title: Liver and spleen transient elastography and Acoustic Radiation Force Impulse Measurements. Performance and comparison of measurements in the same area concurrently assessed for liver fibrosis by biopsy.
abstract: OBJECTIVE
  The estimation of the degree of liver fibrosis is important for prognosis, surveillance, and treatment of chronic liver disease. Although liver biopsy is the gold standard for diagnosis, it is subject to sampling error, while ultrasound-based techniques, such as Acoustic Radiation Force Impulse (ARFI) and transient elastography, have gained popularity. However, no previous comparative study has performed these ultrasound techniques at the time of biopsy. The aim of this study was to compare the reliability of these techniques to define the severity of liver fibrosis in viral hepatitis patients.
  
  
  METHODS
  We compared liver transient elastography and Acoustic Radiation Force Impulse measurements, performed along the intended biopsy track, with liver biopsy results in 46 viral hepatitis patients, all measured on the same morning. Fibrosis was measured by histology using the Ishak fibrosis staging.
  
  
  RESULTS
  The relative sensitivity and specificity of different incremental cut-off values for both techniques, and the predictive ability of pairwise comparison of the 3 tests (including APRI) and of their combined use with more severe grades of histology-measured liver fibrosis, show that the single variable with greatest sensitivity and specificity is TE with a cut-off of >10.0.
  
  
  CONCLUSIONS
  Transient elastography has a better performance than ARFI, which has a lower sensitivity, in the diagnosis of severe stages of fibrosis. Also ARFI of the spleen is correlated with Ishak fibrosis staging, and could be a possible additional tool for the diagnosis of liver fibrosis.
authors.affiliation: Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Catania, Italy; Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK. Electronic address: trovatofrancesca@gmail.com.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Trovato
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Azienda Ospedaliero Universitaria, Sassari, Italy; Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Sebastiana
authors.initials: S
authors.lastname: Atzori
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tooley
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Marcinkowski
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Mary M E
authors.initials: MM
authors.lastname: Crossey
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Nimzing G
authors.initials: NG
authors.lastname: Ladep
authors.affiliation: Emergency Department, MCAU, Vittorio Emanuele Hospital, Catania, Italy.
authors.forename: Giuseppe F
authors.initials: GF
authors.lastname: Martines
authors.affiliation: Department of Histopathology, Imperial College Faculty of Medicine at St Mary's Hospital, London, UK.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Goldin
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000473:pathology*
keywords: AST to platelet ratio index; Acoustic Radiation Force Impulse; Liver fibrosis; Transient elastography; Viral hepatitis