To evaluate the diagnostic value of acoustic radiation force impulse (ARFI) imaging combined with transient elastography (TE) for liver fibrosis in chronic hepatitis B (CHB) patients.

One hundred and twenty-one patients with CHB were included from October 2015 to June 2017 at the Fourth Hospital of Harbin Medical University. Liver biopsy, routine biochemical tests, ARFI, and TE were carried out. The age, AST, ALT, ARFI, and TE were calculated and analyzed by one-way ANOVA, followed by pairwise comparisons using the SNK-q test. The results of ARFI and TE were compared with pathological results. Using the pathological stage of liver fibrosis as the ″golden standard″, the accuracy of ARFI and TE in diagnosing different stages of liver fibrosis were assessed by receiver operating characteristic (ROC) curve analysis. Logistic regression was used to predict the risk of joint diagnosis, and ROC curve was drawn based on the predicted value to compare the diagnostic value of ARFI, TE, and their combination in S≥1 and S≥2 liver fibrosis.

ARFI and TE were positively correlated with the fibrosis degree, and the correlation coefficients were 0.789 and 0.845, respectively (P<0.0001). The areas under the ROC cruves (AUROCs) of ARFI imaging and TE were 0.849 and 0.903 (P=0.424) in diagnosing S≥1 liver fibrosis, 0.874 and 0.923 (P=0.191) for S≥2, 0.938 and 0.954 (P=0.526) for S≥3, and 0.913 and 0.926 (P=0.842) for S4, respectively. The AUROC of ARFI plus TE for diagnosis of S≥1 liver fibrosis was 0.925, with no significant improvement compared with either of them (P>0.05), but the sensitivity, specificity, and accuracy of the combination were improved. The AUROC of the combined diagnosis for S≥2 was 0.949, which was only better than that of ARFI alone (P=0.009), but the sensitivity and accuracy of the combination were improved.

ARFI combined with TE improves the diagnosis of S≥1 and S≥2 liver fibrosis.