title: Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B.
abstract: OBJECTIVE
  To investigate the combined diagnostic accuracy of acoustic radiation force impulse (ARFI), aspartate aminotransferase to platelet ratio index (APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B (CHB).
  
  
  METHODS
  In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated.
  
  
  RESULTS
  ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage (all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI (P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage (Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI (Z = 0.958, P = 0.338).
  
  
  CONCLUSIONS
  ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Chang-Feng
authors.initials: CF
authors.lastname: Dong
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Ling-Bo
authors.initials: LB
authors.lastname: Shan
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Han-Ying
authors.initials: HY
authors.lastname: Li
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Yong-Jia
authors.initials: YJ
authors.lastname: Xiong
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Gui-Lin
authors.initials: GL
authors.lastname: Yang
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Si-Min
authors.initials: SM
authors.lastname: Yao
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Sha-Xi
authors.initials: SX
authors.lastname: Li
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Le
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yuan
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Bo-Ping
authors.initials: BP
authors.lastname: Zhou
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: George L
authors.initials: GL
authors.lastname: Tipoe
authors.affiliation: Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People's Hospital, Shenzhen 518112, China.
authors.forename: Ying-Xia
authors.initials: YX
authors.lastname: Liu
keywords: Acoustic radiation force impulse; Aspartate aminotransferase to platelet ratio index; Forns index; Hepatitis B virus; Non-invasive diagnosis