Performance of real-time strain elastography, transient elastography, and aspartate-to-platelet ratio index in the assessment of fibrosis in chronic hepatitis C

Giovanna Ferraioli, Carmine Tinelli, Antonello Malfitano, Barbara Dal Bello, Gaetano Filice, Carlo Filice, Elisabetta Above, Giorgio Barbarini, Enrico Brunetti, Willy Calderon, Marta Di Gregorio, Raffaella Lissandrin, Serena Ludovisi, Laura Maiocchi, Giuseppe Michelone, Mario Mondelli, Savino F A Patruno, Alessandro Perretti, Gianluigi Poma, Paolo SacchiMarco Zaramella, Mabel Zicchetti

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Abstract

OBJECTIVE. The purpose of this article is to evaluate the diagnostic performance of transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index in assessing fibrosis in patients with chronic hepatitis C by using histologic Metavir scores as reference standard. SUBJECTS AND METHODS. Consecutive patients with chronic hepatitis C scheduled for liver biopsy were enrolled. Liver biopsy was performed on the same day as transient elastography and real-time strain elastography. Transient elastography and real-time strain elastography were performed in the same patient encounter by a single investigator using a medical device based on elastometry and an ultrasound machine, respectively. Diagnostic performance was assessed by using receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) analysis. RESULTS. One hundred thirty patients (91 men and 39 women) were analyzed. The cut-off values for transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index were 6.9 kPa, 1.82, and 0.37, respectively, for fibrosis score of 2 or higher; 7.3 kPa, 1.86, and 0.70, respectively, for fibrosis score of 3 or higher; and 9.3 kPa, 2.33, and 0.70, respectively, for fibrosis score of 4. AUC values of transient elastography, real-time strain elastography, aspartate-to-platelet ratio index were 0.88, 0.74, and 0.86, respectively, for fibrosis score of 2 or higher; 0.95, 0.80, and 0.89, respectively, for fibrosis score of 3 or higher; and 0.97, 0.80, and 0.84, respectively, for fibrosis score of 4. A combination of the three methods, when two of three were in agreement, showed AUC curves of 0.93, 0.95, and 0.95 for fibrosis scores of 2 or higher, 3 or higher, and 4, respectively. CONCLUSION. Transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index values were correlated with histologic stages of fibrosis. Transient elastography offered excellent diagnostic performance in assessing severe fibrosis and cirrhosis. Real-time elastography does not yet have the potential to substitute for transient elastography in the assessment of liver fibrosis.

Original languageEnglish
Pages (from-to)19-25
Number of pages7
JournalAmerican Journal of Roentgenology
Volume199
Issue number1
DOIs
Publication statusPublished - Jul 2012

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Elasticity Imaging Techniques
Chronic Hepatitis C
Aspartic Acid
Fibrosis
Blood Platelets
Area Under Curve
ROC Curve
Biopsy
Liver

Keywords

  • Aspartate-to-platelet ratio index
  • Hepatitis C
  • Liver biopsy
  • Real-time elastography
  • Transient elastography
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{ce6d6de123034f49a43d7b6773683bb8,
title = "Performance of real-time strain elastography, transient elastography, and aspartate-to-platelet ratio index in the assessment of fibrosis in chronic hepatitis C",
abstract = "OBJECTIVE. The purpose of this article is to evaluate the diagnostic performance of transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index in assessing fibrosis in patients with chronic hepatitis C by using histologic Metavir scores as reference standard. SUBJECTS AND METHODS. Consecutive patients with chronic hepatitis C scheduled for liver biopsy were enrolled. Liver biopsy was performed on the same day as transient elastography and real-time strain elastography. Transient elastography and real-time strain elastography were performed in the same patient encounter by a single investigator using a medical device based on elastometry and an ultrasound machine, respectively. Diagnostic performance was assessed by using receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) analysis. RESULTS. One hundred thirty patients (91 men and 39 women) were analyzed. The cut-off values for transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index were 6.9 kPa, 1.82, and 0.37, respectively, for fibrosis score of 2 or higher; 7.3 kPa, 1.86, and 0.70, respectively, for fibrosis score of 3 or higher; and 9.3 kPa, 2.33, and 0.70, respectively, for fibrosis score of 4. AUC values of transient elastography, real-time strain elastography, aspartate-to-platelet ratio index were 0.88, 0.74, and 0.86, respectively, for fibrosis score of 2 or higher; 0.95, 0.80, and 0.89, respectively, for fibrosis score of 3 or higher; and 0.97, 0.80, and 0.84, respectively, for fibrosis score of 4. A combination of the three methods, when two of three were in agreement, showed AUC curves of 0.93, 0.95, and 0.95 for fibrosis scores of 2 or higher, 3 or higher, and 4, respectively. CONCLUSION. Transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index values were correlated with histologic stages of fibrosis. Transient elastography offered excellent diagnostic performance in assessing severe fibrosis and cirrhosis. Real-time elastography does not yet have the potential to substitute for transient elastography in the assessment of liver fibrosis.",
keywords = "Aspartate-to-platelet ratio index, Hepatitis C, Liver biopsy, Real-time elastography, Transient elastography, Ultrasound",
author = "Giovanna Ferraioli and Carmine Tinelli and Antonello Malfitano and {Dal Bello}, Barbara and Gaetano Filice and Carlo Filice and Elisabetta Above and Giorgio Barbarini and Enrico Brunetti and Willy Calderon and {Di Gregorio}, Marta and Raffaella Lissandrin and Serena Ludovisi and Laura Maiocchi and Giuseppe Michelone and Mario Mondelli and Patruno, {Savino F A} and Alessandro Perretti and Gianluigi Poma and Paolo Sacchi and Marco Zaramella and Mabel Zicchetti",
year = "2012",
month = "7",
doi = "10.2214/AJR.11.7517",
language = "English",
volume = "199",
pages = "19--25",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "1",

