Brief Article
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World J Gastroenterol. Mar 14, 2012; 18(10): 1077-1084
Published online Mar 14, 2012. doi: 10.3748/wjg.v18.i10.1077
Evaluation of acoustic radiation force impulse imaging for determination of liver stiffness using transient elastography as a reference
Gerald Kircheis, Abdurrahman Sagir, Christoph Vogt, Stephan vom Dahl, Ralf Kubitz, Dieter Häussinger
Gerald Kircheis, Abdurrahman Sagir, Ralf Kubitz, Dieter Häussinger, Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany
Christoph Vogt, Department of Internal Medicine, St. Josef Hospital Moers, Asberger Str. 4, Moers 47441, Germany
Stephan vom Dahl, Department of Internal Medicine/Gastroenterology, St. Franziskus Hospital, Schönsteinstraße 63, Köln 50825, Germany
Author contributions: Kircheis G and Sagir A contributed equally to the work in this paper; Kircheis G, Sagir A, and Häussinger D designed the study; Kircheis G, Sagir A, Vogt C, vom Dahl S, and Kubitz R performed the study; Kircheis G, Sagir A, and Häussinger D analyzed data; Kircheis G, Sagir A, Kubitz R, and Häussinger D wrote the paper.
Correspondence to: Dr. Dieter Häussinger, Professor, Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany. haeussinger@med.uni-duesseldorf.de
Telephone: +49-211-8116330 Fax: +49-211-8118752
Received: May 9, 2011
Revised: July 27, 2011
Accepted: August 5, 2011
Published online: March 14, 2012
Abstract

AIM: To evaluate cut-off values and performance of acoustic radiation force impulse imaging (ARFI) using transient elastography [FibroScan© (FS)] as a reference.

METHODS: Six hundred and six patients were enrolled in this study. All patients underwent liver stiffness measurement with FS (FS-LS) and ARFI (with shear wave velocity quantification; ARFI-SWV) and the performance of ARFI in comparison to FS was determined. Sixty-eight patients underwent liver biopsy.

RESULTS: Significantly higher success rates for the determination of liver stiffness were found using ARFI as compared to FS [604/606 (99.7%) vs 482/606 (79.5%), P < 0.001]. ARFI-SWV correlated significantly with FS-LS (r = 0.920, P < 0.001). ARFI-SWV increased significantly with the stage of fibrosis (1.09 ± 0.13 m/s for patients with no significant fibrosis (FS-LS < 7.6 kPa); 1.46 ± 0.27 m/s for patients with significant liver fibrosis (7.6 < FS-LS ≤ 13.0 kPa); and 2.55 ± 0.77 m/s for patients with liver cirrhosis (FS-LS > 13.0 kPa)). ARFI-SWV cut-off values were identified for no significant fibrosis (1.29 m/s; sensitivity 91.4% and specificity 92.6%) and for liver cirrhosis (1.60 m/s; sensitivity 92.3% and specificity 96.5%). The optimal cut-off value for predicting liver fibrosis (F ≥ 2) was 1.32 m/s (sensitivity 87.0% and specificity 80.0%) and for liver cirrhosis (F4) 1.62 m/s (sensitivity 100% and specificity 85.7%), for patients who underwent liver biopsy. An excellent inter-and intraobserver reproducibility was observed for ARFI-SWV determinations.

CONCLUSION: An ARFI-SWV cut-off value of 1.29 m/s seems to be optimal for patients with no significant liver fibrosis and 1.60 m/s for patients with liver cirrhosis.

Keywords: Acoustic radiation force impulse imaging, Elastography, Fibroscan, Liver