Comparison Of Imaging And Serology Non-invasive Assessment To Diagnose Liver Fibrosis In Chronic Hepatitis B

Objective：To assess the diagnostic value of5non-invasive methods for liverfibrosis in chronic hepatitis B(CHB) by comparing the correlation among the imagingexamination methods acoustic radiation force impulse (ARFI) and transientultrasound elastography (FibroScan), serological diagnosis model (Forns index,FIB-4, APRI) and liver fibrosis pathological grading in CHB.Methods：161CHB patients were enrolled in this study and were dividedinto four groups according to the result of liver biopsy: no significant liver fibrosisgroup（S0,S1）, significantly fibrosis group（≥S2）, advanced fibrosis group（≥S3）and early cirrhosis group（S4）, examined the liver imaging by FibroScan and ARFI,measured the portal vein’s diameter and spleen size by B-ultrasound, gauged theserum total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase(ALT),aspartate aminotransferase(AST), alkaline phosphatase (ALP), gamma glutamyltransferase (GGT), albumin (ALB), globulin (GLO) and total cholesterol (CHOL)using the fully automatic biochemical analyzer, detected the liver fibrosis four（hyaluronic acid, procollagen tpye III, collage type IV, Laminin） bychemiluminescence method. All patients were calculated the Forns index, FIB-4andAPRI by the serology results. The correlation of5non-invasive diagnosis methodsand liver pathology classification were evaluated and the diagnostic value of5non-invasive diagnosis models to the liver fibrosis was assessed by thereceiver-operating characteristic curve.Results：1. The average length of liver biopsy specimens was16.0mm, liver fibrosisstage: S0, n=16(10%), S1, n=36(22.4%), S2, n=23(14.2%), S3, n=36(22.4%), S4,n=50(31%).2. Main portal vein(PV) diameter was significantly lager in no apparent liver fibrosis group than that in apparent liver fibrosis group, advanced liver fibrosis groupand early cirrhosis group (P<0.0001, respectively). The spleen size was thicker in noapparent liver fibrosis group than that in apparent liver fibrosis group, advanced liverfibrosis group and early cirrhosis group(P<0.0001, respectively).3. It showed that ARFI, FibroScan, Forns index, FIB-4, APRI had a goodcorrelation with liver biopsy (P<0.0001, respectively), and ARFI, FibroScan had thehighest correlation index which were all above0.8.4. The diagnostic performance of FibroScan(AUC=0.922), ARFI(AUC=0.916)and Forns index(AUC=0.868) were the best in apparent liver fibrosis group, followedby FIB-4(AUC=0.814) and APRI(AUC=0.757). There was no significant differenceabout the diagnostic performance among FibroScan(AUC=0.922), ARFI(AUC=0.916)and Forns index(AUC=0.868)(P>0.05, respectively).5. Compared with ARFI(AUC=0.942),the diagnostic performance of FibroScan（AUC=0.980）had no much difference in advanced liver fibrosis group, and thenfollowed by Forns index(AUC=0.856) and FIB-4(AUC=0.828), APRI (AUC=0.772).6. In early cirrhosis group, there were no much difference between FibroScan(AUC=0.947) and ARFI(AUC=0.974), and they were all superior to Fornsindex(AUC=0.828), FIB-4(AUC=0.813), APRI(AUC=0.802), which had diagnosticperformance was no significant difference.Conclusions：1.ARFI and FibroScan can be performed with better diagnostic accuracy in eachstage of liver fibrosis grading than serological diagnosis model.2.Forns index was the best one in the three serological diagnosis model（Fornsindex, FIB-4and APRI） for assessment of liver fibrosis.