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Logo of bmcgastBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Gastroenterology
BMC Gastroenterol. 2012; 12: 105.
Published online Aug 10, 2012. doi:  10.1186/1471-230X-12-105
PMCID: PMC3462151
Effects of patient factors on noninvasive liver stiffness measurement using acoustic radiation force impulse elastography in patients with chronic hepatitis C
Sheng-Hung Chen,1,2 Yu-Fen Li,3 Hsueh-Chou Lai,1,4 Jung-Ta Kao,1,2 Cheng-Yuan Peng,corresponding author1,5 Po-Heng Chuang,1,2 Wen-Pang Su,1,2 and I-Ping Chiang5,6
1Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, No 2 Yuh-Der Road, Taichung, 40402, Taiwan
2China Medical University, Taichung, 40402, Taiwan
3Institute of Biostatistics Center, China Medical University, Taichung, 40402, Taiwan
4College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan
5School of Medicine, China Medical University, Taichung, 40402, Taiwan
6Department of Pathology, China Medical University Hospital, Taichung, 40402, Taiwan
corresponding authorCorresponding author.
Sheng-Hung Chen: d14675/at/; Yu-Fen Li: yufenli/at/; Hsueh-Chou Lai: d3145/at/; Jung-Ta Kao: d16666/at/; Cheng-Yuan Peng: cypeng/at/; Po-Heng Chuang: d12936/at/; Wen-Pang Su: d13845/at/; I-Ping Chiang: d6868/at/
Received February 24, 2012; Accepted August 2, 2012.
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.
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.
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 R2 = 0.661, adjusted R2 = 0.629), ActiTest A scores (R2 = 0.662, adjusted R2 = 0.636), and METAVIR activity (A) grades (R2 = 0.651, adjusted R2 = 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.
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.
Keywords: Liver fibrosis, Cirrhosis, Acoustic radiation force impulse, FibroTest, ActiTest, Chronic hepatitis C
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