title: Liver stiffness measurement by acoustic radiation force impulse is useful in predicting the presence of esophageal varices or high-risk esophageal varices among patients with HCV-related cirrhosis.
abstract: BACKGROUND
  Screening and periodic surveillance for esophageal varices (EVs) by esophagogastroduodenoscopy (EGD) are recommended for cirrhotic patients. We investigated non-invasive liver stiffness measurement using acoustic radiation force impulse (ARFI) for the diagnosis of EV presence and high-risk EVs among patients with HCV-related cirrhosis.
  
  
  METHODS
  Among 181 consecutive patients with HCV-related cirrhosis, we studied 135 patients who had received EGD and ARFI. Serum fibrosis markers [platelet count, FIB-4, and aspartate aminotransferase-to-platelet ratio index (APRI)] were measured in a training set of 92 patients and compared with ARFI in the diagnostic performance for EV presence and high-risk EVs. Furthermore, the obtained optimal cutoff values of ARFI were prospectively examined in a validation set of 43 patients.
  
  
  RESULTS
  In the training set, the ARFI value increased with the EV grade (p < 0.001). The ARFI value for high-risk EVs was significantly higher than that for low-risk EVs (p < 0.001). AUROC values for diagnosis of EV presence and high-risk EVs by ARFI were 0.890 and 0.868, which had the highest diagnostic performance among factors including serum fibrosis markers. The optimal cutoff value of ARFI for EV presence was 2.05 m/s with good sensitivity (83%), specificity (76%), PPV (78%), and NPV (81%), and that for high-risk EVs was 2.39 m/s with good sensitivity (81%), specificity (82%), PPV (69%), and NPV (89%). These cutoff values obtained in the training cohort also showed excellent performance in the validation set.
  
  
  CONCLUSIONS
  Liver stiffness measurement by ARFI is useful in predicting EV presence or high-risk EVs among patients with HCV-related cirrhosis.
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan, n.morishita@gh.med.osaka-u.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Morishita
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiramatsu
authors.forename: Tsugiko
authors.initials: T
authors.lastname: Oze
authors.forename: Naoki
authors.initials: N
authors.lastname: Harada
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamada
authors.forename: Masanori
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yakushijin
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyagi
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Tomohide
authors.initials: T
authors.lastname: Tatsumi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kanto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D004945:Esophagoscopy; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers