Staging Chronic Hepatitis B Related Liver Fibrosis with Diffusion-weighted MRI-based Virtual Elastography: Comparisons with Serum Fibrosis Indexes.

Aim: To evaluate and compare the diagnostic performance of diffusion-weighted imaging (DWI)-based virtual magnetic resonance (MR) elastography and serum fibrosis indexes for staging liver fibrosis in patients with chronic hepatitis B (CHB).

Materials And Methods: This retrospective study included 145 patients with CHB. Virtual shear modulus (μ) was derived from DWI acquisition with b values of 200 and 1500/mm. Aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), S index, Fibro Q and gamma-glutamyl transpeptidase to platelet ratio (GPR) were calculated. The diagnostic efficacies of μ and serum indexes for staging liver fibrosis were compared.

Results: μ APRI, FIB-4, S index, Fibro Q, and GPR increased as the hepatic fibrosis progressed (r=0.23-0.52, P<0.05). Areas under the curves (AUCs) of μ were 0.725, 0.817 and 0.764 for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. μ had greater AUC over FIB-4 (0.686) and Fibro Q (0.638) for advanced fibrosis (P<0.05). The AUCs of combination of μ with APRI, FIB-4, S index, Fibro Q, and GPR individually were 0.779, 0.772, 0.763, 0.728, and 0.756 for significant fibrosis, 0.856, 0.842, 0.834, 0.831, and 0.834 for advanced fibrosis, 0.811, 0.818, 0.784, 0.835, and 0.788 for cirrhosis, respectively. The AUCs of the combinations were significantly higher than individual serum index for advanced fibrosis and cirrhosis (all P<0.05).

Conclusion: DWI-based virtual MR elastography could estimate liver fibrosis stages in patients with CHB, which outperformed FIB-4 and Fibro Q for advanced fibrosis. The combination of μ with each serum index appears superior to individual serum index for advanced fibrosis and cirrhosis.