title: Effects of patient factors on noninvasive liver stiffness measurement using acoustic radiation force impulse elastography in patients with chronic hepatitis C.
abstract: BACKGROUND
  Previous research has shown variation in the effects of patient factors, including hepatic necroinflammatory activity, on liver stiffness measurement (LSM). This prospective study attempts to identify explanatory factors for LSM in patients with chronic hepatitis C (CHC) using acoustic radiation force impulse (ARFI) technology.
  
  
  METHODS
  A cohort of 127 Taiwanese patients with CHC underwent ARFI LSM and immediate percutaneous liver biopsy. This study compares the concurrent diagnostic performances of LSM and FibroTest using receiver operating characteristic (ROC) curves. Three multiple linear regression models were used to evaluate the significance of concurrent patient factors in explaining LSM.
  
  
  RESULTS
  To classify METAVIR fibrosis (F) stages, the areas under ROC curves (AUCs) were ARFI LSM, 0.847 (95% confidence interval (CI), 0.779-0.914) and FibroTest, 0.823 (95% CI, 0.748-0.898), for F1 versus F2-4; ARFI LSM, 0.902 (95% CI, 0.835-0.970) and FibroTest, 0.812 (95% CI, 0.735-0.888), for F1-2 versus F3-4; ARFI LSM, 0.831 (95% CI, 0.723-0.939) and FibroTest, 0.757 (95% CI, 0.648-0.865), for F1-3 versus F4. After adjusting for other demographic and biological covariates, biochemical and histological necroinflammatory factors consistently explained LSM. Factors included serum alanine aminotransferase (ALT)/upper limit of normal (ULN) categories (model R(2) = 0.661, adjusted R(2) = 0.629), ActiTest A scores (R(2) = 0.662, adjusted R(2) = 0.636), and METAVIR activity (A) grades (R(2) = 0.651, adjusted R(2) = 0.620). METAVIR F stages, body mass index, and platelet count were also independently associated with LSM. Necroinflammatory degrees, including ALT/ULN, ActiTest A scores, and METAVIR A grades, explained the false positivity of liver fibrosis staging using ARFI LSM.
  
  
  CONCLUSIONS
  The degree of hepatic necroinflammatory activity independently and significantly exaggerated liver fibrosis evaluation using ARFI LSM. However, comparisons with concurrent FibroTest indicate that ARFI LSM may be a promising alternative, or adjunctive single indicator, for liver fibrosis evaluation in patients with CHC.
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, No 2 Yuh-Der Road, Taichung 40402, Taiwan.
authors.forename: Sheng-Hung
authors.initials: SH
authors.lastname: Chen
authors.forename: Yu-Fen
authors.initials: YF
authors.lastname: Li
authors.forename: Hsueh-Chou
authors.initials: HC
authors.lastname: Lai
authors.forename: Jung-Ta
authors.initials: JT
authors.lastname: Kao
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Peng
authors.forename: Po-Heng
authors.initials: PH
authors.lastname: Chuang
authors.forename: Wen-Pang
authors.initials: WP
authors.lastname: Su
authors.forename: I-Ping
authors.initials: IP
authors.lastname: Chiang
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D015992:Body Mass Index; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000201:enzymology; D006801:Humans; D016014:Linear Models; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D000410:Alanine Transaminase