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Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Real-time tissue elastography (RTE), acoustic radiation force impulse (ARFI) imaging, and transient elastography (TE) are new technologies that are used for liver stiffness evaluation. The aim of this study was to compare these methods in the same population and to determine their diagnostic accuracy in the prediction of liver fibrosis.

Methods

Forty-five consecutive, previously biopsied, patients with chronic liver disease and 27 normal subjects underwent TE, RTE, and ARFI on the right liver lobe. Correlation coefficients between measurements, Metavir fibrosis stage, and histological necro-inflammatory activity (adjusted for fibrosis stage) were evaluated via Spearman’s rank order correlation coefficients. Areas under the receiver operating characteristic curve (AUROCs) were calculated to predict each fibrosis stage.

Results

Failure or inconsistent results occurred in 12.5% of the attempts at TE, but in none of the attempts at RTE and ARFI. The three methods showed high correlation with fibrosis and poor correlation with necro-inflammatory activity. TE and ARFI exhibited high diagnostic accuracy (AUROCs ≥0.9) in diagnosing cirrhosis (F4 Metavir). All three methods presented fair (AUROCs >0.7) to good (AUROCs >0.8) diagnostic accuracy in diagnosing fibrosis (F1–4 Metavir) and significant fibrosis (F2–4 Metavir), with TE showing the best performance (AUROCs were 0.878 for fibrosis and 0.897 for significant fibrosis).

Conclusions

TE and ARFI provide high diagnostic accuracy in the diagnosis of cirrhosis. When feasible, TE may perform better than RTE and ARFI in predicting fibrosis and significant fibrosis, but larger studies are needed.

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Fig. 1
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Abbreviations

LS:

Liver stiffness

TE:

Transient elastography

RTE:

Real-time tissue elastography

ARFI:

Acoustic radiation force impulse

SWV:

Shear wave velocity

CLD:

Chronic liver disease

References

  1. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495–500.

    Article  PubMed  CAS  Google Scholar 

  2. Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol. 2003;39:239–44.

    Article  PubMed  Google Scholar 

  3. Regev A, Berho M, Jeffers LJ, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002;97:2614–8.

    Article  PubMed  Google Scholar 

  4. Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960–74.

    Article  PubMed  Google Scholar 

  5. Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2007;5:1214–20.

    Article  PubMed  Google Scholar 

  6. Castera L, Forns X, Alberti A. Non invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48:835–47.

    Article  PubMed  Google Scholar 

  7. Castera L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828–35.

    PubMed  Google Scholar 

  8. Sporea I, Sirli RL, Deleanu A, Popescu A, Focsa M, Danila M, et al. Acoustic radiation force impulse elastography and liver biopsy in patients with chronic hepatopathies. Ultraschall Med. 2011;32(Suppl 1):S46–52.

    Article  PubMed  Google Scholar 

  9. Boursier J, Konate A, Gorea G, Reaud S, Quemener E, Oberti F, et al. Reproducibility of liver stiffness measurements by ultrasonographic elastometry. Clin Gastroenterol Hepatol. 2008;6:1263–9.

    Article  PubMed  Google Scholar 

  10. Lebray P, Fedchuk L, Pais R, Varaut A, Ingiliz P, De Torres M, Ngo Y, Poynard T, Ratziu V. Clinically significant variability of liver stiffness measurements alters short-term follow-up of patients with chronic liver disease. Hepatology. 2010;52(Suppl):964A.

    Google Scholar 

  11. Friedrich-Rust M, Ong MF, Herrmann E, Dries V, Samaras P, Zeuzem S, Sarrazin C. Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis. Am J Roentgenol. 2007;188:758–64.

    Google Scholar 

  12. Fierbinteanu-Braticevici C, Andronescu D, Usvat R, Cretoiu D, Baicus C, Marinoschi G. Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis. World J Gastroenterol. 2009;15:5525–32.

    Article  PubMed  Google Scholar 

  13. Takahashi H, Ono N, Eguchi Y, Egushi T, Kitajima Y, Kawaguchi Y, Nakashita S, Ozaki I, Mizuta T, Toda S, Kudo S, Miyoshi A, Miyazaki K, Fujimoto K. Evaluation of acoustic radiation force impulse elastography for fibrosis staging of chronic liver disease: a pilot study. Liver Int. 2009;30:538–45.

    Article  PubMed  Google Scholar 

  14. Koizumi Y, Hirooka M, Kisaka Y, Konishi I, Abe M, Murakami H, Matsuura B, Hiasa Y, Onji M. Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography—establishment of the method for measurement. Radiology. 2011;258:610–7.

    Article  PubMed  Google Scholar 

  15. Boursier J, Isselin G, Fouchard-Hubert I, Oberti F, Dib N, Lebigot J, Bertrais S, Gallois P, Calès P, Aubé C. Acoustic radiation force impulse: a new ultrasonographic technology for the widespread noninvasive diagnosis of liver fibrosis. Eur J Gastroenterol Hepatol. 2010;22:1074–84.

