title: Non-invasive evaluation of hepatic manifestation in Wilson disease with transient elastography, ARFI, and different fibrosis scores.
abstract: OBJECTIVE
  Noninvasive investigation of liver fibrosis with ultrasound-based elastography and laboratory-based fibrosis indices have been established in various chronic liver diseases within the last years. We aimed to evaluate feasibility and diagnostic value of transient elastography (TE), acoustic radiation force impulse imaging (ARFI), and different serologic fibrosis indices in Wilson's disease (WD).
  
  
  METHODS
  TE and ARFI were performed in 50 Wilson patients. In addition, AST/Platelet Ratio Index (APRI), FIB-4, and Forns score were calculated. Hepatic fibrosis was classified by a clinical score.
  
  
  RESULTS
  Of the 50 Wilson patients 41 had hepatic manifestation of WD. TE results were significantly increased in advanced hepatic fibrosis (7.0 ± 2.2 kPa; p < 0.05) and cirrhosis (10.1 ± 6.73 kPa; p < 0.05) compared to individuals without hepatic manifestation (5.0 ± 1.4 kPa). Right liver lobe ARFI (R-ARFI) values were only increased in cirrhotic patients (1.43 ± 0.28 vs. 1.19 ± 0.14 m/s; p < 0.05). The cutoff values to best discriminate cirrhosis were 6.1 kPa for TE and 1.29 m/s for R-ARFI. Left lobe ARFI failed to provide additional diagnostic benefit. Elastography methods displayed a significant correlation with APRI, FIB-4, and Forns indices (Pearson's rho > 0.33; p < 0.03).
  
  
  CONCLUSIONS
  TE displayed a gradual increase between different stages of hepatic manifestation in WD and could significantly discriminate cirrhosis. The TE cutoff for cirrhosis may be clinically more relevant than the R-ARFI value.
authors.affiliation: Department of Internal Medicine, Neurology and Dermatology, Medical Clinic for Gastroenterology and Rheumatology, University Hospital of Leipzig, Liebigstrasse 20, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlas
authors.forename: Maria
authors.initials: M
authors.lastname: Hempel
authors.forename: Michael
authors.initials: M
authors.lastname: Tröltzsch
authors.forename: Dominik
authors.initials: D
authors.lastname: Huster
authors.forename: Peter
authors.initials: P
authors.lastname: Günther
authors.forename: Hannelore
authors.initials: H
authors.lastname: Tenckhoff
authors.forename: Joachim
authors.initials: J
authors.lastname: Mössner
authors.forename: Thomas
authors.initials: T
authors.lastname: Berg
authors.forename: Volker
authors.initials: V
authors.lastname: Keim
authors.forename: Johannes
authors.initials: J
authors.lastname: Wiegand
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006527:Hepatolenticular Degeneration / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D001219:Aspartate Aminotransferases