Real-time Tissue Elastography for Evaluation of Liver Fibrosis in Patients with Type B Chronic Hepatitis_West China Medical Journal

Authors：

 CHENYang ,  LUOYan

Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LUOYan, Email: luoyan15957@126.com

Keywords：

Ultrasonic testing; Real-time tissue elastography; Chronic hepatitis; Liver fibrosis

DOI：

10.7507/1002-0179.20150476

Video：

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Objective To explore the significance of quantitative parameters of tissue diffusion included in the real-time ultrasound elastography (RTE), in diagnosing the degree of liver fibrosis. Method From July 2012 to November 2014, liver biopsy being the gold standard for evaluating hepatic fibrosis stage, we performed RTE on 112 hepatitis patients and analyzed the elastogram we got. At the same time, we carried out quantitative analysis of tissue diffusion in these patients, and obtained the values of liver fibrosis index (LFI) of right liver parenchyma. Subsequently, we compared the biopsy pathological results with the values of LFI, and single-factor analysis of variance (ANOVA) was adopted to compare the LFI among patients with variant degrees of liver fibrosis. If there were any discrepancies, least significant difference method would be adopted in order to compare one with the other from different groups. Finally, critical value of LFI of different-stage liver fibrosis was obtained with the help of receiver operator characteristic (ROC)curve. Results Chronological liver fibrosis was classified into stage 0, stage 1, stage 2, stage 3, and stage 4, and their LFI values were 2.36±0.46, 2.38±0.45, 2.84±0.54, 3.16±0.59, and 3.69±0.55, respectively. ANOVA showed that the LFI values of different-stage fibrosis had significant differences (F=29.959, P<0.001). However, there was no difference between stage 0 and stage 1 (P=0.920), or between stage 2 and stage 3 (P=0.076). The area under the ROC curve for stage 0-1 and stage 2-3, stage 2-3 and S4 was respectively 0.784 and 0.799, and their critical value was 2.83 and 3.69 respectively. Conclusions The real-time ultrasound elastography is a feasible and non-invasive method in diagnosing the degree of hepatitis fibrosis and LFI has advantage in distinguishing different stage of liver fibrosis.

Citation： CHENYang, LUOYan. Real-time Tissue Elastography for Evaluation of Liver Fibrosis in Patients with Type B Chronic Hepatitis. West China Medical Journal, 2015, 30(9): 1671-1674. doi: 10.7507/1002-0179.20150476 Copy

1.	Kanamoto M, Shimada M, Ikegami T, et al. Real time elastography for noninvasive diagnosis of liver fibrosis[J]. J Hepatobiliary Pancreat Surg, 2009, 16(4):463-467.
2.	Scheuer PJ. Classification of chronic viral hepatitis:a need for reassessment[J]. Hepatol, 1991, 13(3):372-374.
3.	Scheuer PJ. The nomenclature of chronic hepatitis:time for a change[J]. J Hepatol, 1995, 22(1):112-114.
4.	中華醫學會傳染病與寄生蟲病學分會, 中華醫學會肝病學分會. 病毒性肝炎防治方案[J]. 中華內科雜志, 2001, 40(1):62-70.
5.	Koizumi Y, Hirooka M, Kisaka Y, et al. Liver fibrosis in patients with chronic hepatitis C:noninvasive diagnosis by means of real-time tissue elastography——establishment of the method for measurement[J]. Radiology, 2011, 258(2):610-617.
6.	Gheorghe L, Iacob S, Gheorghe C. Real-time sonoelastography:a new application in the field of liver disease[J]. J Gastrointestin Liver Dis, 2008, 17(4):469-474.
7.	李銀燕, 王學梅, 張義俠, 等. 超聲彈性成像評分在脂肪肝分度中的應用價值[J]. 中國臨床醫學影像雜志, 2009, 20(12):911-913.
8.	曾婕, 鄭榮琴, 蘇中振, 等. 彈性成像定量分析評價肝臟硬度的初步研究[J]. 中華醫學超聲雜志:電子版, 2011, 8(9):1958-1963.
9.	Wang J, Guo L, Shi X, et al. Real-time elastography with a novel quantitative technology for assessment of liver fibrosis in chronic hepatitis B[J]. Eur J Radiol, 2012, 81(1):e31-e36.
10.	Tatsumi C, Kudo M, Ueshima K, et al. Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan) and real-time tissue elastography[J]. Intervirology, 2008, 51(Suppl 1):27-33.
11.	Yada N, Kudo M, Morikawa H, et al. Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis[J]. Oncology, 2013, 84(Suppl 1):13-20.
12.	Kobayashi K, Nakao H, Nishiyama T, et al. Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis:a meta-analysis[J]. Eur Radiol, 2015, 25(1):230-238.
13.	Yada N, Kudo M, Kawada N, et al. Noninvasive diagnosis of liver fibrosis:utility of data mining of both ultrasound elastography and serological findings to construct a decision tree[J]. Oncology, 2014, 87(Suppl 1):63-72.
14.	Sturm N, Marlu A, Arvers P, et al. Comparative assessment of liver fibrosis by computerized morphometry in na?ve patients with chronic hepatitis B and C[J]. Liver Int, 2013, 33(3):428-438.
15.	Gaia S, Carenzi S, Barilli AL, et al. Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis[J]. J Hepatol, 2011, 54(1):64-71.

