Acoustic radiation force impulse elastography of liver as a screening tool for liver fibrosis in alcoholic liver disease

Iranna M Hittalamani; Bhushita B Lakhkar; Ramesh C Pattanashetti; Bhushan N Lakhkar

doi:10.4103/ijri.IJRI_399_18

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(02): 190-194
DOI: 10.4103/ijri.IJRI_399_18

Hepatobiliary and Pancreatic Imaging

Acoustic radiation force impulse elastography of liver as a screening tool for liver fibrosis in alcoholic liver disease

Iranna M Hittalamani

Department of Radiology, Shri B.M. Patil Medical College, BLDE University, Solapur Road, Vijayapur, Karnataka, India

,

Bhushita B Lakhkar

Department of Radiology, Shri B.M. Patil Medical College, BLDE University, Solapur Road, Vijayapur, Karnataka, India

,

Ramesh C Pattanashetti

Department of Radiology, Shri B.M. Patil Medical College, BLDE University, Solapur Road, Vijayapur, Karnataka, India

,

Bhushan N Lakhkar

Department of Radiology, Shri B.M. Patil Medical College, BLDE University, Solapur Road, Vijayapur, Karnataka, India

› Author Affiliations
Subject Editor:

Abstract

Context: Acoustic radiation force impulse (ARFI) elastography is a noninvasive and quantitative technique for diagnosis of liver fibrosis. To the best of our knowledge, there are only two studies reported in literature for evaluation of alcoholic liver disease using ARFI. Aims: The aim of this study was to evaluate the diagnostic performance of ARFI elastography for assessing liver fibrosis in alcoholic liver disease and compare it with biochemical indices aspartate transaminase-to-platelet ratio index (APRI) and fibrosis-4 Index (FIB-4) using histopathology as the reference standard. Settings and Design: Institutional cross-sectional study. Methods and Materials: The patients visiting our hospital over a period of 2 years with a high-risk consumption of alcohol (>40 g/day for men and >20 g/day for women for a cumulative period of more than 5 years) were subjected to ARFI elastography of liver, Liver Function Tests (to calculate APRI and FIB-4 indices), and liver biopsy. Statistical Analysis Used: Area under the receiver operating characteristic (AUROC) curve analysis, Kruskal--Wallis test for ANOVA. Results: A total of 50 patients of chronic alcoholic liver disease were evaluated with ARFI elastography, which performed better than the biochemical indices in distinguishing cirrhosis of the liver (F = 4) from the severe fibrosis (F ≥ 3) with area under the receiver operating characteristic of 0.97, whereas for significant fibrosis (F ≥ 2) and severe fibrosis (F ≥ 3), it was comparable to the biochemical indices with AUROC of 0.65 and 0.70. In our study, the median shear wave velocity cutoff values were 1.37 m/s, 1.51 m/s, and 1.87 m/s for F ≥ 2, F ≥ 3, and F = 4 fibrosis stages, respectively. Conclusions: ARFI elastography is a noninvasive, reliable, and repeatable diagnostic test for grading of liver fibrosis. It performs better than the biochemical indices to differentiate severe fibrosis and cirrhosis of liver.

Keywords

Acoustic radiation force impulse elastography - alcoholic liver disease - shear wave velocity, fibrosis stages

