Liver stiffness measurement using acoustic radiation force impulse (ARFI) elastography and effect of necroinflammation.
BACKGROUND
Acoustic radiation force impulse (ARFI) elastography can be used to assess the degree of liver fibrosis.


OBJECTIVE
We evaluated the performance of ARFI elastography in assessment of liver fibrosis and compared it with the performance of aspartate aminotransferase-to-platelet ratio index (APRI) and transient elastography with Fibroscan (FS).


METHODS
We prospectively analyzed 250 consecutive patients who underwent liver biopsy and ARFI from June 2010 to May 2011. Reliable FS values were obtained for 97 (38.8%) patients.


RESULTS
The mean age of patients (147 male and 103 female) was 46.6 years. Liver stiffness values obtained by use of ARFI elastography significantly correlated with histological fibrosis stage (R = 0.575, P < 0.001). Area under the receiver operating characteristics curves (AUROCs) of ARFI elastography for predicting significant fibrosis (≥F2) and cirrhosis (F4) was 0.74 (95% confidence interval [CI], 0.64-0.86, P = 0.001) and 0.79 (95% CI, 0.67-0.91, P = 0.001), respectively, and those for APRI were 0.69 (95% CI, 0.58-0.79, P = 0.001) and 0.76 (95% CI, 0.64-0.85, P < 0.001), respectively. The optimum cutoff values for ARFI elastography were 1.13 m/s for ≥F2 and 1.98 m/s for F4; these decreased to 1.09 m/s for ≥F2 and 1.81 m/s for F4 when 131 patients with normal alanine aminotransferase (ALT) were selected. In the sub-group of 97 patients with reliable FS values, the performance in predicting ≥F2 or F4 was equivalent between ARFI elastography and FS.


CONCLUSIONS
ARFI elastography is a reliable surrogate marker of liver fibrosis, if its relationship with biochemical markers, for example ALT level, is taken into account.
Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
Ki Tae
KT
Yoon
Sun Min
SM
Lim
Jun Yong
JY
Park
Do Young
DY
Kim
Sang Hoon
SH
Ahn
Kwang-Hyub
KH
Han
Chae Yoon
CY
Chon
Mong
M
Cho
Jun Woo
JW
Lee
Seung Up
SU
Kim
D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000032:analysis / Q000378:metabolism*; D001707:Biopsy, Needle; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006505:Hepatitis / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D001219:Aspartate Aminotransferases