Comparison of real-time shear wave elastography with various noninvasive serum markers for assessing liver fibrosis in chronic viral hepatitis

Abstract

Aims: To investigate the diagnostic accuracy of liver fibrosis using liver stiffness measurement (LSM) by real-time shear wave elastography (SWE) in patients with chronic viral hepatitis and to compare the diagnostic performance of SWE with serum liver fibrosis markers.

Methods: We consecutively analyzed 92 patients with chronic viral hepatitis (45 with hepatitis B, 46 with hepatitis C and 1 with hepatitis B+C). Liver fibrosis was staged from F0 to F4 according to the Batts and Ludwig scoring system. The accuracy of prediction for liver fibrosis for SWE, hyaluronic acid (HA), type 4 collagen, AST to Platelet Ratio Index (APRI), FIB-4, Forns index and red cell volume distribution width-to-platelet ratio (RPR) was analyzed using receiver operator curve (ROC) analysis.

Results: There were 10, 30, 20, and 32 patients at stages F0-1, F2, F3, and F4, respectively. The overall diagnostic accuracies of LSM and serum markers, as determined by the area under ROC, were LSM=0.909, APRI=0.810, FIB-4=0.768, type IV collagen=0.763, Forns index=0.750, RPR 0.717 and HA=0.712 and for predicting significant fibrosis (≥F2); LSM=0.861, type IV collagen=0.804, HA=0.801, RPR=0.770, Forns index=0.768, FIB-4=0.767, and APRI=0.728 for predicting advanced fibrosis (≥F3); and LSM=0.860, Forns index= 0.822, HA=0.817, FIB-4=0.816, RPR=0.799, type IV collagen= 0.783, and APRI=0.723 for predicting cirrhosis (=F4). LSM was superior to HA (P=0.029) and Forns index (P=0.049) for predicting significant fibrosis, and to APRI for predicting advanced fibrosis (P=0.011) and cirrhosis (P=0.011).

Conclusions: SWE was the most accurate method to predict the degree of liver fibrosis in patients with chronic viral hepatitis. Also, the majority of six liver fibrosis markers were comparable to SWE to assess liver fibrosis.