    Article  PubMed  Google Scholar 

  16. Morikawa H, Fukuda K, Kobayashi S, Fujii H, Iwai S, Enomoto M, Tamori A, Sakagichi H, Kawada N. Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C. J Gastroenterol. doi:10.1007/s00535-010-0301-x (published online).

  17. Tatsumi C, Kudo M, Ueshima K, Kitai S, Ishikawa E, Yada N, Hagiwara S, Inoue T, Minami Y, Chung H, Maekawa K, Fujimoto K, Kato M, Tonomura A, Mitake T, Shiina T. Non-invasive evaluation of hepatic fibrosis for type C chronic hepatitis. Intervirology. 2010;53:76–81.

    Article  PubMed  Google Scholar 

  18. Friedrich-Rust M, Scwartz A, Ong M, Dries V, Schirmacher P, Hermann E, Samaras P, Bojunga J, Bohle RM, Zeuzem S, Sarrazin C. Real-time tissue elastography versus Fibroscan for noninvasive assessment of liver fibrosis in chronic liver disease. Ultraschall Med. 2009;30:478–84.

    Article  PubMed  CAS  Google Scholar 

  19. Yoneda M, Suzuki K, Kato S, Fujita K, Nozaki Y, Hosono K, Saito S, Nakajima A. Nonalcoholic fatty liver disease: US based acoustic radiation force impulse elastography. Radiology. 2010;256:640–7.

    Article  PubMed  Google Scholar 

  20. Lupsor M, Badea R, Stefanescu H, Sparchez Z, Branda H, Serban A, Maniu A. Performance of a new elastographic method (ARFI technology) compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results. J Gastrointest Liver Dis. 2009;18:303–10.

    Google Scholar 

  21. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR cooperative study group. Hepatology. 1996;24:289–93.

    Article  PubMed  CAS  Google Scholar 

  22. Delacour H, Servonnet A, Perrot A, Vigezzi JF, Ramirez JM. ROC curve: principles and application in biology. Ann Biol Clin. 2005;63:145–53.

    CAS  Google Scholar 

  23. Toshima T, Shirabe K, Takeishi K, Motomura T, Mano Y, Uchiyama H, Yoshizumi T, Soejima Y, Taketomi A, Maehara Y. New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver. J Gastroenterol. 2011. doi:10.1007/s00535-010-0365-7.

  24. Friedrich-Rust M, Wunder K, Kriener S, Sotoudeh F, Richter S, Bojunga J, Hermann E, Pynard T, Dietrich CF, Vermehren J, Zeuzem S, Sarrazin C. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology. 2009;252:595–604.

    Article  PubMed  Google Scholar 

  25. Sporea I, Sirli R, Popescu A, Danila M. Acoustic radiation force impulse (ARFI), a new modality for the evaluation of liver fibrosis. Med Ultrason. 2010;12:26–31.

    PubMed  Google Scholar 

  26. Myers RP, Pomier-Layrargues G, Duarte-Rojo A, Wong DK, Beaton MD, Levstik MA, Kirsch R, Pollet A, Crotty PM, Sasso MC, Landau M, Elkashab M. Performance of the Fibroscan XL probe for liver stiffness measurement in obese patients: a multicenter validation study. Hepatology. 2010;52(Suppl 4):1121A.

    Google Scholar 

  27. Wang J, Guo L, Shi X, Pan W, Bai Y, Ai H. Real-time elastography with a novel quantitative technology for assessment of liver fibrosis in chronic hepatitis B. Eur J Radiol. 2010. doi:10.1016/j.erad.2010.12.013.

  28. Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology. 2008;48:418–31.

    Article  PubMed  Google Scholar 

  29. McMahon BJ. Natural history of chronic hepatitis B. Clin Liver Dis. 2010;14:381–96.

    Article  PubMed  Google Scholar 

  30. Argo CK, Caldwell SH. Epidemiology and natural history of non-alcoholic steatohepatitis. Clin Liver Dis. 2009;13:511–31.

    Article  PubMed  Google Scholar 

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Conflict of interest

The following authors have nothing to disclose: S. Colombo, M. Buonocore, C. Jamoletti, A. Del Poggio, S. Elia, M. Mattiello, D. Zabbialini, P. Del Poggio.

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Authors and Affiliations

  1. Hepatology Unit, Treviglio Hospital, Piazza Ospedale n.1, 24047, Treviglio (Bergamo), Italy

    Silvia Colombo, Marco Buonocore, Anna Del Poggio, Carlo Jamoletti & Paolo Del Poggio

  2. Radiology Department, Treviglio Hospital, Piazza Ospedale n.1, 24047, Treviglio (Bergamo), Italy

    Stefano Elia, Mario Mattiello & Davide Zabbialini

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  1. Silvia Colombo
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  2. Marco Buonocore
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Correspondence to Paolo Del Poggio.

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Colombo, S., Buonocore, M., Del Poggio, A. et al. Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis. J Gastroenterol 47, 461–469 (2012). https://doi.org/10.1007/s00535-011-0509-4

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  • DOI: https://doi.org/10.1007/s00535-011-0509-4

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