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Updated: Jul 18, 2025
Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Dual elastography to discriminate adjacent stages of fibrosis and inflammation in chronic hepatitis B: A prospective
Dou Jianping1, Chen Xi1, Cheng Guangwen2
1Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Insights
Dual elastography accurately differentiates liver fibrosis and inflammation in chronic HBV patients. This advanced technique shows high diagnostic performance, outperforming other methods for continuous assessment.
Area of Science:
- Hepatology
- Medical Imaging
- Diagnostic Performance Evaluation
Background:
- Chronic Hepatitis B (HBV) infection poses a significant global health burden.
- Accurate staging of liver fibrosis and inflammation is crucial for patient management.
- Current diagnostic methods have limitations in continuous assessment of liver disease severity.
Purpose of the Study:
- To evaluate the diagnostic performance of dual elastography (dual-elasto) for continuous differentiation of liver fibrosis and inflammation.
- To assess the influence of inflammation on fibrosis staging using dual-elasto.
- To compare dual-elasto performance against existing biomarkers and methods.
Main Methods:
- Prospective cohort study including adult patients with chronic HBV.
- Dual-elastography examinations followed by liver biopsy within 3 days.
- Development and validation of series logistic regression models and decision trees.
- Training and validation sets comprised 560 and 240 patients, respectively.
Main Results:
- Dual-elasto series models achieved high AUCs (0.82-0.96) for fibrosis staging (≥F1-F4) in the validation set.
- AUCs for inflammation staging (≥G1-G4) ranged from 0.84-0.95.
- Performance significantly surpassed serum markers and shear wave elastography for most stages.
- Decision trees enabled 5 continuous classifications for fibrosis and inflammation.
Conclusions:
- Dual elastography demonstrates high diagnostic performance for continuous discrimination of fibrosis and inflammation in HBV patients.
- The technique is effective for diagnosing mild fibrosis, independent of inflammation.
- Dual-elasto offers a promising non-invasive approach for comprehensive liver disease assessment.
Background And Aims:
To evaluate the diagnostic performance of dual elastography (dual-elasto) in continuous differentiation of liver fibrosis and inflammation in a large prospective cohort of patients with chronic HBV.
Approach And Results:
Adults with positive HBsAg for at least 6 months were recruited from 12 medical centers. Participants underwent dual-elasto evaluations. Biopsy was performed 3 days after dual-elasto examination. Four logistic regression models were trained and strung together into series models. Decision trees based on the series models were performed to achieve continuous differentiation of liver fibrosis and inflammation. The influence of inflammation on the fibrosis stage was also evaluated. A total of 560 patients were included in the training set and 240 in the validation set. Areas under the receiver operating characteristic curve of the series model were 0.82, 0.86, 0.93, and 0.96 to predict ≥F1, ≥F2, ≥F3, and F4 in the validation set, which were significantly higher than those of serum markers and shear wave elastography (all p < 0.05), except for the ≥ F1 levels ( p = 0.09). The AUCs of the series model were 0.93, 0.86, 0.95, and 0.84 to predict inflammation stages ≥G1, ≥G2, ≥G3, and G4, respectively. Decision trees realized 5 continuous classifications of fibrosis and inflammation. Inflammation could enhance the mild fibrosis stage classification while showing limited influences on severe fibrosis or cirrhosis diagnosis.
Conclusions:
Dual-elasto demonstrated high performance in the continuous discrimination of fibrosis and inflammation in patients with HBV and could be used to diagnose mild fibrosis without the influence of inflammation.
