title: Noninvasive Assessment of Liver Fibrosis Stage Using Ultrasound-Based Shear Wave Velocity Measurements and Serum Algorithms in Patients With Viral Hepatitis B: A Retrospective Cohort Study.
abstract: OBJECTIVE
  Liver biopsy remains the reference standard for the assessment of liver fibrosis, but this procedure is invasive and can lead to complications. Thus, studies to determine the optimal noninvasive test are warranted. This study compared several noninvasive tests and their combinations for evaluating liver fibrosis stages in patients with chronic hepatitis B.
  
  
  METHODS
  The shear wave velocity (SWV) and laboratory indicators were collected from 174 patients with chronic hepatitis B. Formulas were applied to calculate the serum fibrosis model, including the aspartate aminotransaminase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4) and aspartate aminotransferase-to-alanine aminotransferase ratio (AAR). The diagnostic performance of all noninvasive tests was assessed in comparison with percutaneous liver biopsy, based on a receiver operating characteristic curve analysis.
  
  
  RESULTS
  The SWV (area under the receiver operating characteristic curve [AUC], 0.82) and APRI (AUC = 0.77) performed better than the FIB-4 (AUC = 0.62), and the AAR (AUC = 0.47) was not suitable for evaluating substantial liver fibrosis (stage ≥F2). The SWV (AUC = 0.96) was the best indicator, being superior to the APRI (AUC = 0.75) and FIB-4 (AUC = 0.74), and the AAR (AUC = 0.45) was not suitable for assessing cirrhosis (F4). Combining the SWV and APRI, the AUC improved to 0.85 for substantial liver fibrosis, and the sensitivity increased to 100% for cirrhosis.
  
  
  CONCLUSIONS
  The SWV, APRI, and FIB-4 were valid tests for evaluating substantial liver fibrosis and cirrhosis. The combination of these tests with several noninvasive indicators is expected to enhance the assessment of liver fibrosis stages.
authors.affiliation: Department of Infectious Disease, First Affiliated Hospital of Xi'an Jiaotong University Medical College, Shaanxi, China.|Department of Ultrasonography, Baoji Central Hospital, Baoji, China.
authors.forename: Jianxue
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Ultrasonography, Baoji Central Hospital, Baoji, China.
authors.forename: Junzhi
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Ultrasonography, Baoji Central Hospital, Baoji, China.
authors.forename: Yaoren
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Ultrasonography, Baoji Central Hospital, Baoji, China.
authors.forename: Yonghao
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Department of Infectious Disease, First Affiliated Hospital of Xi'an Jiaotong University Medical College, Shaanxi, China.
authors.forename: Shumei
authors.initials: S
authors.lastname: Lin
authors.affiliation: Department of Ultrasonography, Baoji Central Hospital, Baoji, China.
authors.forename: Guoliang
authors.initials: G
authors.lastname: Dun
authors.affiliation: Department of Infectious Disease, Baoji Central Hospital, Baoji, China.
authors.forename: Sujuan
authors.initials: S
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D001219:Aspartate Aminotransferases / Q000097:blood; D001792:Blood Platelets; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: acoustic radiation force impulse imaging; aspartate aminotransaminase-to-platelet ratio index; aspartate aminotransferase-to-alanine aminotransferase ratio; chronic hepatitis B; fibrosis-4 index; general and abdominal ultrasound; liver fibrosis; liver shear wave velocity