Original Article
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 7, 2014; 20(5): 1289-1297
Published online Feb 7, 2014. doi: 10.3748/wjg.v20.i5.1289
Factors correlating with acoustic radiation force impulse elastography in chronic hepatitis C
Toru Nishikawa, Senju Hashimoto, Naoto Kawabe, Masao Harata, Yoshifumi Nitta, Michihito Murao, Takuji Nakano, Yuko Mizuno, Hiroaki Shimazaki, Toshiki Kan, Kazunori Nakaoka, Yuka Takagawa, Masashi Ohki, Naohiro Ichino, Keisuke Osakabe, Kentaro Yoshioka
Toru Nishikawa, Senju Hashimoto, Naoto Kawabe, Masao Harata, Yoshifumi Nitta, Michihito Murao, Takuji Nakano, Yuko Mizuno, Hiroaki Shimazaki, Toshiki Kan, Kazunori Nakaoka, Yuka Takagawa, Masashi Ohki, Kentaro Yoshioka, Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Aichi 470-1192, Japan
Naohiro Ichino, Keisuke Osakabe, Faculty of Medical Technology, School of Health Sciences, Fujita Health University, Aichi 470-1192, Japan
Author contributions: All authors contributed to this work.
Supported by MEXT-Supported Program for the Strategic Research Foundation at Private Universities of the Japanese Government; and by the Ministry of Health, Labor, and Welfare of the Japanese Government
Correspondence to: Kentaro Yoshioka, MD, Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan. kyoshiok@fujita-hu.ac.jp
Telephone: +81-562-932324 Fax: +81-562-938601
Received: August 19, 2013
Revised: September 28, 2013
Accepted: November 12, 2013
Published online: February 7, 2014
Abstract

AIM: To investigate the factors other than fibrosis stage correlating with acoustic radiation force impulse (ARFI) elastograpy in chronic hepatitis C.

METHODS: ARFI elastograpy was performed in 108 consecutive patients with chronic hepatitis C who underwent a liver biopsy. The proportion of fibrosis area in the biopsy specimens was measured by computer-assisted morphometric image analysis.

RESULTS: ARFI correlated significantly with fibrosis stage (β = 0.1865, P < 0.0001) and hyaluronic acid levels (β = 0.0008, P = 0.0039) in all patients by multiple regression analysis. Fibrosis area correlated significantly with ARFI by Spearman’s rank correlation test but not by multiple regression analysis. ARFI correlated significantly with body mass index (BMI) (β = -0.0334, P = 0.0001) in F 0 or F 1, with γ-glutamyltranspeptidase levels (β = 0.0048, P = 0.0012) in F 2, and with fibrosis stage (β = 0.2921, P = 0.0044) and hyaluronic acid levels (β = 0.0012, P = 0.0025) in F 3 or F 4. The ARFI cutoff value was 1.28 m/s for F≥ 2, 1.44 m/s for F≥ 3, and 1.73 m/s for F 4.

CONCLUSION: ARFI correlated with fibrosis stage and hyaluronic acid but not with inflammation. ARFI was affected by BMI, γ-glutamyltranspeptidase, and hyaluronic acid in each fibrosis stage.

Keywords: Acoustic radiation force impulse, Body mass index, Chronic hepatitis C, Computer-assisted morphometric image analysis, Fibrosis stage, Hyaluronic acid, Liver stiffness measurement, Transient elastography, Velocity of shear wave

Core tip: The assessment of liver fibrosis stage is important to estimate prognosis and to identify the patients requiring antiviral treatment in chronic hepatitis C. Liver biopsy is a gold standard for assessing fibrosis, but is invasive. Thus methods for noninvasively assessing fibrosis have been developed. Liver stiffness measurement (LSM) by Fibroscan and acoustic radiation force impulse correlate with fibrosis stage. However, LSM may be affected by factors other than fibrosis, such as edema, steatosis, and inflammation.