Real-time Elastography for Diagnosis of Liver Fibrosis in Chronic Hepatitis B

OBJECTIVES: The purpose of this study was to prospectively investigate the value of real-time ultrasound elastography for diagnosis of liver fibrosis in patients with chronic hepatitis B and to correlate the elastographic findings with histologic stages of liver fibrosis and blood parameters. METHODS: Liver biopsies, blood testing, and real-time elastography were performed in 71 patients with chronic viral hepatitis B and liver cirrhosis. The ratio of the elastic strain of liver tissue to that of muscle tissue was determined and correlated with the histologic fibrosis stages and laboratory examination results. RESULTS: There was a highly negative correlation between the elastic strain ratio and the histologic fibrosis stage (Spearman r = -0.702; P < .001). There was a high correlation observed between a decreasing elastic strain ratio and an increasing fibrosis stage. With substantial liver fibrosis (Scheuer score ≥ S2) and cirrhosis (S4) as diagnostic criteria, the areas under the receiver operating characteristic curves (AUCs) of the elastic strain ratios were 0.863 and 0.797, respectively. The AUC for substantial fibrosis was higher than the AUC for the blood parameters used to diagnose substantial liver fibrosis. Elastic strain ratio cutoff values of 1.10 and 0.60 were identified as diagnostic of substantial fibrosis and cirrhosis, respectively, with sensitivities of 77.8% and 50.0%, respectively, and specificities of 80.0% and 96.7%. CONCLUSIONS: Real-time elastography is a new clinically promising and noninvasive method for quantitative assessment of liver fibrosis.