Veeramachaneni H, Moazzami B, Sharif N, Qayed E, Miller LS. Correlation of liver imaging and transient elastography among patients with hepatitis C at a safety net hospital. World J Hepatol 2025; 17(4): 105065 [DOI: 10.4254/wjh.v17.i4.105065]
Corresponding Author of This Article
Lesley S Miller, MD, FACP, Professor, Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, United States. lmille2@emory.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2025; 17(4): 105065 Published online Apr 27, 2025. doi: 10.4254/wjh.v17.i4.105065
Correlation of liver imaging and transient elastography among patients with hepatitis C at a safety net hospital
Hima Veeramachaneni, Bobak Moazzami, Navila Sharif, Emad Qayed, Lesley S Miller
Hima Veeramachaneni, Division of Transplant Surgery and Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
Bobak Moazzami, Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
Navila Sharif, J Willis Hurst Internal Medicine Residency Program, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
Emad Qayed, Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, United States
Lesley S Miller, Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, United States
Author contributions: Veeramachaneni H, Qayed E, and Miller LS designed the study; Veeramachaneni H, Moazzami B, Sharif N, and Qayed E, and Miller LS analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Emory University, approval No. STUDY00001504.
Informed consent statement: Our study received an institutional review board statement waiver for informed consent and was a retrospective study with de-identified information so we do not have a signed informed consent document.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Our study received an institutional review board statement waiver for informed consent, but the presented data are anonymized, and the risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lesley S Miller, MD, FACP, Professor, Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, United States. lmille2@emory.edu
Received: January 10, 2025 Revised: March 3, 2025 Accepted: April 8, 2025 Published online: April 27, 2025 Processing time: 105 Days and 11.5 Hours
Abstract
BACKGROUND
Liver imaging and transient elastography (TE) are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus (HCV) infection. However, the diagnostic accuracy of conventional imaging in detecting fibrosis and steatosis in this patient population remains unclear.
AIM
To investigate the correlation between steatosis and fibrosis and abnormal findings on liver imaging in patients with HCV.
METHODS
We conducted a retrospective cross-sectional analysis of patients with HCV at Grady Liver Clinic who had TE exams between 2018-2019. We analyzed the correlation of controlled attenuation parameter and liver stiffness measurement on TE and abnormal findings on liver imaging. Liver imaging findings (hepatic steatosis, increased echogenicity, cirrhosis, and chronic liver disease) were further evaluated for their diagnostic performance in detecting fibrosis (≥ F2, ≥ F3, ≥ F4) and steatosis (≥ S1, ≥ S2, ≥ S3).
RESULTS
Of 959 HCV patients who underwent TE, 651 had liver imaging. Higher controlled attenuation parameter scores were observed in patients with abnormal liver findings (P = 0.0050), hepatic steatosis (P < 0.0001), and increased echogenicity (P < 0.0001). Higher liver stiffness measurement values were also noted in those with abnormal liver (P < 0.0001) and increased echogenicity (P = 0.0026). Steatosis severity correlated with hepatic steatosis (r = 0.195, P < 0.001) and increased echogenicity (r = 0.209, P < 0.001). For fibrosis detection, abnormal liver imaging had moderate sensitivity (81.7%) and specificity (70.4%) for cirrhosis (≥ F4), while cirrhosis on imaging had high specificity (99.2%) but low sensitivity (18.3%). Increased echogenicity showed high specificity (92.8%) but low sensitivity (20.9%) for steatosis detection.
CONCLUSION
Liver imaging detects advanced fibrosis and steatosis but lacks early-stage sensitivity. Integrating TE with imaging may improve evaluation in patients with HCV.
Core Tip: Conventional liver imaging and transient elastography (TE) are commonly used to assess liver fibrosis and steatosis in individuals with hepatitis C virus. This study evaluates the diagnostic performance of imaging findings in detecting fibrosis and steatosis across different disease stages and their correlation with TE measurements. While imaging demonstrates high specificity for advanced liver disease, its limited sensitivity in earlier disease stages underscores the need for a multimodal approach. These findings help inform clinicians in resource-limited settings on the strengths and limitations of liver imaging when TE is unavailable.
