How efficient is acoustic radiation force impulse elastography for the evaluation of liver stiffness?

authors:

avatar Ioan Sporea ORCID 1 , * , avatar Radu Badea 2 , avatar Roxana Sirli 3 , avatar Monica Lupsor 2 , avatar Alina Popescu 3 , avatar Mirela Danila 3 , avatar Mircea Focsa 3 , avatar Alexandra Deleanu 3

Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, isporea@umft.ro, Romania
Ultrasonography Department, 3rd Medical Clinic, University of Medicine and Pharmacy, Romania
Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Romania
Hepatitis Monthly: Vol.11, issue 7; 532-538
article type: Research Article
received: December 12, 2010
accepted: March 4, 2011

how to cite: Sporea I, Badea R, Sirli R, Lupsor M, Popescu A, et al. How efficient is acoustic radiation force impulse elastography for the evaluation of liver stiffness?. Hepat Mon. 2011;11(7): 532-538. 

Abstract

Background: In chronic liver diseases, a correct estimation of the severity of liver fibrosis is important for recommendations regarding the treatment. Nowadays, evaluation of fibrosis is done by noninvasive methods such as biochemical scores and transient elastography instead of liver biopsy. The lack of sensitivity to detect fibrosis, because of its heterogeneity is a drawback of liver biopsy (LB).
Objectives: To compare transient elastography (TE) and acoustic radiation force impulse (ARFI) for the evaluation of liver stiffness (LS), against percutaneous LB.
Patients and Methods: Our study comprised of 223 subjects; 52 without fibrosis (38 volunteers and 14 patients with F0 on LB), 36 with F1, 40 with F2, 26 with F3 and 69 with liver cirrhosis (46 with LB and 23 with signs of cirrhosis). For each patient we performed in the same session 10 TE and 5 ARFI measurements. The median values were calculated.
Results: A strong linear correlation (Spearman rho = 0.870) was found between TE and fibrosis (P < 0.0001); there was also a weaker correlation between ARFI and fibrosis (Spearman rho = 0.646; P < 0.0001). TE measurements were also correlated with ARFI measurements (Spearman rho = 0.733, P < 0.0001). The best test for predicting significant fibrosis (F ≥ 2) was TE with a cut-off value of 7.1 kPa (AUROC 0.953). For ARFI, the cut-off value was 1.27 m/s-area under ROC curve (AUROC): 0.890, sensitivity (Se) of 88.7%, specificity (Sp) of 67.5%, positive predictive value (PPV) of 64.5%, and negative predictive value (NPV) of 90% (P = 0.0044). For predicting cirrhosis (F = 4), the optimum cut-off values were 14.4 kPa for TE (AUROC: 0.985, Se: 95.6%, Sp: 94.7%, PPV: 89.2%, NPV: 98%) and 1.7 m/s for ARFI (AUROC: 0.931, Se: 93%, Sp: 86.7%, PPV: 73.6%, NPV: 96.9%) (P = 0.0102).
Conclusions: LS evaluation by means of ARFI is not superior to TE for the assessment of liver fibrosis. ARFI is an accurate test for the diagnosis of cirrhosis.

  • Implication for health policy/practice/research/medical education:
    The correct evaluation of liver fibrosis in chronic diffuse hepatopathies is important for the management of these diseases and the noninvasive methods of evaluation may replace liver biopsy for this assessment in the future. Reading this article is recommended to all interested in this field.
  • Please cite this paper as:
    Sporea I, Badea R, Sirli R, Lupsor M, Popescu A, Danila M, et al. How efficient is acoustic radiation force impulse elastography for the evaluation of liver stiffness? Hepat Mon. 2011;11(7):532-8.

© 2011 Kowsar M.P.Co. All rights reserved.

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