Published online Sep 25, 2024. doi: 10.5501/wjv.v13.i3.96369
Revised: June 23, 2024
Accepted: July 15, 2024
Published online: September 25, 2024
Processing time: 116 Days and 1 Hours
Chronic hepatitis C (CHC) is a health burden with consequent morbidity and mortality. Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment. Noninvasive alternatives for liver biopsy such as transient elastography (TE) and diffusion-weighted magnetic resonance imaging (DW-MRI) are critical needs.
To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.
This prospective cross-sectional study initially recruited 100 children with CHC virus infection. Sixty-four children completed the full set of investigations including liver stiffness measurement (LSM) using TE and measurement of apparent diffusion coefficient (ADC) of the liver and spleen using DW-MRI. Liver biopsies were evaluated for fibrosis using Ishak scoring system. LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.
Most patients had moderate fibrosis (73.5%) while 26.5% had mild fibrosis. None had severe fibrosis or cirrhosis. The majority (68.8%) had mild activity, while only 7.8% had moderate activity. Ishak scores had a significant direct correlation with LSM (P = 0.008) and were negatively correlated with both liver and spleen ADC but with no statistical significance (P = 0.086 and P = 0.145, respectively). Similarly, histopathological activity correlated significantly with LSM (P = 0.002) but not with liver or spleen ADC (P = 0.84 and 0.98 respectively). LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages (area under the curve = 0.700 and 0.747, respectively) with a better performance of liver ADC.
TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.
Core Tip: Although liver biopsy is not a necessity in the diagnosis of hepatitis C virus and is no longer a prerequisite for starting antiviral therapy, it remains a critical necessity to assess liver fibrosis for prognostic purposes. Noninvasive prediction of liver fibrosis is a challenging issue, especially in the pediatric population. Several studies have evaluated noninvasive serological and radiological tools for fibrosis prediction, among which are liver stiffness measurement using transient elastography (TE) and apparent diffusion coefficient using diffusion-weighted magnetic resonance imaging. The current study evaluated TE and diffusion-weighted magnetic resonance imaging compared to liver biopsy in assessing liver fibrosis.