Analysis of three ultrasound elastography techniques for grading liver fibrosis in patients with chronic hepatitis B

Background: Evaluation of liver fibrosis is important to assess prognosis and guide the treatment for chronic hepatitis B.

Objective: To analyze and compare transient, point, and two-dimensional (2D) shear wave elastography techniques in grading the liver fibrosis.

Methods: Based on the severity of liver inflammation and fibrosis (Scheuer criteria), 158 patients with chronic hepatitis B were assigned into group 1 (either G or S classification < 2) or group 2 (either G or S classification ≥ 2). Group 2 patients commonly require anti-viral treatment. All patients received transient (FibroScan), point (STQ), and 2D (STE) elastography examinations. Receiver operating characteristic curves were calculated from three elastography techniques in individual or in combination.

Results: A total of 158 patients were enrolled into the study, with 39.2% (62) female and mean age of 42.8 (standard deviation 19.1) years old. Transient elastography could not differentiate between group 1 and group 2 patients (P = 0.12), whereas point and 2D elastography examinations could distinguish patients in group 1 from group 2 (P < 0.01 for both STQ and STE). Administration of combined three elastography techniques showed the best diagnostic accuracy (90.1%) for liver fibrosis, which was confirmed with hepatic biopsy examination.

Conclusion: Point and 2D elastography were superior to transient elastography to detect liver fibrosis and guide clinical anti-viral treatment. Analysis of combined transient, point, and 2D elastography techniques showed the better diagnostic accuracy for liver fibrosis.