Diagnostic Performance of ElastPQ Point Shear Wave Elastography for Hepatic Fibrosis in Hepatitis B and Hepatitis C Patients

Abstract

Introduction: Chronic viral hepatitis is a condition of hepatotropic viral infection associated with chronic inflammation, hepatocyte injury and progressive fibrosis. Non-invasive assessment of liver fibrosis in chronic hepatitis B and C patients has been increasing and used instead of liver biopsy. Aim: To assess the diagnostic performance of ElastPQ Point Shear Wave Elastography (ElastPQ PSWE) with liver biopsy as the gold standard and comparing these results with other serum fibrosis markers namely Aspartate to Platelet Ratio Index (APRI), Fibrosis-4 Score (FIB4). Materials and Methods: A cross-sectional study was carried out in which 73 patients underwent ElastPQ PSWE and Histopathological Examination (HPE) with METAVIR Scoring system staging. Serum fibrosis indices including APRI and FIB4 values were calculated. The diagnostic performance of ElastPQ PSWE, APRI and FIB4 was evaluated using Area Under Receiver Operating Characteristic (AUROCAUROC) curve analysis, correlations of ElastPQ PSWE, APRI and FIB4 ratio index with histopathological findings (as the reference standard) were determined using Spearman’s correlation coefficient. Results: Study included 73 patients with chronic hepatitis B and hepatitis C, of which 8 (10.96%) were no/early fibrosis (F0- F1); 20 (27.40%) were significant fibrosis (F2); 22 (30.13%) were severe fibrosis (F3), and 23 (31.51%) were cirrhosis (F4). There was a significant positive correlation between different stages of liver fibrosis by liver biopsy and liver stiffness detected by ElastPQ PSWE (r=0.912, p <0.0001). ElastPQ PSWE exhibited higher diagnostic accuracy than the APRI and FIB4 for the diagnosis of F0-F1 AUROC 0.980, 0.730, 0.710, respectively; F2 AUROC 0.840, 0.662, 0.669 respectively; F3 0.564, 0.528, 0.500 AUROC, respectively; and F4 0.967, 0.783, 0.751 AUROC, respectively. Using AUROC curve, the optimal cut-off of ElastPQ PSWE for stages F0-F1 is ≤3.9 kilopascals (kPa); F2 is ≤7.2kPa; F3 is ≥7.2kPa and F4 is≥10kPa. Conclusion: ElastPQ PSWE is a promising non-invasive method used for the evaluation of liver fibrosis, with high diagnostic performance, high Negative Predictive Value (NPV) and good specificity in evaluation of hepatitis B and hepatitis C patients.

Keywords

• chronic viral hepatitis
• liver fibrosis
• non-invasive tissue stiffness assessment