Background: It was a descriptive study to evaluate the accuracy of acoustic radiation force impulse (ARFI) elastography for thedetection of liver fibrosis in patients with diffuse chronic liver diseases (CLD).

Materials and Methods: In our study 36 adult healthy volunteers and 65 adult patients with Chronic liver diseases were evaluated using ARFI based US-elastography. Histopathological correlation was done as and when required.

Results: ARFI was done in all 36 healthy volunteers and all 65 CLD patients and valid measurements were obtained. The mean shear-wave velocity (SWV) in healthy volunteers was 1.19±0.2 m/s. A gradual increase in mean SWV was noted from fibrosis of Grade F0 to F6 (Ishak’s score) and a high positive correlation was found between the mean SWV on ARFI and fibrosis scores at liver biopsy (rho=0.8409). we found statistically significant difference (p<0.001) between the mild (F1 and F2) and significant fibrosis (F3 and F4). The difference in the SWV measurements obtained from consecutive groups (i.e., F1 versus F2, F2 versus F3, and F3 versus F4) was not statistically significant. Using the area under the receiver operating characteristic curve (AUROC), the best calculated cut-off SWVs for the presence of fibrosis (≥F1), significant fibrosis (≥F3), severe fibrosis (≥F4), and cirrhosis (F6) were found to be 1.207, 1.347, 1.513, and 1.92 m/s, respectively. ARFI values were significantly higher in cirrhotic patients than in other patients (p<0.001).

Conclusions: ARFI elastography can be used for non-invasive evaluation of liver stiffness and may help to differentiate between no/mild fibrosis and significant fibrosis. Hence when ARFI suggests significant fibrosis the need for liver biopsy may, indeed, be obviated.

1. Anthony, P. P. et al. The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. Clin. Pathol.31, 395–414 (1978).
2. Sun, Y. et al. New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment. Baltim. Md65, 1438–1450 (2017).
3. Poniachik, J. et al. The role of laparoscopy in the diagnosis of cirrhosis. Endosc.43, 568–571 (1996).
4. Cadranel, J. F., 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). Baltim. Md32, 477–481 (2000).
5. Popescu, A. et al. The mean values of liver stiffness assessed by Acoustic Radiation Force Impulse elastography in normal subjects. Ultrason.13, 33–37 (2011).
6. Trout, A. T., Xanthakos, S. A., Bennett, P. S. & Dillman, J. R. Liver Shear Wave Speed and Other Quantitative Ultrasound Measures of Liver Parenchyma: Prospective Evaluation in Healthy Children and Adults. J. Roentgenol.214, 557–565 (2020).
7. Horster, S., Mandel, P., Zachoval, R. & Clevert, D. A. Comparing acoustic radiation force impulse imaging to transient elastography to assess liver stiffness in healthy volunteers with and without valsalva manoeuvre. Hemorheol. Microcirc.46, 159–168 (2010).
8. Rifai, K. et al. Clinical feasibility of liver elastography by acoustic radiation force impulse imaging (ARFI). Liver Dis. Off. J. Ital. Soc. Gastroenterol. Ital. Assoc. Study Liver43, 491–497 (2011).
9. Friedrich-Rust, M. et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology252, 595–604 (2009).
10. Kim, J. E. et al. Acoustic radiation force impulse elastography for chronic liver disease: comparison with ultrasound-based scores of experienced radiologists, Child-Pugh scores and liver function tests. Ultrasound Med. Biol.36, 1637–1643 (2010).
11. Guzmán-Aroca, F. et al. Reproducibility of shear wave velocity measurements by acoustic radiation force impulse imaging of the liver: a study in healthy volunteers. Ultrasound Med. Off. J. Am. Inst. Ultrasound Med.30, 975–979 (2011).
12. Gallotti, A., D’Onofrio, M. & Pozzi Mucelli, R. Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen. Med. (Torino)115, 889–897 (2010).
13. Lupsor, M. et al. Performance of a new elastographic method (ARFI technology) compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results. Gastrointest. Liver Dis. JGLD18, 303–310 (2009).
14. Sporea, I. et al. How efficient is acoustic radiation force impulse elastography for the evaluation of liver stiffness? Mon.11, 532–538 (2011).
15. Sporea, I. et al. Is ARFI elastography reliable for predicting fibrosis severity in chronic HCV hepatitis? World J. Radiol.3, 188–193 (2011).
16. Haque, M., Robinson, C., Owen, D., Yoshida, E. M. & Harris, A. Comparison of acoustic radiation force impulse imaging (ARFI) to liver biopsy histologic scores in the evaluation of chronic liver disease: A pilot study. Hepatol.9, 289–293 (2010).
17. Fierbinteanu-Braticevici, C. et al. Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis. World J. Gastroenterol. WJG15, 5525–5532 (2009).
18. Jain, V., Dixit, R., Chowdhury, V., Puri, A. S. & Gondal, R. Can acoustic radiation force impulse elastography be a substitute for liver biopsy in predicting liver fibrosis? Radiol.71, 869–875 (2016).
19. Petzold, G., Hofer, J., Ellenrieder, V., Neesse, A. & Kunsch, S. Liver Stiffness Measured by 2-Dimensional Shear Wave Elastography: Prospective Evaluation of Healthy Volunteers and Patients With Liver Cirrhosis. Ultrasound Med. Off. J. Am. Inst. Ultrasound Med.38, 1769–1777 (2019).

Bishnu Prasad Tripathy

Department of Radiology, Silchar Medical College, Assam, India