Value of real-time tissue elastography and contrast-enhanced ultrasonography in liver fibrosis assessment in patients with chronic hepatitis B

Abstract

Objective To investigate the clinical value of real-time elastography (RTE) and contrast-enhanced ultrasound (CEUS) in the evaluation of liver fibrosis in patients with chronic hepatitis B, in order to provide a new noninvasive method for assessment of liver fibrosis in chronic hepatitis B. Methods Sixty-one patients with chronic hepatitis B were divided into five groups according to the pathological stage of hepatic fibrosis: S0-S4. All the patients underwent RTE and CEUS examinations. The liver fibrosis index (LFI) and liver-kidney peak time difference (Lt-Kt) were calculated and analyzed by one-way ANOVA, followed by pairwise comparisons using the LSD-t test and the SNK test. The receiver operating characteristic curves (ROCs) were plotted based on the stage of liver fibrosis and used to evaluate the diagnostic value of real-time elastography and CEUS, alone or in combination. Results There was no significant difference in LFI values between stages S1 and S2 and between stages S0 and S1 (P>0.05); however, a significant difference was observed in LFI values between S0 and S1, S2, S3, or S4 (t=2.32, 3.92, 6.35, 11.58), between S1 and S0, S2, S3, or S4 (t=2.32, 1.59, 4.15, 9.44), between S2 and S0, S1, S3, or S4 (t=3.92, 1.59, -3.31, -9.86), between S3 and S0, S1, S2, or S4 (t=6.35, 4.15, 3.31, 6.28), and between S4 and S0, S1, S2, or S4 (t=11.58, 9.44, 9.86, 6.28) (P<0.05 for all). A significant difference was also observed in Lt-Kt values between S0 and S1, S2, S3, or S4 (t=-1.81, -4.51, -5.98, -9.58), between S1 and S0, S2, S3, or S4 (t=1.81, -2.37, -3.94, -7.60), between S2 and S0, S1, S3, or S4 (t=4.51, 2.37, -2.12, -6.69), between S3 and S0, S1, S2, or S4 (t=5.98, 3.94, 2.12, -4.37), and between S4 and S0, S1, S3, or S4 (t=9.58, 7.60, 6.69, 4.37) (P<0.05 for all). The areas under the ROCs (AUROCs) of LFI for S1-S4 were 0.953, 0.924, 0.916, and 0.983, respectively, and the AUROCs of Lt-Kt for S1-S4 were 0.979, 0.967, 0.902, and 0.949, respectively. The AUROCs of LFI combined with Lt-Kt for S1-S4 were 0.988, 0.974, 0.918, and 0.966, respectively. Conclusion RTE and CEUS have important value in the diagnosis of hepatic fibrosis in chronic hepatitis B. CEUS is superior to RTE in the diagnosis of early fibrosis (S1-S2), while RTE has advantages over CEUS in the detection of middle and late fibrosis (S3-S4). The combination of the two modality can improve the accuracy of diagnosis of liver fibrosis (S1-S3). Key words: Hepatitis B, chronic; Liver cirrhosis; Elasticity imaging techniques