Factors associated with the impossibility to obtain reliable liver stiffness measurements by means of Acoustic Radiation Force Impulse (ARFI) elastography—Analysis of a cohort of 1031 subjects

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Abstract

Introduction

Acoustic Radiation Force Impulse (ARFI) elastography is a non-invasive technique for liver fibrosis assessment.

Aim

To assess the feasibility of ARFI elastography in a large cohort of subjects and to identify factors associated with impossibility to obtain reliable liver stiffness (LS) measurements by means of this technique.

Methods

Our retrospective study included 1031 adult subjects with or without chronic liver disease. In each subject LS was assessed by means of ARFI elastography. Failure of ARFI measurements was defined if no valid measurement was obtained after at least 10 shots and unreliable in the following situations: fewer than 10 valid shots; or median value of 10 valid measurements with a success rate (SR) < 60% and/or an interquartile range interval (IQR)  30%.

Results

Failure of LS measurements by means of ARFI was observed in 4 subjects (0.3%), unreliable measurements in 66 subjects (6.4%), so reliable measurements were obtained in 961 subjects (93.3%). In univariant analysis, the following risk factors were associated with failed and unreliable measurements: age over 58 years (OR = 0.49; 95% CI 0.30–0.80, p = 0.005), male gender (OR = 0.58; 95% CI 0.34–0.94, p = 0.04), BMI > 27.7 kg/m2 (OR = 0.23, 95% CI 0.13–0.41, p < 0.0001). In multivariate analysis all the factors mentioned above were independently associated with the risk of failed and unreliable measurements.

Conclusions

Reliable LS measurements by means of ARFI elastography were obtained in 93.3% of cases. Older age, higher BMI and male gender were associated with the risk of failed and unreliable measurements, but their influence is limited as compared with Transient Elastography.

Introduction

Acoustic Radiation Force Impulse (ARFI) elastography is a non-invasive method for liver fibrosis assessment, valuable for predicting significant and severe fibrosis and with excellent results for predicting liver cirrhosis [1], [2], [3]. This elastographic technique has applications also in other organs, such as spleen [4], [5], thyroid [6], [7], breast [8], kidney [9] or prostate [10].

The principle of ARFI elastography is based on the compression of the examined tissue that induces a smaller strain in hard tissues than in soft ones. The ultrasound probe automatically produces an acoustic “push” pulse that generates shear-waves which propagate into the tissue. Their speed, measured in meters/second (m/s), is displayed on the screen. Also, shear wave speed may be quantified, in a precise anatomical region, focused on a region of interest, with a predefined size (10 mm in length and 5 mm in width), provided by the system [11], [12].

Published studies showed high percentages of patients in whom liver stiffness (LS) could be evaluated by means of ARFI elastography [13], [14], [15], [16], but no data are available regarding the factors associated with the impossibility to obtain reliable LS measurements by means of this elastographic technique.

The aim of this study was to assess the feasibility of ARFI elastography in a large cohort of subjects and to identify factors associated with impossibility to obtain reliable LS measurements by means of this technique.

Section snippets

Subjects

Our retrospective study included 1031 adult subjects with or without chronic liver disease evaluated in our department between October 2009 and December 2012. We included in our study: healthy volunteers – defined as subjects without a history of hepatopathies, with a normal abdominal ultrasound, but additional tests as aminotransferases or viral markers were not performed; patients with chronic hepatitis B and C evaluated by means of ARFI elastography and liver biopsy (LB); patients diagnosed

Results

The main characteristics of the 1031 subjects included in this study are presented in Table 1.

From the 1031 subjects, failure of LS measurements by means of ARFI elastography was observed in 4 subjects (0.3%) and unreliable LS measurements in 66 subjects (6.4%), so reliable LS measurements were obtained in 961 subjects (93.3%).

In univariant analysis, older age, male gender and higher BMI were associated with the risk of failed and unreliable measurements (Table 2).

All factors associated with

Discussion

The feasibility of elastographic methods for the non-invasive evaluation of liver fibrosis is very important, because in order to be used in daily clinical practice, a method should be able to properly evaluate a large number of patients.

Large published studies in the field of TE demonstrated that reliable LS measurements, using the standard M-probe, are obtained in 70–85% of cases [19], [20]. Regarding ARFI elastography, because the manufacturer did not specify that quality criteria are needed

Conflict of interest

Ioan Sporea is in the Advisory Bord of Siemens from November 2013. The authors have any conflict of interest.

Acknowledgment

For the young researchers grant “Utilitatea metodelor elastografice de tip shear-waves în evaluarea pacienţilor cu ciroză hepatică” awarded by the “Victor Babeş” University of Medicine and Pharmacy Timişoara, Romania.

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