title: Changes in liver stiffness using acoustic radiation force impulse imaging in patients with obstructive cholestasis and cholangitis.
abstract: BACKGROUND
  Acoustic radiation force impulse imaging is used to assess stages of liver fibrosis. The aim of our study was to evaluate liver stiffness changes in patients with biliary obstruction with or without sclerosing cholangitis after biliary drainage.
  
  
  METHODS
  A total of 71 patients were enrolled in this prospective study (cohort N=51, control group N=20); 51 patients with obstructive cholestasis, indicated for endoscopic retrograde cholangiography, received stiffness measurement by acoustic radiation force impulse imaging before and 1-2 days after endoscopic retrograde cholangiography. Seventeen patients with obstructive cholestasis had primary or secondary sclerosing cholangitis. Forty one patients had a follow-up acoustic radiation force impulse imaging measurement after 3.0 ± 9.31 weeks.
  
  
  RESULTS
  In all patients with obstructive cholestasis, stiffness decreased significantly after biliary drainage (p<0.001). The main decrease was observed within 2 days after endoscopic retrograde cholangiography (1.92-1.57 m/s, p<0.001) and correlated with the decrease of bilirubin and alkaline phosphatase (p=0.04 and p=0.002, respectively). In patients with sclerosing cholangitis, the initial decrease of stiffness after biliary drainage was weaker than in those without (2.1-1.85 m/s vs. 1.81-1.43 m/s, p=0.016).
  
  
  CONCLUSIONS
  Acoustic radiation force impulse imaging elastography shows that liver stiffness is increased by biliary obstruction, and decreases after endoscopic retrograde cholangiography irrespective of the aetiology. In patients with sclerosing cholangitis the reduction in stiffness after biliary drainage is impaired.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Department of Gastroenterology, Hepatology and Endemic Medicine, Beni Suef University, Beni Suef, Egypt.
authors.forename: Dina
authors.initials: D
authors.lastname: Attia
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Pischke
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Negm
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Kinan
authors.initials: K
authors.lastname: Rifai
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gebel
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Tim O
authors.initials: TO
authors.lastname: Lankisch
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. Electronic address: potthoff.andrej@mh-hannover.de.
authors.forename: Andrej
authors.initials: A
authors.lastname: Potthoff
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D002779:Cholestasis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D004322:Drainage; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: ARFI; Biliary obstruction; Cholangitis; Cholestasis; Liver stiffness