Liver Fibrosis in Viral Hepatitis: Noninvasive Assessment with Acoustic Radiation Force Impulse Imaging versus Transient Elastography

TLDR

The study compares ARFI imaging integrated into conventional ultrasonography with transient elastography and serum fibrosis markers for noninvasive assessment of liver fibrosis in chronic viral hepatitis. ARFI imaging uses short acoustic pulses to generate tissue displacements, tracks shear‑wave propagation with ultrasound correlation, and was applied to 86 chronic viral hepatitis patients alongside TE and serum marker testing. ARFI imaging correlated strongly with histologic fibrosis stage (ρ = 0.71), had an AUC of 0.82 for moderate fibrosis and 0.91 for cirrhosis—comparable to TE (ρ = 0.73, AUC = 0.84 and 0.91) and serum markers (ρ = 0.66, AUC = 0.82).

Abstract

To compare, in a pilot study, acoustic radiation force impulse (ARFI) imaging technology integrated into a conventional ultrasonography (US) system with both transient elastography (TE) and serologic fibrosis marker testing for the noninvasive assessment of liver fibrosis.Informed consent was obtained from all subjects, and the local ethics committee approved the study. ARFI imaging involved the mechanical excitation of tissue with use of short-duration acoustic pulses to generate localized displacements in tissue. The displacements resulted in shear-wave propagation, which was tracked by using US correlation-based methods and recorded in meters per second. Eighty-six patients with chronic viral hepatitis underwent TE, ARFI imaging, and serum fibrosis marker testing. Results were compared with liver biopsy findings, which served as the reference standard.ARFI imaging (rho = 0.71), TE (rho = 0.73), and serum fibrosis marker test (rho = 0.66) results correlated significantly with histologic fibrosis stage (P < .001). Median ARFI velocities ranged from 0.84 to 3.83 m/sec. Areas under the receiver operating characteristic curve for the accuracy of ARFI imaging, TE, and serum fibrosis marker testing were 0.82, 0.84, and 0.82, respectively, for the diagnosis of moderate fibrosis (histologic fibrosis stage, > or = 2) and 0.91, 0.91, and 0.82, respectively, for the diagnosis of cirrhosis.ARFI imaging is a promising US-based method for assessing liver fibrosis in chronic viral hepatitis, with diagnostic accuracy comparable to that of TE in this preliminary study.http://radiology.rsnajnls.org/cgi/content/full/252/2/595/DC1.