Acoustic radiation force impulse elastography and serum fibrosis markers in chronic hepatitis C.

Objective: Liver biopsy (LB) remains the gold standard for the assessment of liver fibrosis, although it is invasive and can have complications. The present study compares several noninvasive methods of fibrosis assessment in chronic hepatitis C (CHC), including acoustic radiation force impulse (ARFI) elastography, aspartate aminotransferase:platelet ratio index (APRI), Forns, FIB-4, and King scores versus percutaneous LB.

Methods: This prospective study enrolled 51 untreated CHC patients. Biological tests necessary for the calculation of the scores (according to the classic formulas) were performed within a week of LB. The time interval between LB and tissue stiffness, assessed according to the Metavir score, was <6 months. Cutoff values were determined using area under receiver-operating characteristic curves (AUROC).

Results: The best test for predicting significant fibrosis (F ≥2 Metavir) was ARFI elastography with an AUROC of 0.90, followed by FIB-4 (AUROC = 0.86), King (AUROC = 0.85), Forns (AUROC = 0.84), and APRI (AUROC = 0.82). For a cutoff of 1.31 m/s, ARFI had 89.3% sensitivity (Se) and 87% specificity (Sp). The best test for predicting cirrhosis was ARFI elastography with an AUROC of 0.98, followed by FIB-4 (AUROC = 0.94), King (AUROC = 0.90), APRI (AUROC = 0.82), and Forns (AUROC = 0.81). For a cutoff of 1.95 m/s, ARFI had 100% Se and 95.2% Sp.

Conclusions: ARFI elastography had very good accuracy for the assessment of liver fibrosis. It was more effective than APRI, Forns, King, and FIB-4 scores for the prediction of significant fibrosis and cirrhosis in CHC patients.