Non-Invasive Evaluation of Hepatic Fibrosis: The Diagnostic Performance of Magnetic Resonance Elastography in Patients with Viral Hepatitis B or C

Ran-Chou Chen,Kwo-Whei Lee,Hwa-Koon Wu,Chih-Wei Lee,Chen-Hua Liu,Wen-Pei Wu,Chen-Te Chou

doi:10.1371/journal.pone.0140068

Abstract

PurposeTo compare the accuracy of magnetic resonance elastography (MRE) with that of aspartate aminotransferase-to-platelet ratio index (APRI) for estimating the stage of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection.Materials and MethodsWe retrospectively enrolled 160 patients with chronic hepatitis and 25 healthy living liver donors. Fibrosis stage (METAVIR, F0 to F4) was determined histopathologically for all patients. APRI was recorded at the time of histopathologic examination and liver stiffness values were measured on MRE quantitative stiffness maps. The cutoff values, sensitivity, and specificity of MRE and APRI for each fibrosis stage were determined using receiver operating characteristic (ROC) analysis.ResultsMRE had a significantly greater area under the ROC curve than APRI score for discriminating among METAVIR stages F2-F4. Using a cutoff value of 2.80 kPa, MRE had a sensitivity of 94.4% and a specificity of 97.8% for detecting significant fibrosis (≥F2). There were no significant differences in fibrosis stage between patients with HBV and those with HCV infection. For ≥F2, the cutoffs were 2.47 kPa (100% sensitivity), 2.80 kP (maximum sum of sensitivity and specificity), and 3.70 kPa (100% specificity).ConclusionsMRE is a more accurate modality than APRI for detecting significant fibrosis in patients with chronic HBV or HCV infection. Antiviral treatment should be considered in patients with liver stiffness values ≥ 2.8 kPa.

Highlights

Viral hepatitis places a heavy burden on health care systems because of the high costs of treatment of liver cancer and liver cirrhosis
magnetic resonance elastography (MRE) had a significantly greater area under the receiver operating characteristic (ROC) curve than aminotransferase—to-platelet ratio index (APRI) score for discriminating among METAVIR stages F2-F4
Chronic hepatitis C virus (HCV) infection is characterized by the triad of lymphocyte nodular inflammation in portal tracts, the presence of steatosis and bile duct damage whereas the presence of “ground-glass” hepatocytes is the histologic hallmark of chronic hepatitis B infection.[12,13,14]

Summary

Introduction

Viral hepatitis places a heavy burden on health care systems because of the high costs of treatment of liver cancer and liver cirrhosis. Identification of significant liver fibrosis in patients with HBV or HCV infection is crucial to establish the timing of antiviral treatment.[1, 2]. A number of studies in western countries have shown that among all currently used noninvasive methods magnetic resonance elastography (MRE) has the highest correlation with liver fibrosis stage in patients with chronic HCV infection.[5,6,7,8,9,10] in Asia HBV rather than HCV infection is the leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma [11]. Chronic HCV infection is characterized by the triad of lymphocyte nodular inflammation in portal tracts, the presence of steatosis and bile duct damage whereas the presence of “ground-glass” hepatocytes is the histologic hallmark of chronic hepatitis B infection.[12,13,14] Liver stiffness values as measured by transient elastography (TS) or acoustic radiation force impulse (ARFI) imaging can differ between patients with HBV infection and those with infection due to HCV, making it difficult to differentiate between different stages of fibrosis in these two groups of patients.[15,16,17]

Objectives

Methods

Results

Conclusion