title: Can acoustic radiation force impulse elastography be a substitute for liver biopsy in predicting liver fibrosis?
abstract: OBJECTIVE
  To evaluate the clinical feasibility and accuracy of acoustic radiation force impulse (ARFI) elastography for the detection of liver fibrosis in patients with chronic viral hepatitis.
  
  
  METHODS
  ARFI-based ultrasound elastography was performed in 69 patients with chronic liver disease (CLD) of viral aetiology and 36 healthy volunteers. Fifty-eight patients with CLD also underwent liver biopsy.
  
  
  RESULTS
  ARFI was feasible in all 36 healthy volunteers and all 69 CLD patients, while valid measurements were obtained in 65 patients (95.6%) and all healthy volunteers. The mean shear-wave velocity (SWV) in healthy volunteers was 1.12±0.2 m/s. A gradual increase in mean SWV was noted from fibrosis of Grade F0 to F6 (Ishak's score) and a high positive correlation was found between the mean SWV on ARFI and fibrosis scores at liver biopsy (rho=0.789). The difference between the mild (F1 and F2) versus significant fibrosis (F3 and F4) was also statistically significant (p<0.001). The difference in the SWV measurements obtained from consecutive groups (i.e., F1 versus F2, F2 versus F3, and F3 versus F4) was not statistically significant. Using the area under the receiver operating characteristic curve (AUROC), the best calculated cut-off SWVs for the presence of fibrosis (≥F1), significant fibrosis (≥F3), severe fibrosis (≥F4), and cirrhosis (F6) were found to be 1.207, 1.347, 1.513, and 1.92 m/s, respectively. ARFI values were significantly higher in cirrhotic patients than in other patients (p<0.001).
  
  
  CONCLUSIONS
  ARFI elastography allows valid non-invasive evaluation of liver stiffness and may help to distinguish between no/mild fibrosis and significant fibrosis and guide management decisions.
authors.affiliation: Department of Radiodiagnosis, Lok Nayak Hospital, India. Electronic address: drviren21may@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Jain
authors.affiliation: Department of Radiodiagnosis, Lok Nayak Hospital, India.
authors.forename: R
authors.initials: R
authors.lastname: Dixit
authors.affiliation: Department of Radiodiagnosis, Lok Nayak Hospital, India.
authors.forename: V
authors.initials: V
authors.lastname: Chowdhury
authors.affiliation: Department of Gastroenterology, G B Pant Hospital, Maulana Azad Medical College, New Delhi 110002, India.
authors.forename: A S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Pathology, G B Pant Hospital, Maulana Azad Medical College, New Delhi 110002, India.
authors.forename: R
authors.initials: R
authors.lastname: Gondal
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D002908:Chronic Disease; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity