title: Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy.
abstract: Nonalcoholic fatty liver disease (NAFLD) has become a major public health issue. The goal of this study was to assess the clinical use of liver stiffness measurement (LSM) evaluated by supersonic shear imaging (SSI), FibroScan, and acoustic radiation force impulse (ARFI) in a cohort of NAFLD patients who underwent liver biopsy. A total of 291 NAFLD patients were prospectively enrolled from November 2011 to February 2015 at 2 French university hospitals. LSM was assessed by SSI, FibroScan (M probe), and ARFI within two weeks prior to liver biopsy. Calculations of the area under the receiver operating curve (AUROC) were performed and compared for the staging of liver fibrosis. AUROC for SSI, FibroScan, and ARFI were 0.86, 0.82, and 0.77 for diagnoses of ≥F2; 0.89, 0.86, and 0.84 for ≥F3; and 0.88, 0.87, and 0.84 for F4, respectively. SSI had a higher accuracy than ARFI for diagnoses of significant fibrosis (≥F2) (P = 0.004). Clinical factors related to obesity such as body mass index ≥ 30 kg/m(2) , waist circumference ≥102 cm or increased parietal wall thickness were associated with LSM failures when using SSI or FibroScan and with unreliable results when using ARFI. In univariate analysis, FibroScan values were slightly correlated with NAFLD activity score and steatosis (R = 0.28 and 0.22, respectively), whereas SSI and ARFI were not; however, these components of NAFLD did not affect LSM results in multivariate analysis. The cutoff values for SSI and FibroScan for staging fibrosis with a sensitivity ≥90% were very close: 6.3/6.2 kPa for ≥F2, 8.3/8.2 kPa for ≥F3, and 10.5/9.5 kPa for F4.
  
  
  
  Although obesity is associated with an increase in LSM failure, the studied techniques and especially SSI provide high value for the diagnosis of liver fibrosis in NAFLD patients. (Hepatology 2016;63:1817-1827).
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.|INSERM U1053, University of Bordeaux, Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cassinotto
authors.affiliation: Department of Hepatology, University Hospital of Angers, France.|Laboratory HIFIH, UPRES 3859, LUNAM University, Angers, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Boursier
authors.affiliation: INSERM U1053, University of Bordeaux, Bordeaux, France.|Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.affiliation: Laboratory HIFIH, UPRES 3859, LUNAM University, Angers, France.|Department of Radiology, University Hospital of Angers, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Lebigot
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lapuyade
authors.affiliation: Department of Hepatology, University Hospital of Angers, France.|Laboratory HIFIH, UPRES 3859, LUNAM University, Angers, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Cales
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Hiriart
authors.affiliation: Laboratory HIFIH, UPRES 3859, LUNAM University, Angers, France.|Department of Pathology, University Hospital of Angers, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Michalak
authors.affiliation: INSERM U1053, University of Bordeaux, Bordeaux, France.|Department of Pathology, Hôpital Pellegrin, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Brigitte Le
authors.initials: BL
authors.lastname: Bail
authors.affiliation: Laboratory HIFIH, UPRES 3859, LUNAM University, Angers, France.|Department of Radiology, University Hospital of Angers, France.
authors.forename: Victoire
authors.initials: V
authors.lastname: Cartier
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Amaury
authors.initials: A
authors.lastname: Mouries
authors.affiliation: Department of Hepatology, University Hospital of Angers, France.|Laboratory HIFIH, UPRES 3859, LUNAM University, Angers, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.affiliation: Department of Hepatology, University Hospital of Angers, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fouchard-Hubert
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.affiliation: Laboratory HIFIH, UPRES 3859, LUNAM University, Angers, France.|Department of Radiology, University Hospital of Angers, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Aubé
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D055815:Young Adult