ARFI, FibroScan®, ELF, and their combinations in the assessment of liver fibrosis: A prospective study

• Published in: Journal of hepatology Vol. 57; no. 2; pp. 281 - 287
• Main Authors: Crespo, Gonzalo, Fernández-Varo, Guillermo, Mariño, Zoe, Casals, Gregori, Miquel, Rosa, Martínez, Stella M, Gilabert, Rosa, Forns, Xavier, Jiménez, Wladimiro, Navasa, Miquel
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.08.2012; Elsevier
• Subjects: Acoustic radiation force impulse; Adult; Aged; Biological and medical sciences; Biopsy; Elasticity Imaging Techniques - methods; Enhanced liver fibrosis; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver - pathology; Liver Cirrhosis - diagnosis; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Transient elastography; shear wave velocity; positive predictive value; TIMP-1; LR; transient elastography; LT; AUROC; aminoterminal propeptide of type III procollagen; hyaluronic acid; SD; diagnostic odds ratio; NPV; PPV; specificity; area under the receiver-operating characteristic curve; interquantile range; variation coefficient; BMI; liver stiffness measurement; tissue inhibitor of matrix metalloproteinase type-1; body mass index; DOR; LSM; ARFI; IQR; ROI; VC; likelihood ratio negative; TE; PIIINP; enhanced liver fibrosis; Se; SWV; region of interest; HA; sensitivity; kilopascals; kPa; Sp; ELF; liver transplantation; negative predictive value; likelihood ratio positive; acoustic radiation force impulse; standard deviation; Transient elastography; Acoustic radiation force impulse; Enhanced liver fibrosis; Liver transplantation; Hepatic fibrosis; Gastroenterology; Medical imagery; Digestive diseases; Hepatic disease; Impulse
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2012.03.016

Background & Aims Our aim was to evaluate a serologic marker (ELF) and two ultrasound-based methods (FibroScan® and ARFI), as well as their combinations, in the assessment of liver fibrosis. Methods One-hundred and forty-six patients (87 liver transplant recipients, 59 non-transplant patients) who underwent liver biopsy were prospectively included. We evaluated the diagnostic accuracy of FibroScan®, ARFI, ELF and the combination of ELF with either ARFI or FibroScan®. After analyzing in separate transplant and non-transplant patients, the whole cohort was divided into a training set and a validation set. Results ARFI imaging was successfully performed across the whole cohort, while FibroScan® failed in 16 (11%) patients. The three methods showed similar AUROCs and best cut-off values in transplant and non-transplant patients. In the training set, differences between the AUROCs of ARFI, FibroScan® and ELF to diagnose F ⩾2 (0.879, 0.861, and 0.764, respectively) and cirrhosis (0.936, 0.918, and 0.841) were not statistically significant, although both ultrasound-based methods showed higher accuracy than ELF. The combination of ELF with ARFI or FibroScan® increased the negative and positive predictive values of single tests for the diagnosis of F ⩾2 and cirrhosis. Similar results were obtained when the methods were tested in the validation set. Conclusions ARFI is as effective as either FibroScan® or ELF in the non-invasive assessment of liver fibrosis, and its inclusion in an ultrasound device could facilitate its incorporation into routine clinical practice. The combination of ARFI or FibroScan® with ELF may help better identify patients with or without significant fibrosis or cirrhosis.