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

Research output: Contribution to journalArticlepeer-review

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

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

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