Shear wave elastography vs aspartate aminotransferase to platelet ratio index in diagnosing liver fibrosis in hepatitis B patients with mildly elevated ALT

Abstract

Objective To investigate the value of shear wave elastography (SWE) vs aspartate aminotransferase to platelet ratio index (APRI) in diagnosing liver fibrosis in patients with chronic hepatitis B and mildly elevated alanine aminotransferase (ALT) level. Methods A total of 66 chronic hepatitis B patients who were registered to our hospital between December 2014 and June 2015 and with elevated ALT level below 2 times the upper limit of normal range, received liver biopsy for pathological study. SWE and APRI scoring were conducted for these patients. We compare the correlation between severity of pathologically-confirmed liver fibrosis and SWE or APRI. Receiver operating characteristic curve (ROC) was used to analyse the value of the two non-invasive options in diagnosing liver fibrosis. Results In the 66 patients, there was none case of F0 and F4 stages of liver fibrosis, 22 of F1, 29 of F2 and 15 of F3 stages. SWE measurements (r=0.826 4) and APRI scores (r=0.728 0) were positively correlated with the staging of liver fibrosis (P<0.01). The area under the ROC (AUROC) for diagnosing liver fibrosis F2 and F3 by using SWE were 0.924 and 0.955, respectively, compared with 0.892 and 0.864 by using APRI. The sensitivity of APRI in diagnosing liver fibrosis F2 and F3 was similar to that of SWE (95.5% vs 95.5%, 87.8% vs 89.8%) , but SWE showed higher specificity (73.8% vs 81% , 86.7% vs 100% ). SWE showed better efficiency in diagnosing liver fibrosis F2 and F3 compared with APRI (Z=5.153 2, P<0.001; Z=13.439 4, P<0.001). Conclusion SWE is advantagous over APRI in diagnosing liver fibrosis in hepatitis B patients with mildly elevated ALT. Key words: Hepatitis B, chronic; Ultrasonography; Elastography; Liver fibrosis