title: Non-invasive assessment of liver fibrosis using real-time tissue elastography in patients with chronic hepatitis B.
abstract: OBJECTIVE
  To evaluate the utility of the elastic ratio calculated using real-time tissue elastography for assessing liver fibrosis in patients with chronic hepatitis B (CHB).
  
  
  METHODS
  Ninety-six patients with CHB were enrolled between September 2012 and August 2013. The elastic ratio of the liver for the intrahepatic venous small vessel was calculated to measure liver stiffness. Diagnostic performance of the elastic ratio and aminotransferase-to-platelet ratio index (APRI) were compared with histological fibrosis stage at liver biopsy. In addition, 45 healthy adult volunteers were participated in intra- and interobserver reliability studies.
  
  
  RESULTS
  There was no significant influence of hepatitis B e antigen (HBeAg) status or hepatitis B virus DNA levels on the elastic ratio measurements in CHB patients. The elastic ratio was significantly correlated with histological fibrosis stage (r = 0.873, p < 0.001). Cut-off values were 2.62 for stage 2 and over (S ≥ 2), 3.20 for state 3 and over, and 3.86 for stage 4, respectively. The areas under the receiver operating characteristic (ROC) curves for elastic ratio and APRI diagnosis of significant fibrosis (S ≥ 2) was 0.91 (95% CI: 0.84-0.98) and 0.71 (95% CI: 0.57-0.86), and 0.94 (95% CI: 0.89-0.99) and 0.81 (95% CI: 0.71-0.91) for cirrhosis (S = 4), respectively. The elastic ratio measurements had good reproducibility: 0.838 for intra-observer reliability and 0.805 for inter-observer reliability, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Elastic ratio determined using real-time tissue elastography was an accurate and reproducible method for evaluating liver fibrosis in patients with CHB.
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Hu
authors.affiliation: Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Guangxi, China. Electronic address: gxmuzhushangyong@163.com.
authors.forename: S Y
authors.initials: SY
authors.lastname: Zhu
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China.
authors.forename: L K
authors.initials: LK
authors.lastname: Kang
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China.
authors.forename: X Y
authors.initials: XY
authors.lastname: Wang
authors.affiliation: Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
authors.forename: H M
authors.initials: HM
authors.lastname: Lun
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China.
authors.forename: C M
authors.initials: CM
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D015203:Reproducibility of Results; D055815:Young Adult