Liver echogenicity by ultrasound to predict liver fibrosis of chronic hepatitis B patients without clear treatment indications

Objective: To evaluate the value of liver echogenicity in predicting liver fibrosis in chronic hepatitis B patients who have no clear indication for antiviral treatment. Methods: One hundred and sixty five chronic hepatitis B (CHB) patients who had no clear indication for antiviral treatment, and who underwent liver biopsies were included in this study. Ultrasound parameters and 11 serum makers were assessed retrospectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed. Results: Among the ultrasound parameters and serum makers, only liver echogenicity showed a significant difference (P < 0.009) between the mild (Metavir fibrosis stage F < 2) and severe groups (Metavir fibrosis stage F >= 2). Increased liver echogenicity (=2) had a sensitivity of 18.3%, a specificity of 94.6%, and a PPV of 72.2%. Coarse liver echogenicity had a sensitivity of 67.6%, a specificity of 47.87% and a NPV of 66.2%. Conclusion: In this study ultrasound was not found to be reliable in evaluating liver fibrosis. Patients with normal ultrasound result need advanced investigations such as MRI, FibroScan and liver biopsy. Increased liver echogenicity may be a potential treatment indication for CHB patients.