Acoustic radiation force impulse imaging for assessing liver fibrosis in alcoholic liver disease

Abstract

Aim: To evaluate the performance of elastography by ultrasound with acoustic radiation force impulse (ARFI) in determining fibrosis stage in patients with alcoholic liver disease (ALD) undergoing alcoholic detoxification in relation to biopsy.

Methods: Eighty-three patients with ALD undergoing detoxification were prospectively enrolled. Each patient underwent ARFI imaging and a liver biopsy on the same day. Fibrosis was staged according to the METAVIR scoring system. The median of 10 valid ARFI measurements was calculated for each patient.

Results: Sixty-nine males and thirteen females (one patient excluded due to insufficient biopsy size) were assessed with a mean alcohol consumption of 132.4 ± 128.8 standard drinks per week and mean cumulative year duration of 17.6 ± 9.5 years. Sensitivity and specificity were respectively 82.4% (0.70-0.95) and 83.3% (0.73-0.94) (AUROC = 0.87) for F ≥ 2 with a cut-off value of 1.63m/s; 82.4% (0.64-1.00) and 78.5% (0.69-0.89) (AUROC = 0.86) for F ≥ 3 with a cut-off value of 1.84m/s; and 92.3% (0.78-1.00] and 81.6% (0.72-0.90) (AUROC = 0.89) for F = 4 with a cut-off value of 1.94 m/s.

Conclusion: ARFI is an accurate, non-invasive and easy method for assessing liver fibrosis in patients with ALD undergoing alcoholic detoxification.

Keywords: Acoustic radiation force impulse; Alcoholic liver disease; Elastography; Fibrosis; Non-invasive.

Figures

Figure 1

Image of liver stiffness measurement by acoustic radiation force impulse in patients with alcoholic liver disease. A: Acoustic radiation force impulse examination of a patient; B: Ten values with associated depths.

Figure 2

Patient flowchart. ARFI: Acoustic radiation force impulse.

Figure 3

Relationship between acoustic radiation force impulse predicting values and histological fibrosis stages. The relationship was significant between the velocity of the sheer wave (median of 10 ARFI values) and the fibrosis stage (assessed by the METAVIR score on biopsies) in all 82 patients (P < 0.0001). The box represents the interquartile range, the horizontal line in the box indicates the median value and the diamond indicates the mean value. The horizontal lines above and below the box indicate the maximum and minimum values.

Figure 4

Receiver operating characteristic curves of acoustic radiation force impulse predicting liver fibrosis in patients with alcoholic liver disease. A: ROC curve for F ≥ 2; B: ROC curve for F ≥ 3; C: ROC curve for F = 4.

Figure 5

Decision tree for acoustic radiation force impulse predicting as a screening test for F = 4.