Abstract: Objective The aim of this study was to explore the diagnostic efficacy of real-time tissue elastography (RTE) in evaluating the liver fibrosis in patients with non-alcoholic steatohepatitis (NASH). Methods 159 patients with non-alcoholic fatty liver diseases (NAFLD), including simple fatty liver (SFL) in 89 cases, NASH in 47 cases and liver cirrhosis (LC) in 23 cases, and 53 healthy persons at physical examination were enrolled in our hospital between June 2021 and June 2022, and all underwent RTE examination. All patients with NAFLD received liver biopsies. The area under the receiver operating characteristic curve (AUROC) was applied to predict the diagnostic performance. Results The relative strain value in patients with LC was (94.3±13.5), significantly lower than [(105.2±20.6), P<0.05] in patients with NASH or [(115.1±9.8), P<0.05] in patients with SFL or [(121.3±17.1), P<0.05] in healthy control, but the percentage of blue area, complexity, measure skewness, contrast and clutter were(25.9±4.3)%, (38.5±4.2), (0.6±0.1), (241.0±30.5) and (0.4±0.1), all significantly higher than [(21.2±4.1)%, (31.9±3.7), (0.4±0.1), (191.3±27.9) and (0.2±0.1), P<0.05] in patients with NASH or [(16.2±1.9)%, (25.1±3.5), (0.3±0.1), (153.0±19.8) and (0.1±0.1), P<0.05] in patients with SFL or [(9.2±1.5)%, (19.5±2.4), (0.2±0.0), (113.5±20.3) and (0.1±0.0), P<0.05] in healthy persons; out the 47 patients with NASH, the histopathological examination showed liver fibrosis S0/S1 in 16 cases, S2 in 19 cases and S3 in 12 cases; the relative strain value in patients with S3 and with S2 were (101.2±7.9) and (106.7±10.3), significantly lower than [(112.5±9.8), P<0.05] in patients with S0/S1, while the percentage of blue area, complexity, measure skewness, contrast and clutter in patients with S3 were(23.1±3.4)%, (34.6±3.7), (0.4±0.1), (202.5±23.7) and (0.2±0.0), all significantly greater than [(19.8±2.5)%, (29.3±2.9), (0.3±0.1), (179.1±25.9) and (0.2±0.0), P<0.05] in patients with S2 or [(16.2±3.8)%, (25.9±3.5), (0.3±0.1), (152.8±21.1) and (0.1±0.1), respectively, P<0.05] in patients with S0/S1; the ROC analysis showed that the AUC was 0.977, with the sensitivity of 84.2%, the specificity of 66.7% and the accuracy of 77.4%, when the RTE parameters were synthetically applied to predict the significant and advanced liver fibrosis in patients with NASH. Conclusion The RTE parameters in deed has to some extent a diagnostic efficacy in predicting the significant and advanced liver fibrosis in patients with NASH, and needs further clinical investigation.

Key words: Non-alcoholic steatohepatitis, Liver fibrosis, Real-time tissue elastography, Diagnosis