title: Acoustic radiation force impulse elastography and serum fibrosis markers in chronic hepatitis C.
abstract: OBJECTIVE
  Liver biopsy (LB) remains the gold standard for the assessment of liver fibrosis, although it is invasive and can have complications. The present study compares several noninvasive methods of fibrosis assessment in chronic hepatitis C (CHC), including acoustic radiation force impulse (ARFI) elastography, aspartate aminotransferase:platelet ratio index (APRI), Forns, FIB-4, and King scores versus percutaneous LB.
  
  
  METHODS
  This prospective study enrolled 51 untreated CHC patients. Biological tests necessary for the calculation of the scores (according to the classic formulas) were performed within a week of LB. The time interval between LB and tissue stiffness, assessed according to the Metavir score, was <6 months. Cutoff values were determined using area under receiver-operating characteristic curves (AUROC).
  
  
  RESULTS
  The best test for predicting significant fibrosis (F ≥2 Metavir) was ARFI elastography with an AUROC of 0.90, followed by FIB-4 (AUROC = 0.86), King (AUROC = 0.85), Forns (AUROC = 0.84), and APRI (AUROC = 0.82). For a cutoff of 1.31 m/s, ARFI had 89.3% sensitivity (Se) and 87% specificity (Sp). The best test for predicting cirrhosis was ARFI elastography with an AUROC of 0.98, followed by FIB-4 (AUROC = 0.94), King (AUROC = 0.90), APRI (AUROC = 0.82), and Forns (AUROC = 0.81). For a cutoff of 1.95 m/s, ARFI had 100% Se and 95.2% Sp.
  
  
  CONCLUSIONS
  ARFI elastography had very good accuracy for the assessment of liver fibrosis. It was more effective than APRI, Forns, King, and FIB-4 scores for the prediction of significant fibrosis and cirrhosis in CHC patients.
authors.affiliation: Liver and Portal Hypertension Group, Santa Casa de São Paulo School of Medical Sciences , São Paulo , Brazil.
authors.forename: Roberto Gomes
authors.initials: RG
authors.lastname: Silva Junior
authors.forename: Joel
authors.initials: J
authors.lastname: Schmillevitch
authors.forename: Maria de Fátima Araujo
authors.initials: Mde F
authors.lastname: Nascimento
authors.forename: Maria Luiza Queiroz
authors.initials: ML
authors.lastname: Miranda
authors.forename: Paulo Eugênio Araujo Caldeira
authors.initials: PE
authors.lastname: Brant
authors.forename: Perla Oliveira
authors.initials: PO
authors.lastname: Schulz
authors.forename: Andrea
authors.initials: A
authors.lastname: Vieira
authors.forename: Luiz Arnaldo
authors.initials: LA
authors.lastname: Szutan
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases
keywords: acoustic radiation force impulse; cirrhosis; diagnosis; liver biopsy; liver disease