Liver stiffness assessed by acoustic radiation force impulse (ARFI) technology is considerably increased in patients with cholestasis.
OBJECTIVE
To explore the impact of cholestasis on liver stiffness assessed by acoustic radiation force impulse (ARFI) technology.


METHODS
Over a period of four months, patients with sonographic cholestasis and increased cholestatic blood values (Bilirubin, γGT, AP > 2 times ULN) scheduled for endoscopic therapy were recruited. Exclusion criteria were: known liver disease; signs of cirrhosis at ultrasound (irregular liver veins and/or surface); heart insufficiency (NYHA III-VI). ARFI (Siemens S2000), ultrasound and blood examinations were performed before and in a subgroup after successful biliary drainage.


RESULTS
In total, 21 patients with cholestasis were included in the study. ARFI measurements were above the cut-off for cirrhosis (1.8  m/s) in all patients with a mean of 2.91  m/s ± 0.89  m/s without a history or signs of cirrhosis. Bilirubin, γGT and AP were elevated on average to 9.7 ± 5.3  mg/dl, 1192 ± 960  U/l and 730 ± 389  U/l. A subgroup of 10 patients was measured after successful drainage. ARFI measurements declined in all patients of that subgroup on average by 0.76  m/s at a mean time interval of 4.5 days (p < 0.001).


CONCLUSIONS
Cholestasis significantly increases liver stiffness assessed by ARFI. Therefore, it is important to exclude profound cholestasis when using ARFI for evaluating patients for liver fibrosis.
Departement of Internal Medicine 1, University of Erlangen.
L
L
Pfeifer
Departement of Internal Medicine 1, University of Erlangen.
D
D
Strobel
Departement of Internal Medicine 1, University of Erlangen.
M F
MF
Neurath
Departement of Internal Medicine 1, University of Erlangen.
D
D
Wildner
D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging*; D054459:Elasticity Imaging Techniques; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
D001663:Bilirubin