±1.20)k Pa,stage S2(7.60±1.90)k Pa,stage S3(10.46±3.52)k Pa,stage S4(18.43±5.78)k Pa.The VTQ and LSM values increased gradually with the progression of stages of liver fibrosis.There were significant differences in ARFI and Fibro Scan measurements in different stages of liver fibrosis(P < 0.05).2.VTQ value was significantly correlated with pathological stage(r = 0.758),LSM value was significantly correlated with pathological stage(r = 0.751).There was a significant correlation between the two technologies(r = 0.771).(P < 0.05)3.The area under the curve of ARFI in the diagnosis of different stages of hepatic fibrosis was 0.845,0.890,0.897 and 0.932.The sensitivity was 74.3%,80.0%,78.6%,76.9%,and the specificity was 87.5%,92.5%,100.0% and 94.8%.The area under the curve of Fibro Scan in the diagnosis of different stages of hepatic fibrosis was 0.877,0.880,0.878 and 0.928.The sensitivity was 74.3%,74.0%,71.4%,84.6%,and the specificity was 100.0%,90.0%,100.0% and 98.7%.The area under the two technical curves increased with the degree of liver fibrosis.The area under the overall curve of ARFI technology was higher than that of Fibro Scan technology,and the specificity of Fibro Scan technology was higher.The area under the curve of the combined diagnosis of the two techniques for different stages of liver fibrosis was0.884,0.946,0.898 and 0.932.The sensitivity was 79.7%,74.0%,78.6%,84.6%,and the specificity was 100.0%,95.0%,100.0% and 98.7%.The diagnostic accuracy was higher than that of the two techniques alone.4.VTQ values were significantly correlated with BMI,liver parenchymal changes and spleen,R values were(0.616,0.685,0.611),and LSM values were significantly correlated with liver parenchymal changes(r = 0.579)(P < 0.05).Conclusion:1.ARFI and Fibro Scan have good clinical value in non-invasive assessment ofliver fibrosis stage of chronic hepatitis B,which is conducive to the further diagnosis and treatment of chronic hepatitis B patients.2.Compared with pathological staging,ARFI has better correlation than Fibro Scan,and the combination of the two techniques has higher diagnostic value.3.The degree of liver parenchyma change,spleen thickness and BMI index may affect the accuracy of ultrasound elastography.These interference factors should be removed as far as possible in clinical practice.