Acoustic radiation force impulse predicts long-term outcomes in a large-scale cohort: High liver cancer, low comorbidity in hepatitis B virus

Figure 1 Patient flow chart. HCC: Hepatocellular carcinoma; ARFI: Acoustic radiation force impulse; HBV: Hepatitis B; HCV: Hepatitis C; NBNC: Non-hepatitis B, hepatitis C.

Figure 2 Cumulative risk of hepatocellular carcinoma after enrollment in different acoustic radiation force impulse-fibrosis grades. Higher risk of hepatocellular carcinoma (HCC) was found in acoustic radiation force impulse (ARFI)-severe fibrosis and -cirrhosis grades than in none to moderate fibrosis grades. The 5-year risk of HCC was 9.8 % for ARFI fibrosis graded as cirrhosis; 5.9% for that graded as severe fibrosis; and only 1.7%-2.0% for that lower or equal to moderate fibrosis. Purple: Cirrhosis; Yellow: Severe fibrosis; Green: Moderate fibrosis, Blue: None or mild fibrosis [Log rank test: P = 0.026 (3 vs 4); P = 0.015 (3 vs 1 + 2); P < 0.001 (4 vs 1 + 2)]. HCC: Hepatocellular carcinoma; ARFI: Acoustic radiation force impulse.

Figure 3 Area under the receiver operating characteristic curve of hepatocellular carcinoma prediction in different non-invasive scoring models. A: Within 3-year period after enrollment; B: Within 5-year period after enrollment. The area under the receiver operating characteristic curve (AUROC) shows that acoustic radiation force impulse (ARFI) or FIB4 alone give similar 3- or 5-year predictions of hepatocellular carcinoma (HCC) (AUROC around 0.739-0.756). After adding G (gender score), E (etiology score), A (age score), and P (platelet score), the AUROC may increase to 0.772-0.840. Both ARFI and FIB4 models predict 3- or 5-year HCC quite satisfactorily, suggesting that fibrosis is the main risk factor for HCC. ARFI: Acoustic radiation force impulse; FIB4: Fibrosis index based on four factors; G: Gender score, male = 2, female = 0; E: Etiology score, hepatitis B virus (HBV) = 3, HCV = 2, NBNC = 1; A: Age score (year), 0-35 = 0, 35-40 = 1, 40-45 = 2, 45-50 = 3, 50-55 = 4, 55-60 = 5; > 60 = 6; P: Platelet score (10⁹), 0-100 = 3, 100-150 = 2, > 150 = 1; Sen: Sensitivity; Spe: specificity; HCC: Hepatocellular carcinoma; ARFI: Acoustic radiation force impulse; FIB4: Fibrosis-4 index.