Performance of real-time strain elastography, transient elastography, and aspartate-to-platelet ratio index in the assessment of fibrosis in chronic hepatitis C.
OBJECTIVE
The purpose of this article is to evaluate the diagnostic performance of transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index in assessing fibrosis in patients with chronic hepatitis C by using histologic Metavir scores as reference standard.


METHODS
Consecutive patients with chronic hepatitis C scheduled for liver biopsy were enrolled. Liver biopsy was performed on the same day as transient elastography and real-time strain elastography. Transient elastography and real-time strain elastography were performed in the same patient encounter by a single investigator using a medical device based on elastometry and an ultrasound machine, respectively. Diagnostic performance was assessed by using receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) analysis.


RESULTS
One hundred thirty patients (91 men and 39 women) were analyzed. The cutoff values for transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index were 6.9 kPa, 1.82, and 0.37, respectively, for fibrosis score of 2 or higher; 7.3 kPa, 1.86, and 0.70, respectively, for fibrosis score of 3 or higher; and 9.3 kPa, 2.33, and 0.70, respectively, for fibrosis score of 4. AUC values of transient elastography, real-time strain elastography, aspartate-to-platelet ratio index were 0.88, 0.74, and 0.86, respectively, for fibrosis score of 2 or higher; 0.95, 0.80, and 0.89, respectively, for fibrosis score of 3 or higher; and 0.97, 0.80, and 0.84, respectively, for fibrosis score of 4. A combination of the three methods, when two of three were in agreement, showed AUC curves of 0.93, 0.95, and 0.95 for fibrosis scores of 2 or higher, 3 or higher, and 4, respectively.


CONCLUSIONS
Transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index values were correlated with histologic stages of fibrosis. Transient elastography offered excellent diagnostic performance in assessing severe fibrosis and cirrhosis. Real-time elastography does not yet have the potential to substitute for transient elastography in the assessment of liver fibrosis.
Ultrasound Unit, Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Via Taramelli 5, Pavia 27100, Italy. giovanna.ferraioli@unipv.it
Giovanna
G
Ferraioli
Carmine
C
Tinelli
Antonello
A
Malfitano
Barbara
B
Dal Bello
Gaetano
G
Filice
Carlo
C
Filice
Elisabetta
E
Above
Giorgio
G
Barbarini
Enrico
E
Brunetti
Willy
W
Calderon
Marta
M
Di Gregorio
Raffaella
R
Lissandrin
Serena
S
Ludovisi
Laura
L
Maiocchi
Giuseppe
G
Michelone
Mario
M
Mondelli
Savino F A
SF
Patruno
Alessandro
A
Perretti
Gianluigi
G
Poma
Paolo
P
Sacchi
Marco
M
Zaramella
Mabel
M
Zicchetti
D000328:Adult; D019540:Area Under Curve; D001224:Aspartic Acid / Q000097:blood*; D001706:Biopsy; D001792:Blood Platelets / Q000378:metabolism; D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood* / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
D001224:Aspartic Acid