Background: The prognosis and management of hepatic fibrosis are closely related to the stage of the disease. The limitations of liver biopsy, which is the gold standard for treatment, include its invasiveness and sampling error. Ultrasound elasticity might be the most promising imaging technology for the noninvasive and accurate assessment of hepatic fibrosis. Real-time tissue elastography (RTE) measures the relative stiffness of the tissue in the region of interest caused by the heartbeat. Many studies have verified that RTE is useful for the diagnosis of hepatic fibrosis in patients with chronic hepatitis C (CHC). Purpose: To determine the formula of the liver fibrosis index for chronic hepatitis B (BLFI) and to validate the diagnostic accuracy of the BLFI for hepatic fibrosis compared with the liver fibrosis index (LFI). Materials and Methods: RTE was performed in 747 prospectively enrolled patients with chronic hepatitis B (CHB) or cirrhosis from 8 centers in China; 375 patients were analyzed as the training set, and 372 patients were evaluated as the validation set. The fibrosis stage was diagnosed from pathological specimens obtained by ultrasound-guided liver biopsy. Nine image features were measured from strain images, and the new formula for the BLFI was obtained by combining the nine imaging features of the RTE images using multiple regression analysis of the training set. The BLFI and LFI were compared with the pathological fibrosis stage at diagnosis, and the diagnostic performances of the indexes were compared. Results: The Spearman correlation coefficient between the BLFI and hepatic fibrosis stages was significantly positive (r = 0.711, p < 0.001), and significant differences were present between all disease stages. The areas under the receiver-operating characteristic (AUROC) curves of the BLFI and LFI for predicting significant fibrosis (S0-S1 vs. S2-S4) were 0.858 and 0.858, respectively. For cirrhosis (S0-S3 vs. S4), the AUROC curves of the BLFI and LFI were 0.868 and 0.862, respectively. Conclusion: The results of this large, multicenter study confirmed that RTE is valuable for the diagnosis of hepatic fibrosis in patients with CHB. However, the diagnostic efficiencies of the new BLFI and the original LFI, which were based on CHC, for the assessment of CHB hepatic fibrosis were similar; thus, the LFI has the potential to be used to directly evaluate the extent of hepatic fibrosis in patients with CHB.

Cui Y, Jia J: Update on epidemiology of hepatitis B and C in China. J Gastroenterol Hepatol 2013;28(suppl 1):7-10.
EASL clinical practice guidelines: management of hepatitis C virus infection. J Hepatol 2011;55:245-264.
Kudo M: Prediction of hepatocellular carcinoma incidence risk by ultrasound elastography. Liver Cancer 2014;3:1-5.
Kim do Y, Han KH: Epidemiology and surveillance of hepatocellular carcinoma. Liver Cancer 2012;1:2-14.
Kudo M: Japan's successful model of nationwide hepatocellular carcinoma surveillance highlighting the urgent need for global surveillance. Liver Cancer 2012;1:141-143.
Kawanaka M, Nishino K, Nakamura J, et al: Quantitative levels of hepatitis B virus DNA and surface antigen and the risk of hepatocellular carcinoma in patients with hepatitis B receiving long-term nucleos(t)ide analogue therapy. Liver Cancer 2014;3:41-52.
Cadranel JF, Rufat P, Degos F: Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology 2000;32:477-481.
Bedossa P, Dargere D, Paradis V: Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38:1449-1457.
Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 1994;20:15-20.
Friedrich-Rust M, Ong MF, Martens S, et al: Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008;134:960-974.
Fung J, Lai CL, But D, et al: Prevalence of fibrosis and cirrhosis in chronic hepatitis B: implications for treatment and management. Am J Gastroenterol 2008;103:1421-1426.
EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol 2012;57:167-185.
Bamber J, Cosgrove D, Dietrich CF, et al: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med 2013;34:169-184.
Cosgrove D, Piscaglia F, Bamber J, et al: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: clinical applications. Ultraschall Med 2013;34:238-253.
Kudo M, Shiina T, Moriyasu F, et al: JSUM ultrasound elastography practice guidelines: liver. J Med Ultrasonics 2013;40:325-357.
Fujimoto K, Kato M, Kudo M, et al: Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C. Oncology 2013;84(suppl 1):3-12.
Yada N, Kudo M, Morikawa H, et al: Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis. Oncology 2013;84(suppl 1):13-20.
Koizumi Y, Hirooka M, Kisaka Y, et al: Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography - establishment of the method for measurement. Radiology 2011;258:610-617.
Lorenz A, Ermert H, Sommerfeld HJ, et al: Ultrasound elastography of the prostate. A new technique for tumor detection. Ultraschall Med 2000;21:8-15.
Fujimoto K, Wada S, Ohshita M, et al: Non-invasive evaluation of hepatic fibrosis in patients with chronic hepatitis C using elastography. Medix 2007;Suppl:24-27.
Xie L, Chen X, Guo Q, et al: Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B. J Ultrasound Med 2012;31:1053-1060.
Wang J, Guo L, Shi X, et al: Real-time elastography with a novel quantitative technology for assessment of liver fibrosis in chronic hepatitis B. Eur J Radiol 2012;81:e31-e36.
Ogawa E, Furusyo N, Toyoda K, et al: Transient elastography for patients with chronic hepatitis B and C virus infection: non-invasive, quantitative assessment of liver fibrosis. Hepatol Res 2007;37:1002-1010.
Sporea I, Sirli R, Deleanu A, et al: Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis: a comparative study. World J Gastroenterol 2010;16:4832-4837.
Cardoso AC, Carvalho-Filho RJ, Stern C, et al: Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C. Liver Int 2012;32:612-621.
Fiel MI: Pathology of chronic hepatitis B and chronic hepatitis C. Clin Liver Dis 2010;14:555-575.
Hinkle D, Wiersma W, Jurs S: Applied Statistics for the Behavioral Sciences, ed 2. Boston, Houghton Mifflin Company, 1988.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.