Korean J Radiol.  2016 Jun;17(3):396-404. 10.3348/kjr.2016.17.3.396.

Liver Shear-Wave Velocity and Serum Fibrosis Markers to Diagnose Hepatic Fibrosis in Patients with Chronic Viral Hepatitis B

• Liu J
• Ji Y
• Ai H
• Ning B
• Zhao J
• Zhang Y
• Dun G

• KMID: 2451413
• DOI: http://doi.org/10.3348/kjr.2016.17.3.396

Abstract

OBJECTIVE
To compare several noninvasive indices of fibrosis in chronic viral hepatitis B, including liver shear-wave velocity (SWV), hyaluronic acid (HA), collagen type IV (CIV), procollagen type III (PCIII), and laminin (LN).
MATERIALS AND METHODS
Acoustic radiation force impulse (ARFI) was performed in 157 patients with chronic viral hepatitis B and in 30 healthy volunteers to measure hepatic SWV (m/s) in a prospective study. Serum markers were acquired on the morning of the same day of the ARFI evaluation. Receiver operating characteristic (ROC) analysis was performed to evaluate and compare the accuracies of SWV and serum markers using METAVIR scoring from liver biopsy as a reference standard.
RESULTS
The most accurate test for diagnosing fibrosis F ≥ 1 was SWV with the area under the ROC curve (AUC) of 0.913, followed by LN (0.744), HA (0.701), CIV (0.690), and PCIII (0.524). The best test for diagnosing F ≥ 2 was SWV (AUC of 0.851), followed by CIV (0.671), HA (0.668), LN (0.562), and PCIII (0.550). The best test for diagnosing F ≥ 3 was SWV (0.854), followed by CIV (0.693), HA (0.675), PCIII (0.591), and LN (0.548). The best test for diagnosing F = 4 was SWV (0.965), followed by CIV (0.804), PCIII (0.752), HA (0.744), and LN (0.662). SWV combined with HA and CIV did not improve diagnostic accuracy (AUC = 0.931 for F ≥ 1, 0.863 for F ≥ 2, 0.855 for F ≥ 3, 0.960 for F = 4).
CONCLUSION
The performance of SWV in diagnosing liver fibrosis is superior to that of serum markers. However, the combination of SWV, HA, and CIV does not increase the accuracy of diagnosing liver fibrosis and cirrhosis.

Keyword

Liver fibrosis; ARFI imaging; Chronic hepatitis B; Serum markers

MeSH Terms

Adult
Area Under Curve
Biomarkers/*blood
Case-Control Studies
Collagen Type III/blood
Collagen Type IV/blood
Elasticity Imaging Techniques
Female
Hepatitis B, Chronic/complications/*diagnosis/pathology
Humans
Hyaluronic Acid/blood
Laminin/blood
Liver/diagnostic imaging/pathology/*physiology
Liver Cirrhosis/complications/*diagnosis/pathology
Male
Middle Aged
Prospective Studies
Pulse Wave Analysis
ROC Curve
Severity of Illness Index
Young Adult
Biological Markers
Collagen Type III
Collagen Type IV
Laminin

Figure

• 

  Fig. 1 Acoustic radiation force impulse, ARFI (A) and liver biopsy (B) were performed in same tissue area (segment eight of right lobe). ARFI = acoustic radiation force impulse

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  Fig. 2 Box plots show correlation between shear-wave velocity (SWV) and histologic results from liver biopsy.

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  Fig. 3 Receiver operating characteristic (ROC) curves show performances in diagnosis of liver fibrosis F ≥ 1 by acoustic radiation force impulse, hyaluronic acid (HA), collagen type IV (CIV), procollagen type III (PCIII), laminin (LN), and combination testing. SWV = shear-wave velocity

• 

  Fig. 4 Receiver operating characteristic (ROC) curves show performances in diagnosis of liver fibrosis F ≥ 2 by acoustic radiation force impulse, hyaluronic acid (HA), collagen type IV (CIV), procollagen type III (PCIII), laminin (LN), and combination testing. SWV = shear-wave velocity

• 

  Fig. 5 Receiver operating characteristic (ROC) curves show performances in diagnosis of liver fibrosis F ≥ 3 by acoustic radiation force impulse, hyaluronic acid (HA), collagen type IV (CIV), procollagen type III (PCIII), laminin (LN), and combination testing. SWV = shear-wave velocity

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  Fig. 6 Receiver operating characteristic (ROC) curves show performances in diagnosis of liver fibrosis F = 4 by acoustic radiation force impulse, hyaluronic acid (HA), collagen type IV (CIV), procollagen type III (PCIII), laminin (LN), and combination testing. SWV = shear-wave velocity

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