Evaluation Of Hepatic Fibrosis In Patients With Chronic Hepatitis B: Utilizing Contrast-enhanced Ultrasonography And Ultrasonic Elastography

ObjectiveTo explore the application value of the hepatic artery to vein transit time (HAVTT) measured by contrast-enhanced ultrasonography and liver shear wave velocity (SWV) measured by acoustic radiation force impulse (ARFI) technology in hepatic fibrosis caused by chronic hepatitis B.MethodsA bolus injection of0.6ml SonoVue was performed on patients with chronic hepatitis B(n=169) and normal volunteers(n=22),and HAVTT by directly visualization method and the time intensity curve(TIC) method were measured. The measurement of liver SWV in left lateral decubitus were performed on patients with chronic hepatitis B (n=210) and normal volunteers (n=20) and the position were as liver biopsy as possible.83patients with chronic hepatitis B and5normal volunteers were accepted two motheds. All patients with chronic hepatitis B were accepted liver biopsy under ultrasound-guided.P<0.05was considered statistically significant.Results1. There were no significant differences in HAVTT values between directly visualization method and TIC method. However, success ratio was more high by directly visualization method because of fewer impact factors.2. HAVTT values in those cases with chronic hepatitis B tended to decrease with the degree of hepatic fibrosis going up. The HAVTT values between S2and S3degree were statistically significant(P<0.01), but there exsited no obvious difference between any other neighboring groups. The HAVTT values were remarkably different among the three groups (the non-fibrosis group, the fibrosis group and the cirrhosis group, P<0.05).Taking HAVTT1≤8s,HAVTT2≤10s as diagnostic criteria of cirrhosis, the sensitivity, specificity and accuracy were83.7%, 73.3%,87.2%and81.6%,76.8%,87.6%respectively. Taking HAVTT1≥11s, HAVTT2>13s as diagnostic criteria of none-fibrosis, the index were83.3%,82.6%,88.3%and84.4%,80.0%,89.6%respectively. Taking HAVTT1:(8.1～10.9) s、 HAVTT2:(10.1～12.9) s as diagnostic criteria of fibrosis, the index were91.9%,70.0%,85.0%and88.9%,80.8%,89.1%respectively.3. SWV values in the cases with chronic hepatitis B increased gradually with the growing degree of hepatic fibrosis. SWV values among each fibrosis groups were remarkably different (P=0.000).Using the cutoff values of1.43m/s,1.78m/s,2.15m/s and2.45m/s for diagnosis of≥S1,≥S2,≥S3and=S4, the corresponding areas under receiver operating characteristic curves(AUROC) were0.826,0.829,0.845and0.880respectively. The sensitivity was85.3%,90.6%,87.1%and89.1%; the specificity was87.5%,90.1%,82.8%and87.4%; the accuracy was89.4%,84.6%,88.1%and83.2%respectively.4. Undertaking Spearman double variables correlated analysis between the SWV values and the parameters of fibrosis grade, inflammation grade and steatosis grade, the analyses shown were statistically significant between SWV value and fibrosis grade, SWV value and inflammation grade. The correlation coefficient were0.713(P=0.000) and0.496(P=0.001),but there was no obvious correlation between SWV value and steatosis grade in our study, the correlation coefficient was0.145(P=3.368).It presented the maximum positive correlation between SWV values and fibrosis grade. Multiple linear regression showed that it had correlation relationship between SWV values and fibrosis grade (P=0.000),the standard regression coefficient was0.664,but there was no obvious correlation relationship between SWV values and inflammation grade, SWV values and steatosis grade (P>0.05)5.HAVTT and SWV value obtained in the third part were in concordance with the value acquired in the first and the second part(P>0.05).Taking SWV, HAVTT1, HAVTT2values obtained in the first and the second part to judge the cases in the third part, the accuracy was89.2%,72.3%and77.1%respectively. Taking paired chi-square test to analyze the diagnosis rate between SWV and HAVTT1, HAVTT2 value, showing that there exsited obvious difference between them (P value was0.007and0.041).Conclusions1. It is reliable to apply contrast-enhanced ultrasonography and ultrasonic elastography to the evaluation of hepatic fibrosis degree with stable measured value and high repetitiveness.2. HAVTT detected by real time gray scale CEUS with SonoVue can reflect the changes of hepatic microcirculation, with its values helpful to differentiate normal liver,hepatic fibrosis and hepatic cirrhosis, and to classify S2and S3stage of hepatic fibrosis.3. Shear Wave Velocity measurement can directly reflect the elasticity modulus of liver, and the value can reflect the difference of hardness among every S stage. It can also identify hepatic fibrosis degree in a more effective, convenient and non-invasive way compared the applying of contrast-enhanced ultrasonography. SWV measurement can be recommended as a new and to judge hepatic fibrosis degree.