Abstract
Background
Acoustic radiation force impulse (ARFI) elastography can be used to assess the degree of liver fibrosis.
Aim
We evaluated the performance of ARFI elastography in assessment of liver fibrosis and compared it with the performance of aspartate aminotransferase-to-platelet ratio index (APRI) and transient elastography with Fibroscan (FS).
Methods
We prospectively analyzed 250 consecutive patients who underwent liver biopsy and ARFI from June 2010 to May 2011. Reliable FS values were obtained for 97 (38.8%) patients.
Results
The mean age of patients (147 male and 103 female) was 46.6 years. Liver stiffness values obtained by use of ARFI elastography significantly correlated with histological fibrosis stage (R = 0.575, P < 0.001). Area under the receiver operating characteristics curves (AUROCs) of ARFI elastography for predicting significant fibrosis (≥F2) and cirrhosis (F4) was 0.74 (95% confidence interval [CI], 0.64–0.86, P = 0.001) and 0.79 (95% CI, 0.67–0.91, P = 0.001), respectively, and those for APRI were 0.69 (95% CI, 0.58–0.79, P = 0.001) and 0.76 (95% CI, 0.64–0.85, P < 0.001), respectively. The optimum cutoff values for ARFI elastography were 1.13 m/s for ≥F2 and 1.98 m/s for F4; these decreased to 1.09 m/s for ≥F2 and 1.81 m/s for F4 when 131 patients with normal alanine aminotransferase (ALT) were selected. In the sub-group of 97 patients with reliable FS values, the performance in predicting ≥F2 or F4 was equivalent between ARFI elastography and FS.
Conclusions
ARFI elastography is a reliable surrogate marker of liver fibrosis, if its relationship with biochemical markers, for example ALT level, is taken into account.
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Abbreviations
- ARFI:
-
Acoustic radiation force impulse
- FS:
-
Fibroscan
- AUROC:
-
Area under the receiver operating characteristic
- APRI:
-
Aspartate aminotransferase-to-platelet ratio index
- CI:
-
Confidence interval
- LSM:
-
Liver stiffness measurement
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- ULN:
-
Upper limit of normal
- ROI:
-
Region of interest
- kPa:
-
Kilopascal
- IQR:
-
Interquartile range
- PPV:
-
Positive predictive value
- NPV:
-
Negative predictive value
- ROC:
-
Receiver operating characteristic
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Acknowledgments
This study was supported by a grant from the Korea Healthcare technology R&D project, Ministry of Health and Welfare, Republic of Korea (A102065).
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Ki Tae Yoon and Sun Min Lim contributed equally to this work.
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10620_2012_2044_MOESM1_ESM.tif
Supplementary Fig. 1. Median LSM values using ARFI elastography according to fibrosis stage and activity grade. The Y-axis represents the median LSM values (m/s) using ARFI elastography, which tended to increase with fibrosis stage and activity grade. LSM, liver stiffness measurement; ARFI, acoustic radiation force impulse. (TIFF 36 kb)
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Yoon, K.T., Lim, S.M., Park, J.Y. et al. Liver Stiffness Measurement Using Acoustic Radiation Force Impulse (ARFI) Elastography and Effect of Necroinflammation. Dig Dis Sci 57, 1682–1691 (2012). https://doi.org/10.1007/s10620-012-2044-4
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DOI: https://doi.org/10.1007/s10620-012-2044-4