1. Kanamoto M, Shimada M, Ikegami T, et al. Real time elastography for noninvasive diagnosis of liver fibrosis[J]. J Hepatobiliary Pancreat Surg, 2009, 16(4):463-467.
2. Scheuer PJ. Classification of chronic viral hepatitis:a need for reassessment[J]. Hepatol, 1991, 13(3):372-374.
3. Scheuer PJ. The nomenclature of chronic hepatitis:time for a change[J]. J Hepatol, 1995, 22(1):112-114.
4. 中華醫學會傳染病與寄生蟲病學分會, 中華醫學會肝病學分會. 病毒性肝炎防治方案[J]. 中華內科雜志, 2001, 40(1):62-70.
5. Koizumi Y, Hirooka M, Kisaka Y, et al. Liver fibrosis in patients with chronic hepatitis C:noninvasive diagnosis by means of real-time tissue elastography——establishment of the method for measurement[J]. Radiology, 2011, 258(2):610-617.
6. Gheorghe L, Iacob S, Gheorghe C. Real-time sonoelastography:a new application in the field of liver disease[J]. J Gastrointestin Liver Dis, 2008, 17(4):469-474.
7. 李銀燕, 王學梅, 張義俠, 等. 超聲彈性成像評分在脂肪肝分度中的應用價值[J]. 中國臨床醫學影像雜志, 2009, 20(12):911-913.
8. 曾婕, 鄭榮琴, 蘇中振, 等. 彈性成像定量分析評價肝臟硬度的初步研究[J]. 中華醫學超聲雜志:電子版, 2011, 8(9):1958-1963.
9. Wang J, Guo L, Shi X, et al. Real-time elastography with a novel quantitative technology for assessment of liver fibrosis in chronic hepatitis B[J]. Eur J Radiol, 2012, 81(1):e31-e36.
10. Tatsumi C, Kudo M, Ueshima K, et al. Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan) and real-time tissue elastography[J]. Intervirology, 2008, 51(Suppl 1):27-33.
11. Yada N, Kudo M, Morikawa H, et al. Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis[J]. Oncology, 2013, 84(Suppl 1):13-20.
12. Kobayashi K, Nakao H, Nishiyama T, et al. Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis:a meta-analysis[J]. Eur Radiol, 2015, 25(1):230-238.
13. Yada N, Kudo M, Kawada N, et al. Noninvasive diagnosis of liver fibrosis:utility of data mining of both ultrasound elastography and serological findings to construct a decision tree[J]. Oncology, 2014, 87(Suppl 1):63-72.
14. Sturm N, Marlu A, Arvers P, et al. Comparative assessment of liver fibrosis by computerized morphometry in na?ve patients with chronic hepatitis B and C[J]. Liver Int, 2013, 33(3):428-438.
15. Gaia S, Carenzi S, Barilli AL, et al. Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis[J]. J Hepatol, 2011, 54(1):64-71.

West China Medical Journal

Real-time Tissue Elastography for Evaluation of Liver Fibrosis in Patients with Type B Chronic Hepatitis

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