title: Prospective Evaluation of Acoustic Radiation Force Impulse (ARFI) Elastography and High-Frequency B-Mode Ultrasound in Compensated Patients for the Diagnosis of Liver Fibrosis/Cirrhosis in Comparison to Mini-Laparoscopic Biopsy.
abstract: OBJECTIVE
  Ultrasound is a well-established noninvasive test for assessing patients with liver disease. This study aims to prospectively compare ultrasound to the new technique elastography (ARFI) for the assessment of liver fibrosis/cirrhosis.
  
  
  METHODS
  High-frequency B-mode ultrasound (liver surface/vein irregularity, liver homogeneity, spleen size), ARFI quantification, mini-laparoscopic liver evaluation including biopsy were prospectively obtained in compensated patients scheduled for liver biopsy. For the diagnosis of cirrhosis, a combined gold standard (cirrhosis at histology and/or at macroscopic liver evaluation) was used.
  
  
  RESULTS
  Out of 157 patients, 35 patients were diagnosed cirrhotic. Ultrasound (combination of liver vein and/or surface irregularity) showed no significant difference compared to ARFI quantification for the diagnosis of significant liver fibrosis (Ishak> = 3) and cirrhosis. Diagnosis of cirrhosis had a sensitivity/specificity/PPV/NPV of 83 %(± 12) / 82 %(± 7) / 57 %(± 14) / 94 %(± 4), respectively, with ultrasound and 86 %(± 12) / 81 %(± 7) / 57 %(± 13) / 95 %(± 4), respectively, with ARFI quantification. The sensitivity/specificity/PPV/NPV for the detection of significant fibrosis were 68 %(± 13) / 86 %(± 7) / 71 %(± 13) / 84 %(± 7), respectively, for ultrasound and 70 %(± 12) / 84 %(± 7) / 69 %(± 12) / 84 %(± 7), respectively, for ARFI quantification.
  
  
  CONCLUSIONS
  ARFI elastography and high-frequency B-mode ultrasound show similar and good results for the diagnosis of compensated liver cirrhosis and high-grade fibrosis. A key benefit of both methods is the high NPV suggesting them as noninvasive exclusion tests.
authors.affiliation: Department of Internal Medicine 1, University of Erlangen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Pfeifer
authors.affiliation: Department of Internal Medicine 1, University of Erlangen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Zopf
authors.affiliation: Department of Internal Medicine 1, University of Erlangen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Siebler
authors.affiliation: Institut of Medical Informatics, Biometry and Epidemiology, University of Erlangen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schwitulla
authors.affiliation: Department of Internal Medicine 1, University of Erlangen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Wildner
authors.affiliation: Institut of Pathology, University of Erlangen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Wachter
authors.affiliation: Department of Internal Medicine 1, University of Erlangen, Germany.
authors.forename: M F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Department of Internal Medicine 1, University of Erlangen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Strobel
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity