It has been established that the long-term infection of chronic hepatitis C leads to the increased risk of hepatic fibrosis and hepatocellular carcinoma. Currently, histological diagnosis by invasive and painful liver biopsy is the gold standard for evaluating the hepatic fibrosis stage. Because of a side effect or patient inability to cope with the pain, it is difficult to assess the fibrosis stage frequently using liver biopsy. Recently, instead of liver biopsy, many articles have been published showing the usefulness of ultrasound elastography to evaluate the stage of hepatic fibrosis. We also reported the usefulness of real-time tissue elastography (RTE) for liver fibrosis staging in 2007. However, in our previous report, fibrosis classification was performed manually and the number of patients involved was also small. In the current study, the fibrosis staging is performed automatically using software by characterizing the elastography images. We have also increased the number of patients from 64 to 310. Thus, the aim of this study is to increase objectivity by using a newly developed automatic analysis method. We obtain the Liver Fibrosis Index (LFI), which is calculated from image features of RTE images, using multiple regression analysis performed on clinical data of 310 cases as the training data set. The correlation coefficient obtained between the LFI and the stage of hepatic fibrosis was r = 0.68, and significant differences exist between all stages of fibrosis (p < 0.001). Our new method seems promising since it has the ability to diagnose fibrosis even in the presence of inflammation.

WHO International Agency for Research on Cancer: World Cancer Report 2008. Section 1 - global cancer control, chapter 1.3: worldwide cancer burden.
WHO International Agency for Research on Cancer: World Cancer Report 2008. Section 2 - etiology of cancer, chapter 2.5: chronic Infections.
Yoshida H, Shiratori Y, Moriyama M, et al: Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. Ann Intern Med 1999;131:174-181.
Shiratori Y, Imazeki F, Moriyama M, et al: Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med 2000;132:517-524.
Desmet VJ, Gerber M, Hoofnagle JH, et al: Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994;19:1513-1520.
Ichida F, Tsuji T, Omata M, et al: Classification report: new inuyama classification for histological assessment of chronic hepatitis. Internat Hepatol Comm 1996;6:112-119.
Ishak K, Baptista A, Bianchi L, et al: Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696.
Bataller R, Brenner DA: Liver fibrosis. J Clin Invest 2005;115:209-218.
Pinzani M, Rombouts K, Colagrande S: Fibrosis in chronic liver diseases: diagnosis and management. J Hepatol 2005;42:S22-S26.
Dienstag JL: The role of liver biopsy in chronic hepatitis C. Hepatology 2002;36: S152-S160.
Gebo KA, Herlong HF, Torbenson MS, et al: Role of liver biopsy in management of chronic hepatitis C: a systemic review. Hepatology 2002;36:161-172.
Regev A, Berho M, Jeffers LJ, Milikowski C, et al: Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002;97:2614-2618.
Bedossa P, Dargère D, Paradis V: Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38:1449-1457.
Omata M: A strategy of the treatment for the viral hepatitis (in Japanese). J Jpn Soc Int Med 2004;93:269-276.
Manning DS, Afdhai NH: Diagnosis and quantitation of fibrosis. Gastroenterology, 2008;134:1670-1681.
Wai CT, Greenson JK, Fontana RJ, et al: A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-526.
Imbert-Bismut F, Ratziu, Pieroni L, Charlotte F, et al: Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001;357:1069-1075.
Forns X, Ampurdanes S, Llovet JM, et al: Indentification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2001;36:986-992.
Freeman MP, Vick CW, Taylor KJ, et al: Regenerating nodules in cirrhosis: sonographic appearance with anatomic correlation. AJR Am J Roentgenol 1986;146:533-536.
Ishikawa H, Ono M, Goto M, et al: Ultrasonographic findings in patients with liver cirrhosis; relationships between parenchymal, superficial echo patterns, and histological findings (in Japanese). Jpn J Med Ultrason 1990;17:522-529.
Fujimoto K, Yamamoto Y, Waki H, et al: Tissue characterization using integrated backscatter in viral chronic liver disease. J Ultrasound Med 1999;18(suppl):472.
