Acoustic Radiation Force Impulse Elastography as Compared to Transient Elastography and Liver Biopsy in Patients with Chronic Hepatopathies

 

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Zusammenfassung

Ziel: Vergleich zweier nicht invasiver Beurteilungsmethoden: transiente Elastografie (TE) und Acoustic Radiation Force Impulse Imaging (ARFI). Patienten und Methoden: In die Studie wurden 114 Patienten eingeschlossen. 38 gesunde Probanden (ohne Fibrose – F0) und 76 Patienten mit chronischen Lebererkrankungen: 53 hiervon hatten eine Leberbiopsie (LB) (7 mit F1, 24 mit F2 und 22 mit F3 Stadium nach Metavir) und 23 zuvor mit Leberzirrhose diagnostizierte Patienten (F4 nach Metavir). Die Leberelastizität wurde bei allen Patienten mittels TE und ARFI untersucht. ARFI (Quantifizierung transversaler Wellengeschwindigkeiten) wurde an 3 Lokalisationen durchgeführt: ausgehend von der Kapsel bei 0 – 1 cm, bei 1 – 2 cm und bei 2 – 3 cm. In jeder Untersuchungstiefe wurden 5 valide Messungen durchgeführt und daraus der Median kalkuliert (in m/s). Ergebnisse: Es zeigte sich eine direkte starke lineare Korrelation zwischen TE und dem Stadium der Fibrose (Spearman rho = 0,848; p < 0,001). Eine signifikante direkte Korrelation zeigte sich auch zwischen den ARFI Messungen bei 1 – 2 cm und 2 – 3 cm unterhalb der Leberkapsel und dem Stadium der Fibrose (rho = 0,675 bzw. 0,714). Die subkapsulär erhobenen ARFI Werte zeigten nur eine schlechte Korrelation mit dem Fibrosegrad (rho = 0,469). Die beste Methode zur Prädiktion einer signifikanten Fibrose (F ≥ 2) war TE; hier ergab sich eine „area under receiver-operating characteristic curve” (AUROC) von 0,908, was signifikant größer war als die mittels ARFI gemessenen AUROCs. Bezüglich der ARFI Messungen hatten die aus einer Untersuchungstiefe von 1 – 2 cm und von 2 – 3 cm unterhalb der Leberkapsel den besten prädiktiven Wert. Hierbei unterschieden sich die AUROCs nicht signifikant voneinander (0,767 bzw. 0,731). Zur Prädiktion einer Fibrose (F > 0) hatte TE den besten prädiktiven Wert: der optimale Cut-off Wert lag bei 5,65 kPa (AUROC – 0,898). Für ARFI lagen die Cut-off Werte bei 1,4 m/s, AUROC - 0,747 (1 – 2 cm), und 1,26 m/s AUROC – 0,721 (2 – 3 cm). Zur Vorhersage einer Zirrhose (F = 4 nach Metavir) waren die optimierten Cut-off Werte: TE –12,9 kPa (AUROC – 0,994); ARFI – 1,78 m/s für die Messung bei 2 – 3 cm subkapsulär, AUROC – 0,951. Schlussfolgerung: Aktuell ist die Messung der Leberelastizität mittels ARFI der Messung mittels TE zur Beurteilung der Leberfibrose nicht überlegen. Mittels ARFI werden die besten Ergebnisse bei Messung 1 – 2 bzw. 2 – 3 cm subkapsulär erzielt. ARFI ist eine akkurate Untersuchungsmethode zur Diagnose einer Zirrhose.

Abstract

Purpose: To compare two methods of noninvasive assessment: transient elastography (TE) and acoustic radiation force impulse elastography (ARFI). Patients and Methods: Our study included 114 subjects: 38 healthy volunteers, (considered to have no fibrosis – F 0) and 76 patients with chronic liver disease: 53 who had undergone liver biopsy (LB) (7 with F 1, 24 with F 2, 22 with F 3 Metavir) and 23 previously diagnosed with cirrhosis (F4 Metavir). In each patient we performed a liver stiffness measurement by means of TE and ARFI. ARFI (shear wave velocity quantification) was performed at 3 points: at 0 – 1 cm, at 1 – 2 cm and at 2 – 3 cm under the capsule. For each depth, 5 valid measurements were made, and a median value was calculated, measured in m/sec. Results: A direct, strong, linear correlation (Spearman rho = 0.848) was found between TE and the stage of fibrosis (p < 0.001). A significant, direct correlation was found between ARFI measurements made 1 – 2 cm and 2 – 3 cm below the liver capsule and the severity of fibrosis (rho = 0.675 and 0.714 respectively). The subcapsularly measured ARFI values showed a poor correlation with fibrosis (rho = 0.469). The best test for predicting significant fibrosis (F ≥ 2) was TE, with the area under receiver-operating characteristic curve (AUROC) 0.908, significantly larger than the AUROCs for ARFI. If only ARFI is considered, measurements made 1 – 2 and 2 – 3 cm below the capsule have the best predictive value, with AUROCs not significantly different from each other (0.767 and 0.731, respectively). For predicting fibrosis (F > 0), TE had the best predictive value: optimized cut-off 5.65 kPa (AUROC –0.898). For ARFI, the cut-offs were: 1.4 m/sec, AUROC –0.747 (1 – 2 cm), and 1.26 m/sec AUROC –0.721 (2 – 3 cm). For predicting cirrhosis (F = 4 Metavir), the optimized cut-offs were: TE –12.9 kPa (AUROC –0.994); ARFI – 1.78 m/sec for measurements made 2 – 3 cm below the capsule, AUROC – 0.951. Conclusion: At present, liver elasticity evaluation by means of ARFI is not superior to TE for the assessment of liver fibrosis. For ARFI, the most reliable results are obtained if measurements are made 1 – 2 and 2 – 3 cm below the liver capsule. ARFI is an accurate test for the diagnosis of cirrhosis.

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Prof. Ioan Sporea

Gastroenterology, University of Medicine and Pharmacy Timisoara

Iosif Bulbuca 156

300731 Timisoara

Romania

Phone: ++ 40/2 56/30 94 55

Fax: ++ 40/2 56/48 80 03

Email: isporea@umft.ro