Evaluation of Liver Fibrosis and Portal Hypertension in Chronic Hepatitis B Patients by Acoustic Radiation Force Impulse Elastography

Background: Accurate evaluation of the degree of fibrosis and cirrhosis is crucial for determining treatment strategies, surveillance, and prognosis in patients with chronic hepatitis B (CHB). Objectives: To explore the value of acoustic radiation force impulse (ARFI) elastography in assessing the stage of liver fibrosis and the severity of cirrhosis based on portal hypertension. Patients and Methods: One hundred ninety-six consecutive CHB patients who underwent partial hepatectomy and sixty-four advanced cirrhosis patients who underwent hepatic vein pressure gradient (HVPG) measurement were examined with ARFI imaging. Liver stiffness measurements (LSMs) were obtained and compared with the hepatic histological findings by using Scheuer scoring system and with the value of HVPG, respectively. A spleen stiffness measurement (SSM) and spleen index were also performed, and the values were compared with HVPG measurements. Results: Areas under the receiver operating characteristics curve (AUROCs) were 0.952 and 0.976, respectively for the diagnosis of significant fibrosis (S ≥ S2) and cirrhosis (S4), with the corresponding values of 1.26 m/s and 1.58 m/s for optimal LSM cutoff points. For advanced cirrhotic patients (n = 64), the correlation coefficient between LSM and HVPG was 0.637 (P < 0.001). The cutoff values for predicting HVPG ≥ 10 mm Hg and HVPG ≥ 12 mm Hg were 1.79 m/s and 1.90 m/s, respectively (AUROC: 0.665 and 0.859). Neither the value of SSM nor the spleen index showed a statistical relationship with HVPG in the advanced cirrhosis group, but they were significantly correlated with each other (ρ = 0.604, P < 0.05). Conclusion: As a noninvasive elastosonography for the evaluation of liver stiffness, ARFI imaging could not only be used to stage liver fibrosis in CHB patients, but also to evaluate the severity of cirrhosis based on portal hypertension.