Full Text

References

References
1 World Health Organization. WHO country profile -India. 2010 [online] Available from: http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf?ua=1 [Last accessed on 2017 Oct 02]
2 Friedman SL. Hepatic fibrosis-overview. Toxicology 2008; 254: 120-9
3 Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J. et al. Elastography assessment of liver fibrosis: Society of radiologists in ultrasound consensus conference statement. Radiology 2015; 276: 845-61
4 Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: Results of a prospective nationwide survey. For the group of epidemiology of the French association for the study of the liver (AFEF). Hepatology 2000; 32: 477-81
5 Afdhal NH, Nunes D. Evaluation of liver fibrosis: A concise review. Am J Gastroenterol 2004; 99: 1160-74
6 Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s Principles of Internal Medicine. McGraw Hill Professional; 2015: 2052
7 United States of America. Siemens Healthcare White Paper: Best practices for detecting liver fibrosis with ARFI. 2015
8 Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR. et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: Liver. Ultrasound Med Biol 2015; 41: 1161-79
9 Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D. et al. Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: A pooled meta-analysis. J Viral Hepat 2012; 19: 212-9
10 Faria SC, Ganesan K, Mwangi I, Shiehmorteza M, Viamonte B, Mazhar S. et al. MR imaging of liver fibrosis: Current state of the art. Radiographics 2009; 29: 1615-35
11 Bota S, Herkner H, Sporea I, Salzl P, Sirli R, Neghina AM. et al. Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int 2013; 33: 1138-47
12 Rizzo L, Calvaruso V, Cacopardo B, Alessi N, Attanasio M, Petta S. et al. Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic Hepatitis C. Am J Gastroenterol 2011; 106: 2112-20
13 Leung VY, Shen J, Wong VW, Abrigo J, Wong GL, Chim AM. et al. Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: Comparison of shear-wave elastography and transient elastography with liver biopsy correlation. Radiology 2013; 269: 910-8
14 Doherty J, Trahey G, Nightingale K, Palmeri M. Acoustic radiation force elasticity imaging in diagnostic ultrasound. IEEE Trans Ultrason Ferroelectr Freq Control 2013; 60: 685-701
15 Jaffer OS, Lung PFC, Bosanac D, Patel VM, Ryan SM, Heneghan MA. et al. Acoustic radiation force impulse quantification: Repeatability of measurements in selected liver segments and influence of age, body mass index and liver capsule-to-box distance. Br J Radiol 2012; 85: 858-63
16 Friedrich-Rust M, Romen D, Vermehren J, Kriener S, Sadet D, Herrmann E. et al. Acoustic radiation force impulse-imaging and transient elastography for non-invasive assessment of liver fibrosis and steatosis in NAFLD. Eur J Radiol 2012; 81: e325-31
17 Gerber L, Kasper D, Fitting D, Knop V, Vermehren A, Sprinzl K. et al. Assessment of liver fibrosis with 2-D shear wave elastography in comparison to transient elastography and acoustic radiation force impulse imaging in patients with chronic liver disease. Ultrasound Med Biol 2015; 41: 2350-9
18 Zhang D, Li P, Chen M, Liu L, Liu Y, Zhao Y. et al. Non-invasive assessment of liver fibrosis in patients with alcoholic liver disease using acoustic radiation force impulse elastography. Abdom Imaging 2014; 40: 723-9
19 Kiani A, Brun V, Lainé F, Turlin B, Morcet J, Michalak S. et al. Acoustic radiation force impulse imaging for assessing liver fibrosis in alcoholic liver disease. World J Gastroenterol 2016; 22: 4926
20 Tang A, Cloutier G, Szeverenyi NM, Sirlin CB. Ultrasound elastography and MR elastography for assessing liver fibrosis: Part 1, principles and techniques. Am J Roentgenol 2015; 205: 22-32
21 Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG. et al. Wfumb Guidelines and recommendations for clinical use of ultrasound elastography: Part 1: Basic principles and terminology. Ultrasound Med Biol 2015; 41: 1126-47
22 Samir AE, Dhyani M, Vij A, Bhan AK, Halpern EF, Méndez-Navarro J. et al. Shear-wave elastography for the estimation of liver fibrosis in chronic liver disease: Determining accuracy and ideal site for measurement. Radiology 2015; 274: 888-96
23 Toshima T, Shirabe K, Takeishi K, Motomura T, Mano Y, Uchiyama H. et al. New method for assessing liver fibrosis based on acoustic radiation force impulse: A special reference to the difference between right and left liver. J Gastroenterol 2011; 46: 705-11