Kumada T, Toyoda H, Ogawa S, et al: Quantification of fibrosis in hepatitis C using statistics analysis tool of ultrasonics (2nd report). Jpn J Med Ultrasonics 2007;34:S641.
Ziol M, Handra-Luca A, Kettaneh A, et al: Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005;41:48-54.
Joo I, Choi BI: New Paradigm for management of hepatocellular carcinoma by imaging. Liver Cancer 2012;1:94-109.
Sandrin L, Fourquet B, Hasquenoph JM, et al: Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003;29:1705-1713.
Foucher J, Chanteloup E, Vergniol J, et al: Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006;55:403-408.
Fraquelli M, Rigamonti C, Casazza G, et al: Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007;56:968-973.
Kim DY, Kim SU, Park JY, Ahn SH, Song KJ, Han KH: FibroScan based risk estimation of HBV-related HCC occurrence: development and validation of a predictive model. Liver Cancer 2012;1:123.
Friedrich-Rust M, Wunder K, Kriener S, et al: Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology 2009;252:595-604.
Shiina T, Nitta N, Ueno E, et al: Real time tissue elasticity imaging using the combined autocorrelation method. J Med Ultrasonics 1999;26:57-66.
Shiina T, Nitta N, Ueno E, et al: Real time tissue elasticity imaging using the combined autocorrelation method. J Med Ultrasonics 2002;29:119-128.
Joo I, Choi BI: New paradigm for management of hepatocellular carcinoma by imaging. Liver Cancer 2012;1:94-109.
Itoh A, Ueno E, Tohno E, et al: Breast disease: clinical application of US elastography for diagnosis. Radiology 2006;239:341-350.
Fukunari N: More accurate and sensitive diagnosis for thyroid tumors with elastography - detection and differential diagnosis of thyroid cancers. MEDIX Suppl. 2007.
Tsutsumi M, Miyagawa T, Matsumura T, et al: Real-time balloon inflation elastography for prostate cancer detection and initial evaluation of clinic pathologic analysis, AJR Am J Roentgenol 2010;194:W471-W476.
Hirooka Y, Itoh A, Kawashima H, et al: Diagnosis of pancreatic disorders using contrast-enhanced endoscopic ultrasonography and endoscopic elastography. Clin Gastroenterol Hepatol 2009;7:S63-S67.
Fujimoto K, Wada S, Oshita M, et al: Non-invasive evaluation of hepatic fibrosis in patients with chronic hepatitis C using elastography. MEDIX Suppl. 2007.
Tatsumi C, Kudo M, Ueshima K, et al: Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan), and real-time tissue elastography. Intervirology 2008;1:S27-S33.
Tatsumi C, Kudo M, Ueshima K, et al: Non-invasive evaluation of hepatic fibrosis for type C chronic hepatitis. Intervirology 2010;53:76-81.
Fujimoto K, Kato M, Tonomura A, et al: Non-invasive evaluation method of the liver fibrosis using real-time tissue elastography - usefulness of judgment liver fibrosis stage by Liver Fibrosis Index (LF Index) (in Japanese). Kanzo 2010;51:539-541.
Haralick RM, Shanmugan K, Dinstein I: Textural features for image classification. IEEE Trans Syst Man Cybern 1973;3:610-621.
Mittal D, Kumara V, et al: Neural network based focal liver lesion diagnosis using ultrasound images. Comp Med Imaging Graphics 2011;35:315-323.
Matsumura T, Shiina T, Oosaka T, et al: Development of real-time tissue elastography (in Japanese). MEDIX 2004;41:30-35.
Hoon L, Kim Y, Lee J: Regenerative nodules in liver cirrhosis: findings at CT during arterial portography and CT hepatic arteriography with histopathologic correlation. Radiology 1999;210:451-458.
Arena U, Vizzutti F, Abraldes JG, et al: Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C. Gut 2008;57:1288-1293.
Vispo E, Barreiro P, Del Valle J, et al: Overestimation of liver fibrosis staging using transient elastography in patients with chronic hepatitis C and significant liver inflammation. Antivir Ther 2009;14:187-193.
Rifai K, Cornberg J, Mederacke I, et al: Clinical feasibility of liver elastography by acoustic radiation force impulse imaging (ARFI). Dig Liver Dis 2011;43:491-497.
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.