Clin Mol Hepatol.  2013 Jun;19(2):156-164. 10.3350/cmh.2013.19.2.156.

The usefulness of transient elastography, acoustic-radiation-force impulse elastography, and real-time elastography for the evaluation of liver fibrosis

• Chung JH
• Ahn HS
• Kim SG
• Lee YN
• Kim YS
• Jeong SW
• Jang JY
• Lee SH
• Kim HS
• Kim BS

• KMID: 1776803
• DOI: http://doi.org/10.3350/cmh.2013.19.2.156

Abstract

BACKGROUND/AIMS
Several noninvasive methods have recently been developed for the evaluation of liver fibrosis. The accuracy of transient elastography (TE), acoustic-radiation-force impulse (ARFI) elastography, and real-time elastography (RTE) in predicting liver fibrosis were evaluated.
METHODS
Seventy-four patients who had undergone a liver biopsy within the previous 6 months were submitted to evaluation with TE, ARFI, and RTE on the same day.
RESULTS
There were significant correlations between fibrosis stage and liver stiffness measurement (LSM) using the three tested methods: TE, r2=0.272, P=0.0002; ARFI, r2=0.225, P=0.0017; and RTE, r2=0.228, P=0.0015. The areas under the receiver operating characteristic curves (AUROC) for the diagnosis of significant fibrosis (> or =F2, Metavir stage) by TE, ARFI, RTE, TE/platelet count (PLT), velocity of shear wave (Vs)/PLT, and elasticity score (Es)/PLT were 0.727, 0.715, 0.507, 0.876, 0.874, and 0.811, respectively. The AUROC for the diagnosis of cirrhosis by TE, ARFI, RTE, TE/PLT, Vs/PLT, and Es/PLT were 0.786, 0.807, 0.767, 0.836, 0.819, and 0.838, respectively. Comparisons of AUROC between all LSMs for predicting significant fibrosis (> or =F2) produced the following results: TE vs. RTE, P=0.0069; ARFI vs. RTE, P=0.0277; and TE vs. ARFI, P=0.8836. Applying PLT, the ability of each LSM to predict fibrosis stage significantly increased: TE/PLT vs. TE, P=0.0004; Vs/PLT vs. ARFI, P=0.0022; and Es/PLT vs. RTE, P<0.0001. However, the ability to predict cirrhosis was not enhanced, combining LSM and PLT.
CONCLUSIONS
TE and ARFI may be better methods for predicting significant liver fibrosis than RTE. This predictive ability increased significantly when accounting for platelet count. However, all of the measures had comparable efficacies for predicting cirrhosis.

Keyword

Transient elastography; Acoustic-radiation-force impulse elastography; Real-time elastography; Liver fibrosis

MeSH Terms

Adult
Aged
Aged, 80 and over
Alanine Transaminase/blood
Aspartate Aminotransferases/blood
Bilirubin/blood
*Elasticity Imaging Techniques
Female
Humans
Liver/pathology
Liver Cirrhosis/diagnosis/*physiopathology
Male
Middle Aged
Odds Ratio
Platelet Count
Predictive Value of Tests
ROC Curve
Serum Albumin/analysis
Severity of Illness Index
Serum Albumin
Aspartate Aminotransferases
Alanine Transaminase
Bilirubin