Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging for evaluating fibrosis regression in chronic hepatitis C patients after direct-acting antiviral

Table 1 Comparison of demographic and clinical data of patients

Parameters	Ishak 0-2 (n = 9)	Ishak 3-4 (n = 18)	Ishak 5-6 (n = 12)
Age (yr)	36.3 ± 15.5	37.9 ± 12.4	53.1 ± 11.0b
Male, n (%)	2 (22.2)	11 (61.1)	7 (58.3)
ALT (U/L)	44 (22.5)	52.5 (35.5)	75.5 (98.7)a
TB (μmol/L)	11 (7.5)	14 (3.5)	12.5 (7.5)
Alb (g/L)	46.78 ± 3.77	45.72 ± 3.75	44.17 ± 3.35
INR	0.99 ± 0.07	1.00 ± 0.09	1.09 ± 0.16
PLT (× 109/L)	171 (62.5)	177.5 (64.7)	114 (67.5)b
HCV RNA (log10 IU/mL)	6.43 ± 0.96	6.50 ± 0.71	6.33 ± 0.64
mHAI score	3.4 ± 1.7	5.3 ± 1.6a	11.3 ± 4.0c

^aP < 0.05 compared with patients with Ishak 0-2.

^bP < 0.01 compared with patients with Ishak 0-2.

^cP < 0.001 compared with patients with Ishak 0-2.

ALT: Alanine aminotransferase; TB: Total bilirubin; INR: International normalized ratio; HCV: Hepatitis C virus; mHAI: Modified histology activity index.

Table 2 Clinical characteristics of patients for pre and post sustained virological response

	Pre SVR	Post SVR	Z/t value	P value
ALT (U/L)	55 (29.5)	17 (11)	-4.015	< 0.001
AST (U/L)	40 (29.5)	20 (10.5)	-4.016	< 0.001
TB (μmol/L)	14 (6.5)	15.5 (11.3)	-0.541	0.588
Alb (g/L)	44.90 ± 3.40	47.43 ± 3.06	-3.919	0.001
Platelet (× 109/L)	165 (87)	199 (130)	-2.576	0.01
INR	1.04 ± 0.14	1.02 ± 0.07	0.425	0.675
mHAI score, n (%)			-2.362	0.023
0-4	5 (24)	15 (71)
5-8	10 (48)	4 (9)
13-18	6 (28)	2 (10)
Ishak score, n (%)			-0.370	0.713
0-2	5 (24)	7 (33)
3-4	9 (43)	7 (33)
5-6	7 (33)	7 (33)
APRI	0.58 (1.32)	0.25 (0.40)	-4.015	< 0.001
FIB-4	1.34 (3.61)	0.99 (1.81)	-3.007	0.003
LSM (kpa)	6.6 (7.5)	5.8 (4.0)	-2.746	0.006
CEI	1.65 ± 0.11	1.68 ± 0.16	-1.087	0.29

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; APRI: AST-to platelet ratio index; CEI: Contrast enhancement index; HCV: Hepatitis C virus; INR: International normalized ratio; mHAI: Modified histology activity index; LSM: Liver stiffness measurement; SVR: Sustained virological response; TB: Total bilirubin.

Table 3 Distribution of patients in stratified analysis

Stratified analysis	Group 1	Group 2	Group 3
mHAI score	Ishak score
	0-2	3-4	5-6
0-4	14	11	1
5-8	3	13	9
13-18	0	0	9
Ishak score	mHAI score
	0-4	5-8	13-18
0-4	14	2	0
3-4	10	15	0
5-6	1	9	9

mHAI: Modified histology activity index.

Table 4 The area under receiver operating curve and cut-off value for liver cirrhosis and significant liver fibrosis at pre-sustained virological response and post-sustained virological response with contrast enhancement index, aspartate aminotransferase-to-platelet ratio index, Fibrosis-4 and liver stiffness measurement

	Ishak score ≥ 5		Ishak score ≥ 3
	Pre SVR	Post SVR	Pre SVR	Post SVR
CEI
AUROC (95%CI)	0.93 (0.74, 0.97)	0.87 (0.65, 0.97)	0.88 (0.79, 1.00)	0.87 (0.71, 1.00)
Cut-off value	1.58	1.59	1.71	1.68
LSM
AUROC (95%CI)	0.87(0.71, 1.00)	0.87(0.79, 1.00)	0.91(0.78, 1.00)	0.80(0.60,0.98)
Cut-off value	10.8	7.1	6.2	5.95
APRI
AUROC (95%CI)	0.89(0.72, 1.00)	0.89(0.74, 1.00)	0.83(0.64, 1.00)	N2
Cut-off value	1.05	0.241	0.39	N2
FIB-4
AUROC (95%CI)	0.92(0.80, 1.00)	0.92(0.79, 1.00)	0.80(0.58, 1.00)	N2
Cut-off value	1.78	1.281	0.87	N2

¹The cutoff values of aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) or the diagnosis of liver cirrhosis decreased dramatically after sustained virological response (SVR).

²N: No diagnosis value of APRI or FIB-4 in patients with significant fibrosis after achieving SVR.

APRI: Aspartate aminotransferase-to-platelet ratio index; AUROC: Area under receiver operating curve; CEI: Contrast enhancement index; CI: Confidence interval; FIB-4: Fibrosis-4; LSM: Liver stiffness measurement; SVR: Sustained virological response.

Table 5 Relationship between the changes of contrast enhancement index, aminotransferase-to-platelet ratio index, Fibrosis-4, liver stiffness measurement and fibrosis regression

	Fibrosis regression		P value
	Yes (n = 7)	No (n = 14)
CEI%1	107.36 ± 6.33	99.23 ± 7.14	0.020
LSM%	72.06 ± 20.32	81.31 ± 27.44	0.441
APRI%	45.40 ± 13.16	42.51 ± 16.41	0.702
FIB-4%	90.39 ± 24.09	75.69 ± 23.66	0.936

¹Value% = Value_post/Value_pre × 100%.

CEI: Contrast enhancement index; SVR: Sustained virological response; LSM: Liver stiffness measurement; APRI: Aspartate aminotransferase-to-platelet ratio index; FIB-4: Fibrosis-4.