Published online Mar 21, 2019. doi: 10.3748/wjg.v25.i11.1366
Peer-review started: November 12, 2018
First decision: December 28, 2018
Revised: January 30, 2019
Accepted: February 15, 2019
Article in press: February 15, 2019
Published online: March 21, 2019
Hepatitis C virus infection is considered one of the most widespread causes of chronic liver disease that results in cirrhosis, fibrosis together with portal hypertension, and hepatocellular carcinoma. When it is possible to diagnose early hepatic fibrosis, the therapy will be more effective in the reduction of hepatic decompensation and improvement of patient survival. Liver biopsy is considered the gold standard for early detection of hepatic fibrosis, but it is invasive and has many side effects. Multiple non-invasive laboratory and imaging modalities could be used in detection and quantification of hepatic fibrosis but have variable accuracy. The liver contains multiple micro-RNAs (miR) (21, 200b and 29b) that have been correlated to the presence and degree of hepatic fibrosis. Magnetic resonance imaging (MRI) with diffusion-weighted imaging and apparent diffusion coefficient (ADC) can also detect and are correlated with hepatic fibrosis.
Early detection and staging of hepatic fibrosis are of great value in treatment of chronic liver disease caused by hepatitis C virus. The available methods to detect and stage fibrosis are either invasive (like biopsy) or non-invasive (like laboratory and imaging), which is not accurate. The combination of serum markers of hepatic fibrosis (miR 21, 200b and 29b) together with MRI with diffusion-weighted imaging is a potential new dependable and non-invasive method to help in early detection and staging of hepatic fibrosis and cirrhosis.
In this prospective study, we evaluated the role of combining ADC and miR (21, 200b and 29b) as an alternative non-invasive tool for detection and staging of hepatic fibrosis in patients with chronic hepatitis C viral infection.
From October 2012 to December 2015, 215 consecutive patients with histopathological evidence of chronic hepatitis C virus cirrhosis were included in our study. Seven cases were excluded, so the final number of the study patients was 208. Diffusion-weighted MRI (DWI) together with hepatitis C serum markers and serum miR (21, 200b and 29b) were performed for all patients. The MRI and laboratory results were compared with that of the control group containing 82 normal volunteers and with the results of liver biopsy histopathological examination.
In the current study, it was found that there was a significant decrease in ADC values in patients with early hepatic fibrosis and late fibrosis when compared to controls. Combining ADC results and miR data (200b, 21 and 29b) provided a highly sensitive, specific, and accurate tool to differentiate patients with hepatic fibrosis from normal control patients. This tool was best at differentiating patients from controls, with and accuracy of 96.9% and had an accuracy of 80.2% for differentiating early from late fibrosis.
Combination of ADC and miR (21, 200b and 29b) is considered a safe, easy, and non-invasive tool in the detection and staging of hepatic fibrosis resulting from chronic hepatitis C viral infection.
Combining imaging and laboratory results in detection and staging of hepatic fibrosis resulting from chronic hepatitis C virus infection is a valuable method because it is easy and non-invasive. However, a study with more patients will generate more accurate results. Also, use of advanced MRI machines with advanced post processing technology like diffusion tensor and diffusion kurtosis will improve the effectiveness and power of our findings.