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ARFI elastography predicts fibrosis in patients with HCV who achieved SVR
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In a prospective study, acoustic radiation force impulse elastography, or ARFI, accurately predicted fibrosis severity in patients with hepatitis C virus infection who achieved sustained virologic response with therapy.
“We conducted the interesting findings about ARFI elastography, which was an acceptable method for predicting the severity of fibrosis in chronic hepatitis C patients with SVR,” Yoshihiko Tachi, MD, PhD, department of gastroenterology, Komaki City Hospital, Japan, told Infectious Disease News. “Major results show that ARFI values are lower for each fibrosis stage in SVR patients than in patients with active HCV disease.”
Tachi and colleagues evaluated 336 patients seen at Komaki City Hospital. Of these, 215 had HCV and 121 had achieved SVR with either interferon monotherapy, interferon plus ribavirin or pegylated interferon plus ribavirin. Among the 215 patients with HCV, 70 were previously treated with interferon-based therapy, and the remainder were never treated. Approximately 48% of patients with HCV were women, and 44.6% of patients who achieved SVR were women. Each patient underwent ARFI elastography on the same day as liver biopsy.
“We investigated the diagnostic performance of ARFI elastography for the assessment of liver fibrosis in patients with SVR and patients with HCV. This study includes a relatively large number of patients, and histology is available in all patients,” Tachi said.
Yoshihiko Tachi
Using area under the receiver operating characteristic curves (AUROC) to measure diagnostic accuracies of ARFI elastography, Tachi and colleagues determined that patients who achieved SVR had 0.818 accuracy, and patients with HCV had 0.875 accuracy for the diagnosis of significant fibrosis. Patients who achieved SVR had 0.909 accuracy, and patients with HCV had a 0.888 accuracy for the diagnosis of severe fibrosis. Further, patients who achieved SVR had 0.981 accuracy, and patients with HCV had 0.89 accuracy for the diagnosis of liver cirrhosis.
Cut-off values for ARFI elastography were 1.26 m/s for significant fibrosis, 1.31 m/s for severe fibrosis and 1.49 m/s for liver cirrhosis in patients who attained SVR. Liver stiffness values were lower in patients with SVR compared with patients with HCV at the same fibrosis stage. Necroinflammatory activity and the time after SVR impacted liver stiffness values, according to Tachi and colleagues.
“The clinical impact of our results is that identified ARFI elastography thresholds might be confidently used to stratify patients who achieve a SVR,” they wrote. “ARFI elastography can predict histologically significant fibrosis, severe fibrosis and cirrhosis of the liver in patients in whom HCV has been eradicated, or in patients with persistent HCV.” – by Melinda Stevens
Disclosure: Tachi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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