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
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.
References (30)
- et al.
Renal ultrasound elastography
Diagn Interv Imaging
(2013) - et al.
Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility
Ultrasound Med Biol
(2002) - et al.
Quantifying hepatic shear modulus in vivo using acoustic radiation force
Ultrasound Med Biol
(2008) - et al.
Acoustic Radiation Force Impulse elastography for fibrosis evaluation in patients with chronic hepatitis C: an international multicenter study
Eur J Radiol
(2012) - et al.
Clinical feasibility of liver elastography by acoustic radiation force impulse imaging (ARFI)
Dig Liver Dis
(2011) - et al.
Factors which influence the accuracy of acoustic radiation force impulse (ARFI) elastography for the diagnosis of liver fibrosis in patients with chronic hepatitis C
Ultrasound Med Biol
(2013) - et al.
Factors influencing reliability of liver stiffness measurements using transient elastography (M-probe) – monocentric experience
Eur J Radiol
(2013) - et al.
Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease
J Hepatol
(2011) - et al.
Comparative study concerning the value of acoustic radiation force impulse elastography (ARFI) in comparison with transient elastography (TE) for the assessment of liver fibrosis in patients with chronic hepatitis B and C
Ultrasound Med Biol
(2012) - et al.
The influence of aminotransferase levels on the liver stiffness values as assessed by Acoustic Radiation Force Impulse Elastography - a multicentre study
Dig Liver Dis
(2013)
Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis
J Viral Hepat
The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis
Eur Radiol
Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis
Liver Int
Spleen assessment by Acoustic Radiation Force Impulse Elastography (ARFI) for prediction of liver cirrhosis and portal hypertension
Med Ultrason
Noninvasive assessment of liver fibrosis via spleen stiffness measurement using acoustic radiation force impulse sonoelastography in patients with chronic hepatitis B or C
J Viral Hepat
Cited by (65)
Reliability Criteria of Two-Dimensional Shear Wave Elastography: Analysis of 4277 Measurements in 788 Patients
2022, Clinical Gastroenterology and HepatologyLiver Elastography in Primary Sclerosing Cholangitis Patients Using Three Different Scanner Systems
2020, Ultrasound in Medicine and BiologyCitation Excerpt :The ICC for pSWE versus TE was excellent (0.91). The ICC for 2-D-SWE.GE versus pSWE or TE was only moderate (0.49 and 0.43, respectively), but improved markedly when excluding overweight individuals with a BMI >27–28 kg/m2, agreeing with reports of increased unreliable LSM measurements in patients with a BMI >27.7 kg/m2 (Bota et al. 2014). Exploring the intersystem difference for LSM values (ΔLSM), we found that these correlated with a few select parameters, which differed between each intersystem comparison.
Magnetic resonance elastography vs. point shear wave ultrasound elastography for the assessment of renal allograft dysfunction
2020, European Journal of RadiologyCorrelation between Liver Elasticity by Ultrasound Elastography and Liver Functional Reserve
2019, Ultrasound in Medicine and BiologyInfluence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology
2019, Ultrasound in Medicine and BiologyCitation Excerpt :Another study that included 13 patients with SCDs >3.50 cm found that increased acoustic power was necessary to obtain successful measurements (Deng et al. 2015). Several factors affect the SWE result, including body position (Goertz et al. 2012, Iwao et al. 1999), type of transducer (Goertz et al. 2012), food intake (Goertz et al. 2012), blood flow variations in the liver (depending on body position) (Grgurevic et al. 2011; Iwao et al. 1999), transjugular intrahepatic portosystemic shunt (TIPS) implantation (Piecha et al. 2018), respiratory phase (Goertz et al. 2012; Ling et al. 2013), physical effort (Gersak et al. 2016) and gender (Bota et al. 2013, 2014; Castera et al. 2010; Corpechot et al. 2006; Ling et al. 2013). In this study, we found that abdominal obesity had different effects in men and women.
- 1
Address: 10, Bd. Iosif Bulbuca, 300736 Timisoara, Romania. Tel.: +40 256488003; fax: +40 256488003.