To evaluate the diagnostic performance of a model constructed based on ultrasound combined with elastography for significant hepatic inflammation in patients with chronic hepatitis B.

This was a multicenter prospective study, in which patients with chronic hepatitis B were recruited from six medical institutions between October 2020 and March 2022. All patients underwent liver needle biopsy and combined ultrasound-elastography examination. Hepatic inflammatory activity was graded according to the Scheuer scoring system, and pathological inflammation was classified as either non-significant (Scheuer score ≤G1) or significant (Scheuer score ≥G2). The patients were divided into a training set (from 3 centers), a validation set (from 1 center), and a test set (from 2 centers). Biomarkers, ultrasound parameters and demographic characteristics were analyzed using the random forest method. Stepwise regression was used for feature selection to obtain the optimal subset, which was incorporated into logistic regression to establish a diagnostic model. Receiver operating characteristic (ROC) curves were generated to evaluate the model's performance in diagnosing significant hepatic inflammation (≥G2) in the three datasets, and its performance was then compared with traditional inflammatory assessment methods, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and both ALT and AST ≥5 times the upper limit of normal (ULN).

A total of 792 patients were enrolled, including 463 in the training set, 166 in the validation set, and 163 in the test set. Nineteen covariates were initially included, and seven ultrasound features were selected for inclusion in the logistic regression model (named "Best Features"), including shear wave velocity (Vs), elastography (E), A index (liver combined elastography indicator), portal vein flow velocity, splenic length, splenic thickness, and abdominal wall thickness. The area under the ROC curve (AUC) of this model was 0.831 (95% confidence interval [CI]: 0.794–0.868) in the training set, 0.758 (95%CI: 0.681–0.834) in the validation set, and 0.726 (95%CI: 0.645–0.808) in the test set. In the training, validation, and test sets, the AUC values were 0.501, 0.537, and 0.540 for ALT, 0.516, 0.436, and 0.491 for AST, and 0.508, 0.519, and 0.481 for the combination of both ALT and AST ≥5 times ULN.

Ultrasound combined with elastography demonstrates high and stable diagnostic efficacy in evaluating significant hepatic inflammation in chronic hepatitis B, significantly outperforms traditional assessment methods, and can serve as a valuable reference for anti-inflammatory treatment in patients with chronic hepatitis B.