Non-invasive assessment of liver fibrosis in patients with hepatitis C: Shear wave elastography and colour Doppler velocity profile technique versus liver biopsy.

BACKGROUND AND STUDY AIMS: Determination of the presence and degree of liver fibrosis is essential for the prognosis and treatment of patients with chronic hepatitis C. Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy. We determined the efficacy of shear wave elastography (SWE) and colour Doppler velocity as non-invasive methods for the assessment of liver fibrosis compared to liver biopsy among patients with chronic hepatitis C virus (HCV) infection. PATIENTS AND METHODS: In total, 117 patients with chronic HCV infection and 50 healthy age- and sex-matched control subjects were included. For each patient and control, abdominal ultrasonography, Doppler ultrasonography of the right portal vein (PV), and SWE were performed, whereas liver biopsy was performed for patients. RESULTS: The mean value of the right PV maximum velocity was lower in patients with different stages of fibrosis than in controls (p<0.001). The mean value of liver stiffness determined by SWE was significantly higher in patients with different stages of fibrosis than in controls. Cutoff values for liver stiffness determined by SWE for assessing fibrosis stages were F2⩾4.815, F3⩾6.335, and F4=7.540 with a sensitivity of 84.6%, 96.2%, and 100.0%; specificity of 88.5%, 93.8%, and 100.0%; positive predictive value (PPV) of 93.6%, 98.0%, and 100.0%; negative predictive value (NPV) of 74.2%, 88.2%, and 100.0%; and overall accuracy of 85.9%, 95.6%, and 100.0% [area under the ROC curve (AUC): 0.89, 0.96, and 1.0], respectively. Cutoff values for the right PV maximum velocity for assessing fibrosis stages were F2<23.4, F3<21, and F4<20 with a sensitivity of 65.0%, 57.4%, and 57.1%; specificity of 59.8%, 76.4%, and 75.5%; PPV of 33.8%, 58.3%, and 32.0%; NPV of 84.4%, 75.7%, and 89.7%; and overall accuracy of 61.1%, 69.5%, and 72.5% (AUC: 0.614, 0.696, and 0.625), respectively. CONCLUSION: SWE is effective for the non-invasive assessment of liver fibrosis in patients with HCV infection. SWE provides a more accurate correlation with liver fibrosis stage than colour Doppler velocity profile for the assessment of liver fibrosis, especially in advanced stages (F3 and F4).

Evaluation of transforming growth factor alpha and vascular endothelial growth factor in diagnosis of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors. It is important to detect disease and recurrence at its earlier period. We aimed to evaluate the usefulness of TGF-alpha and VEGF in diagnosis of HCC patients. Thirty patients with liver cirrhosis, 30 patients with confirmed HCC and 20 healthy volunteers were subjected to abdominal ultrasonography, and alpha-fetoprotein, TGF-alpha and VEGF were assessed. Serum level of AFP was significantly higher in HCC than cirrhotic patients and controls and in cirrhosis patients than controls. The level of TGF-alpha was significantly increased in HCC and cirrhosis groups than in control group with no difference between cirrhosis and HCC groups. Serum VEGF was higher in HCC than in cirrhosis group and in both groups than in control group. Sensitivity and specificity of makers in diagnosis of HCC were 63%, 90% respectively for AFP using a cutoff value of 19.96 ng/ml; 60% and 92% for VEGF at cut off 268 and 73% and 84 % for TGF-alpha using a cutoff value of 13.95 pg/ml. VEGF may be useful serum marker for detection of HCC in addition to traditional markers.