title: Liver fibrosis: noninvasive assessment with acoustic radiation force impulse elastography--comparison with FibroScan M and XL probes and FibroTest in patients with chronic liver disease.
abstract: OBJECTIVE
  To compare the diagnostic performance of acoustic radiation force impulse (ARFI) elastography with that of FibroScan M and XL probes and FibroTest in the staging of fibrosis in patients with chronic liver disease.
  
  
  METHODS
  This study received ethics approval, and all participants provided written informed consent. A total of 321 consecutive patients with chronic liver disease who underwent liver biopsy were prospectively enrolled from April 2010 to May 2012. Liver disease was caused by viral hepatitis (n = 136), alcoholic or nonalcoholic steatohepatitis disorders (n = 113), or some other disease (n = 72). In each patient, liver stiffness was evaluated with ARFI elastography, M and XL probes, and FibroTest within 1 month before liver biopsy. Histologic staging of liver fibrosis served as the reference standard.
  
  
  RESULTS
  Liver stiffness measurement failure rates were 11.2% with the M probe (36 of 321 patients), 2.3% with the XL probe (six of 260 patients), and 0% with ARFI elastography (0 of 321 patients). Unreliable results with ARFI elastography were more frequent in obese patients (those with a body mass index of 30 kg/m(2) or more) (42 of 86 patients [48.8%] vs 34 of 235 patients [14.5%], P < .0001). No significant difference was found between ARFI elastography and the M probe in the diagnosis of cirrhosis (area under under the receiver operating characteristic curve [Az], 0.88 vs 0.91; P = .12) or severe fibrosis (Az, 0.85 vs 0.89; P = .15); however, the M probe demonstrated better results in the diagnosis of moderate fibrosis (Az, 0.81 vs 0.88; P = .008). No significant difference was found between ARFI elastography and the XL probe in the diagnosis of moderate fibrosis, severe fibrosis, or cirrhosis. The diagnostic performance of ARFI elastography improved when it was applied in nonobese patients (Az of ARFI for cirrhosis and severe fibrosis = 0.92 and 0.91, respectively, in nonobese patients [P = .0002] and 0.63 and 0.63, respectively, in obese patients [P < .0001]).
  
  
  CONCLUSIONS
  ARFI elastography is reliable in the assessment of liver fibrosis in patients with chronic liver disease, especially nonobese patients.
authors: Service de Radiologie and Service d'hépato-gastro-entérologie, Centre d'investigation de la fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, Avenue de Magellan, 33604 Pessac, France; Service d'anatomo-pathologie, Hôpital Pellegrin, Centre Universitaire de Bordeaux, Bordeaux, France.
authors: Christophe
authors: C
authors: Cassinotto
authors: Bruno
authors: B
authors: Lapuyade
authors: Ania
authors: A
authors: Aït-Ali
authors: Julien
authors: J
authors: Vergniol
authors: Delphine
authors: D
authors: Gaye
authors: Juliette
authors: J
authors: Foucher
authors: Claire
authors: C
authors: Bailacq-Auder
authors: Faiza
authors: F
authors: Chermak
authors: Brigitte
authors: B
authors: Le Bail
authors: Victor
authors: V
authors: de Lédinghen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D054459:Elasticity Imaging Techniques / Q000295:instrumentation* / Q000379:methods*; D058625:End Stage Liver Disease / Q000097:blood* / Q000175:diagnosis*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014159:Transducers; D055815:Young Adult
chemical_list: D015415:Biomarkers