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. 2019 Jan 23:2019:3951574.
doi: 10.1155/2019/3951574. eCollection 2019.

Transient Elastography and Ultrasonography: Optimal Evaluation of Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease

Geng-Lin Zhang  1   2 , Qi-Yi Zhao  1   2 , Chao-Shuang Lin  1   2 , Zhao-Xia Hu  1   2 , Ting Zhang  3 , Zhi-Liang Gao  1   2   4
Affiliations

Transient Elastography and Ultrasonography: Optimal Evaluation of Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease

Geng-Lin Zhang et al. Biomed Res Int. .

Abstract

Background and aims: Concordance between transient elastography (TE) and ultrasonography (US) in assessing liver fibrosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD) has been rarely studied. This study aimed to evaluate the individual and combined performances of TE and US in assessing liver fibrosis and cirrhosis.

Patients and methods: Consecutive CHB patients with NAFLD were prospectively enrolled. TE and US examinations were performed, with liver biopsy as a reference standard. Receiver operating characteristic (ROC) curves were obtained to evaluate the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared using DeLong's test.

Results: TE and US scores correlated significantly with the histological fibrosis staging scores. TE was significantly superior to US in the diagnosis of significant fibrosis (AUC, 0.84 vs 0.73; P=0.02), advanced fibrosis (AUC, 0.95 vs 0.76; P<0.001), and cirrhosis (AUC, 0.96 vs 0.71; P<0.001). Combining TE with US did not increase the accuracy of detecting significant fibrosis, advanced cirrhosis, or cirrhosis (P=0.62, P=0.69, and P=0.38, respectively) compared to TE alone. However, TE combined with US significantly increased the positive predictive value for significant fibrosis when compared to TE alone. The optimal cut-off values of TE for predicting advanced fibrosis and cirrhosis were 8.7 kPa and 10.9 kPa, with negative predictive values of 92.4% and 98.7%, respectively.

Conclusions: TE is useful for predicting hepatic fibrosis and excluding cirrhosis in CHB patients with NAFLD. A combination of TE and US does not improve the accuracy in assessing liver fibrosis or cirrhosis.

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Figures

Figure 1
Figure 1
B-mode images of conventional ultrasonography (US) scoring system. (a) Smooth liver surface, score of 1. (b) Uneven liver surface, score of 2. (c) Irregular nodular liver surface, score of 3. (d) Homogeneous parenchyma, score of 1; and smooth hepatic vein vessel wall, score of 1. (e) Heterogeneous liver parenchyma with fine scattered hyperechoic or hypoechoic areas, score of 2. Obscured or slightly irregular hepatic vein vessel wall, score of 2. (f) Coarse liver parenchyma with an irregular pattern, score of 3.
Figure 2
Figure 2
Selection and deposition of patients.
Figure 3
Figure 3
Box and whisker plots of TE and US scores at each fibrosis stage. The central box represents values from lower to upper quartile (25th -75th percentile). The line through each box represents the median. The mean liver stiffness measured with TE increased significantly from F2 to F4 (F2 vs F3, P<0.001; F3 vs F4, P=0.002). ∗∗, P <0.01. ∗∗∗, P <0.001.
Figure 4
Figure 4
ROC curves of TE, US, and TE combined with US for significant fibrosis assessment (a), advanced fibrosis assessment (b), and cirrhosis assessment (c) in CHB patients concurrent with nonalcoholic fatty liver disease.
See this image and copyright information in PMC

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