Open Access Research article

Effects of patient factors on noninvasive liver stiffness measurement using acoustic radiation force impulse elastography in patients with chronic hepatitis C

Sheng-Hung Chen12, Yu-Fen Li3, Hsueh-Chou Lai14, Jung-Ta Kao12, Cheng-Yuan Peng15*, Po-Heng Chuang12, Wen-Pang Su12 and I-Ping Chiang56

Author Affiliations

1 Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, No 2 Yuh-Der Road, Taichung, 40402, Taiwan

2 China Medical University, Taichung, 40402, Taiwan

3 Institute of Biostatistics Center, China Medical University, Taichung, 40402, Taiwan

4 College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan

5 School of Medicine, China Medical University, Taichung, 40402, Taiwan

6 Department of Pathology, China Medical University Hospital, Taichung, 40402, Taiwan

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BMC Gastroenterology 2012, 12:105  doi:10.1186/1471-230X-12-105

Published: 10 August 2012



Previous research has shown variation in the effects of patient factors, including hepatic necroinflammatory activity, on liver stiffness measurement (LSM). This prospective study attempts to identify explanatory factors for LSM in patients with chronic hepatitis C (CHC) using acoustic radiation force impulse (ARFI) technology.


A cohort of 127 Taiwanese patients with CHC underwent ARFI LSM and immediate percutaneous liver biopsy. This study compares the concurrent diagnostic performances of LSM and FibroTest using receiver operating characteristic (ROC) curves. Three multiple linear regression models were used to evaluate the significance of concurrent patient factors in explaining LSM.


To classify METAVIR fibrosis (F) stages, the areas under ROC curves (AUCs) were ARFI LSM, 0.847 (95% confidence interval (CI), 0.779-0.914) and FibroTest, 0.823 (95% CI, 0.748-0.898), for F1 versus F2-4; ARFI LSM, 0.902 (95% CI, 0.835-0.970) and FibroTest, 0.812 (95% CI, 0.735-0.888), for F1-2 versus F3-4; ARFI LSM, 0.831 (95% CI, 0.723-0.939) and FibroTest, 0.757 (95% CI, 0.648-0.865), for F1-3 versus F4. After adjusting for other demographic and biological covariates, biochemical and histological necroinflammatory factors consistently explained LSM. Factors included serum alanine aminotransferase (ALT)/upper limit of normal (ULN) categories (model R2 = 0.661, adjusted R2 = 0.629), ActiTest A scores (R2 = 0.662, adjusted R2 = 0.636), and METAVIR activity (A) grades (R2 = 0.651, adjusted R2 = 0.620). METAVIR F stages, body mass index, and platelet count were also independently associated with LSM. Necroinflammatory degrees, including ALT/ULN, ActiTest A scores, and METAVIR A grades, explained the false positivity of liver fibrosis staging using ARFI LSM.


The degree of hepatic necroinflammatory activity independently and significantly exaggerated liver fibrosis evaluation using ARFI LSM. However, comparisons with concurrent FibroTest indicate that ARFI LSM may be a promising alternative, or adjunctive single indicator, for liver fibrosis evaluation in patients with CHC.

Liver fibrosis; Cirrhosis; Acoustic radiation force impulse; FibroTest; ActiTest; Chronic hepatitis C