Abstract
BACKGROUND AND AIMS: Chronic liver disease (CLD) represents a significant global health challenge necessitating the evaluation of liver fibrosis. This study aimed to evaluate the diagnostic performance of microvascular flow (MV-flow) imaging in evaluating liver fibrosis and compare it with other non-invasive tools. METHODS: Between July 2020 and June 2022, we prospectively enrolled patients scheduled for liver biopsy, concurrently measuring MV-flow imaging, transient elastography (TE), and two-dimensional shear wave elastography (2D-SWE) as part of the assessment process. We evaluated the diagnostic performance of MV-flow imaging, 2D-SWE, and TE based on histologic staging of liver fibrosis using the area under the receiver operating characteristic curve (AUROC), and calculated the optimal cut-off value. RESULTS: A total of 89 participants were included. Non-alcoholic fatty liver disease was the most common etiology of CLD (32.6%). The liver fibrosis stage distribution was as follows: stage 0 (11.2%), stage 1 (31.5%), stage 2 (25.8%), stage 3 (13.5%), and stage 4 (18.0%). The MV-flow scoring system's cut-off values and AUROCs for predicting stage 2, stage 3, and cirrhosis were 2.1 (0.836), 2.5 (0.955), and 2.9 (0.942), respectively. The MV-flow scoring system's performance in predicting advanced fibrosis (stage 3) was comparable to TE (p = 0.170) and 2D-SWE (p = 0.456). MV-flow imaging misclassified 9.0% of patients in predicting advanced fibrosis. A sequential combination of 2D-SWE and MV-flow imaging, following the specified cut-off, minimized the risk of missing advanced fibrosis to 1.2%. CONCLUSION: MV-flow imaging is an effective tool for predicting liver fibrosis stage. Integrating MV-flow imaging with 2D-SWE can enhance the assessment of liver fibrosis in patients with CLD.