Prospective study of multiparameter ultrasound for one-stop assessment of liver fibrosis, inflammation, and steatosis in patients with chronic hepatitis B.

OBJECTIVE

To evaluate a multiparameter ultrasound protocol combining liver stiffness (LS), shear-wave dispersion slope (DS), and attenuation coefficient (AC) measurements for noninvasive, one-stop assessment of liver fibrosis, inflammatory activity, and steatosis in chronic hepatitis B (CHB), and to analyze the influence of alanine transaminase (ALT) levels and body mass index (BMI) on the diagnostic accuracy.

MATERIALS AND

METHODS

This prospective study enrolled 146 patients with CHB who underwent the ultrasound protocol and liver biopsy. Correlations with histological findings and diagnostic performance were analyzed, and stratified analyses by ALT levels and BMI categories were performed.

RESULTS

LS showed superior diagnostic performance for ≥F2 (area under the curve [AUC]: 0.83 vs. 0.74, P = 0.014) and F4 (AUC: 0.92 vs. 0.73, P = 0.001) than DS. In comparison with the ALT < 2 ULN group, the ALT ≥ 2 ULN group showed decreasing AUCs of DS for diagnosing ≥F2 (0.778 vs. 0.572, P = 0.075) and a significant decrease for F4 (0.829 vs. 0.603, P = 0.045). In contrast, the AUCs of LS for diagnosing ≥F2 (0.836 vs. 0.728, P = 0.279) and F4 (0.961 vs. 0.858, P = 0.142) did not differ significantly between the ALT subgroups. AC showed good diagnostic performance for steatosis grade ≥S1 (AUC: 0.933) and this was consistent across patients with different BMI.

CONCLUSION

The multiparameter ultrasound protocol allowed comprehensive, one-stop assessment of liver pathology in CHB. AC showed good diagnostic performance for steatosis grade ≥S1 and this was consistent across patients with different BMI. However, the diagnostic performance of DS for detecting fibrosis was susceptible to elevated ALT levels.