title: ARFI, FibroScan, ELF, and their combinations in the assessment of liver fibrosis: a prospective study.
abstract: OBJECTIVE
  Our aim was to evaluate a serologic marker (ELF) and two ultrasound-based methods (FibroScan and ARFI), as well as their combinations, in the assessment of liver fibrosis.
  
  
  METHODS
  One-hundred and forty-six patients (87 liver transplant recipients, 59 non-transplant patients) who underwent liver biopsy were prospectively included. We evaluated the diagnostic accuracy of FibroScan, ARFI, ELF and the combination of ELF with either ARFI or FibroScan. After analyzing in separate transplant and non-transplant patients, the whole cohort was divided into a training set and a validation set.
  
  
  RESULTS
  ARFI imaging was successfully performed across the whole cohort, while FibroScan failed in 16 (11%) patients. The three methods showed similar AUROCs and best cut-off values in transplant and non-transplant patients. In the training set, differences between the AUROCs of ARFI, FibroScan and ELF to diagnose F⩾2 (0.879, 0.861, and 0.764, respectively) and cirrhosis (0.936, 0.918, and 0.841) were not statistically significant, although both ultrasound-based methods showed higher accuracy than ELF. The combination of ELF with ARFI or FibroScan increased the negative and positive predictive values of single tests for the diagnosis of F ≥ 2 and cirrhosis. Similar results were obtained when the methods were tested in the validation set.
  
  
  CONCLUSIONS
  ARFI is as effective as either FibroScan or ELF in the non-invasive assessment of liver fibrosis, and its inclusion in an ultrasound device could facilitate its incorporation into routine clinical practice. The combination of ARFI or FibroScan with ELF may help better identify patients with or without significant fibrosis or cirrhosis.
authors.affiliation: Liver Unit, Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Crespo
authors.forename: Guillermo
authors.initials: G
authors.lastname: Fernández-Varo
authors.forename: Zoe
authors.initials: Z
authors.lastname: Mariño
authors.forename: Gregori
authors.initials: G
authors.lastname: Casals
authors.forename: Rosa
authors.initials: R
authors.lastname: Miquel
authors.forename: Stella M
authors.initials: SM
authors.lastname: Martínez
authors.forename: Rosa
authors.initials: R
authors.lastname: Gilabert
authors.forename: Xavier
authors.initials: X
authors.lastname: Forns
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jiménez
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies