| Objective: 1. To compare the clinical utility of acoustic radiation force impulse(ARFI) and real-time tissue elastography(RTE) for staging liver fibrosis in patients with chronic hepatitis B. 2. To investigate the feasibility of ARFI and RTE for evaluation of free portal pressure. 3. To compare the clinical utility of ARFI and contrast-enhanced ultrasonography(CEUS) for assessment of esophageal varices(EV) in HBV-related cirrhosis. 4. To investigate the influence of food intake and different area of the region of interest(ROI) on the measurements of RTE.Methods: 1. In total, 69 cases of chronic hepatitis B patients were included. For each of the patients, ARFI and RTE were performed on the same day. Within the following week, hepatectomy and biopsy were performed on 38 cases and 31 cases of patients, respectively. Hepatic tissues were obtained from all the cases and evaluated for histological features. The diagnostic accuracies of ARFI and RTE for staging liver fibrosis were compared. 2. A total of 38 chronic hepatitis B patients who scheduled hepatectomy underwent both of ARFI and RTE. Free portal pressure(FPP) was measured as hepatectomy was conducted. The correlationships between mentioned techniques and FPP were explored. 3. Patients with HBV-related cirrhosis who had undergone endoscopy were prospectively recruited. Hepatic dynamic CEUS and ARFI were performed. The diagnostic accuracies of ARFI and hepatic dynamic CEUS features for assessing EV were analyzed. 4. A toal of 112 healthy volunteers were prospectively recruited: 72 subjects in the study group and 40 subjects in the control group. The study group received a standard meal after the fasting RTE measurements, and the RTE measurements repeated between 30 and 40 minutes after food intake. In the control group, RTE measurements were performed 2 times during a 30-40 minutes interval without food intake. All the measurements performed with a ROI of 28mm×26mm and repeated with a ROI of 13mm×10mm. The results of RTE were shown as Liver fibrosis index(LF index). The statistic analyses were done.Results: 1. According to the results of receiver operating characteristic curves(ROC), the area under the ROCs(AUC) of ARFI for evaluation of liver fibrosis stage F≥1, F≥2, F≥3 and F=4 were 0.906, 0.895, 0.947, 0.947, respectively. Sensitivities were 80.3%, 75.0%, 82.4%, 90.0%, respectively. Specificities were 100%, 86.2%, 90.4% and 94.9%, respectively. AUC of RTE for assessment of liver fibrosis stage F≥1, F≥2, F≥3 and F=4 were 0.876, 0.760, 0.831 and 0.828, respectively. Sensitivities were 83.6%, 80.0%, 88.2%, 70.0%, respectively. Specificities were 87.5%, 62.1%, 65.4% and 88.1%, respectively. In the pairwise comparison of AUCs between ARFI and RTE, the AUCs of ARFI for staging of F≥2 and F≥3 were significant larger than those of RTE. It was indicated that the diagnostic performance of ARFI for assessing liver fibrosis stage F≥2 and F≥3 was better than RTE(P<0.05). 2. The shear wave velocity(SWV) measured with ARFI was correlated with FPP(r=0.665, P<0.001). The LF index measured with RTE was correlated with FPP(r=0.570, P<0.001). The correlations between ARFI and FPP was compared with the correlations between RTE and FPP by Z statistics test, and no significant difference was found(Z=0.645, P=0.519). 3. The interval between hepatic artery arrive time and hepatic vein arrive time(HV-HA) was one of the hepatic dynamic CEUS features which was better than other features for assessing EV and high-risk EV(HEV). For predicting EV and HEV, its AUCs were 0.883 and 0.915, respectively. Sensitivities were 85.0% and 82.1%. Specificities were 77.8% and 90.0%, respectively. The AUCs of ARFI for predicting the EV and HEV were 0.770 and 0.819, respectively. Sensitivity were 72.5% and 57.14%. Specificities were 72.2% and 96.67%, respectively. In the pairwise comparison of AUCs between ARFI and HV-HA, the difference of AUCs was not significant. 4. When using both of the two sizes of ROI for the RTE measurements, LF index increased after food intake in study group(both P<0.05), while no statistical difference of LF index was found between twice measurements in control group(both P>0.05). LF index obtained before and after food intake in study group as well as twice measurement results in control group using lager ROI for RTE were higher than those using smaller ROI for RTE(all P<0.001).Conclusion: 1. Both ARFI and RTE were useful for staging liver fibrosis. The diagnostic performance of ARFI for assessing moderate fibrosis(F≥2) and severe fibrosis(F≥3) were better than RTE. 2. Both ARFI and RTE could be used to indirectly predict the portal venous pressure by detect the liver stiffness. 3. The interval between hepatic artery arrive time and hepatic vein arrive time(HV-HA) was the best feature of hepatic dynamic CEUS for predicting EV. There was no statistical difference between HV-HA and ARFI for predicting EV. Both CEUS and ARFI could be used to predict EV. 4. Both of food intake and the size of ROI could influence the results of RTE. LF index was higher when selecting lager ROI or after food intake. |
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