}

TY - JOUR

T1 - Performance of real-time strain elastography, transient elastography, and aspartate-to-platelet ratio index in the assessment of fibrosis in chronic hepatitis C

AU - Ferraioli, Giovanna

AU - Tinelli, Carmine

AU - Malfitano, Antonello

AU - Dal Bello, Barbara

AU - Filice, Gaetano

AU - Filice, Carlo

AU - Above, Elisabetta

AU - Barbarini, Giorgio

AU - Brunetti, Enrico

AU - Calderon, Willy

AU - Di Gregorio, Marta

AU - Lissandrin, Raffaella

AU - Ludovisi, Serena

AU - Maiocchi, Laura

AU - Michelone, Giuseppe

AU - Mondelli, Mario

AU - Patruno, Savino F A

AU - Perretti, Alessandro

AU - Poma, Gianluigi

AU - Sacchi, Paolo

AU - Zaramella, Marco

AU - Zicchetti, Mabel

PY - 2012/7

Y1 - 2012/7

N2 - OBJECTIVE. The purpose of this article is to evaluate the diagnostic performance of transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index in assessing fibrosis in patients with chronic hepatitis C by using histologic Metavir scores as reference standard. SUBJECTS AND METHODS. Consecutive patients with chronic hepatitis C scheduled for liver biopsy were enrolled. Liver biopsy was performed on the same day as transient elastography and real-time strain elastography. Transient elastography and real-time strain elastography were performed in the same patient encounter by a single investigator using a medical device based on elastometry and an ultrasound machine, respectively. Diagnostic performance was assessed by using receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) analysis. RESULTS. One hundred thirty patients (91 men and 39 women) were analyzed. The cut-off values for transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index were 6.9 kPa, 1.82, and 0.37, respectively, for fibrosis score of 2 or higher; 7.3 kPa, 1.86, and 0.70, respectively, for fibrosis score of 3 or higher; and 9.3 kPa, 2.33, and 0.70, respectively, for fibrosis score of 4. AUC values of transient elastography, real-time strain elastography, aspartate-to-platelet ratio index were 0.88, 0.74, and 0.86, respectively, for fibrosis score of 2 or higher; 0.95, 0.80, and 0.89, respectively, for fibrosis score of 3 or higher; and 0.97, 0.80, and 0.84, respectively, for fibrosis score of 4. A combination of the three methods, when two of three were in agreement, showed AUC curves of 0.93, 0.95, and 0.95 for fibrosis scores of 2 or higher, 3 or higher, and 4, respectively. CONCLUSION. Transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index values were correlated with histologic stages of fibrosis. Transient elastography offered excellent diagnostic performance in assessing severe fibrosis and cirrhosis. Real-time elastography does not yet have the potential to substitute for transient elastography in the assessment of liver fibrosis.

AB - OBJECTIVE. The purpose of this article is to evaluate the diagnostic performance of transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index in assessing fibrosis in patients with chronic hepatitis C by using histologic Metavir scores as reference standard. SUBJECTS AND METHODS. Consecutive patients with chronic hepatitis C scheduled for liver biopsy were enrolled. Liver biopsy was performed on the same day as transient elastography and real-time strain elastography. Transient elastography and real-time strain elastography were performed in the same patient encounter by a single investigator using a medical device based on elastometry and an ultrasound machine, respectively. Diagnostic performance was assessed by using receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) analysis. RESULTS. One hundred thirty patients (91 men and 39 women) were analyzed. The cut-off values for transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index were 6.9 kPa, 1.82, and 0.37, respectively, for fibrosis score of 2 or higher; 7.3 kPa, 1.86, and 0.70, respectively, for fibrosis score of 3 or higher; and 9.3 kPa, 2.33, and 0.70, respectively, for fibrosis score of 4. AUC values of transient elastography, real-time strain elastography, aspartate-to-platelet ratio index were 0.88, 0.74, and 0.86, respectively, for fibrosis score of 2 or higher; 0.95, 0.80, and 0.89, respectively, for fibrosis score of 3 or higher; and 0.97, 0.80, and 0.84, respectively, for fibrosis score of 4. A combination of the three methods, when two of three were in agreement, showed AUC curves of 0.93, 0.95, and 0.95 for fibrosis scores of 2 or higher, 3 or higher, and 4, respectively. CONCLUSION. Transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index values were correlated with histologic stages of fibrosis. Transient elastography offered excellent diagnostic performance in assessing severe fibrosis and cirrhosis. Real-time elastography does not yet have the potential to substitute for transient elastography in the assessment of liver fibrosis.

KW - Aspartate-to-platelet ratio index

KW - Hepatitis C

KW - Liver biopsy

KW - Real-time elastography

KW - Transient elastography

KW - Ultrasound

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U2 - 10.2214/AJR.11.7517

DO - 10.2214/AJR.11.7517

M3 - Article

C2 - 22733889

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VL - 199

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JO - American Journal of Roentgenology

JF - American Journal of Roentgenology

SN - 0361-803X

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