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Liver Stiffness Measurement Using Acoustic Radiation Force Impulse (ARFI) Elastography and Effect of Necroinflammation

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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).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea

    Ki Tae Yoon & Mong Cho

  2. Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun–gu, Seoul, 120–752, Korea

    Sun Min Lim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon & Seung Up Kim

  3. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

    Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon & Seung Up Kim

  4. Department of Radiology, Pusan National University School of Medicine, Yangsan, Korea

    Jun Woo Lee

  5. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

    Ki Tae Yoon, Mong Cho & Jun Woo Lee

  6. Liver Cirrhosis Clinical Research Center, Seoul, Korea

    Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon & Seung Up Kim

Authors
  1. Ki Tae Yoon
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  2. Sun Min Lim
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  8. Mong Cho
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  10. Seung Up Kim
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Corresponding author

Correspondence to Seung Up Kim.

Additional information

Ki Tae Yoon and Sun Min Lim contributed equally to this work.

Electronic supplementary material

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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

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