Real-Time Elastography: Noninvasive Diagnostic Tool in the Evaluation of Liver Stiffness in Patients with Chronic Viral Hepatitis, Correlation with Histological Examination

Dig Dis. 2018;36(4):289-297. doi: 10.1159/000480699. Epub 2018 Apr 26.


Purpose: To determine the value of real-time elastography (RTE) in the assessment of liver stiffness in patients with chronic viral hepatitis, correlating RTE data with the extent of fibrosis based on biopsy findings (Ishak score).

Methods: We evaluated 98 patients (45-75 years) with chronic viral hepatitis (51 HCV, 47 HBV) by using ultrasonography (US) study combined with RTE analysis. In the RTE images, relative tissue stiffness is expressed, according to color scale, with soft areas represented in green/red colors and hard areas in blue. We divided the patients into 2 groups based on the fibrosis degree: soft degree (D1, corresponding to F1-F3 Ishak score) and hard degree (D2, corresponding to F4-F6). Before RTE, all patients underwent a US-guided percutaneous liver biopsy (right lobe).

Results: Quantitative RTE data were compared with liver biopsy by using the Spearman correlation coefficient in order to assess the correlation between the RTE (D) and fibrosis, according to Ishak score (F) at histology. At RTE, out of 98 patients 55 had degree D1 and 43 had degree D2; at histological analysis, we observed the following: 15 patients with F1, 28 with F2, 17 with F3, 16 with F4, 12 with F5, and 10 with F6. The Spearman's coefficient showed significant correlation between D and F degree, obtaining rho = 0.573, p = 0.003.

Conclusions: RTE analysis showed high diagnostic accuracy in the assessment of fibrosis, and it appears to be a useful diagnostic tool for noninvasive quantification of fibrosis in patients with chronic viral hepatitis.

Keywords: Chronic hepatitis; Cirrhosis; Elastography; Liver fibrosis; Ultrasound imaging.

MeSH terms

  • Adult
  • Aged
  • Area Under Curve
  • Biomechanical Phenomena
  • Computer Systems*
  • Elasticity Imaging Techniques / methods*
  • Female
  • Hepatitis C, Chronic / diagnosis*
  • Hepatitis C, Chronic / pathology*
  • Hepatitis C, Chronic / physiopathology
  • Humans
  • Image Processing, Computer-Assisted
  • Liver / pathology*
  • Liver / physiopathology*
  • Male
  • Middle Aged
  • ROC Curve
  • Sensitivity and Specificity
  • Statistics, Nonparametric