THE USEFULNESS OF TRANSINET ELASTOGRAPHY, ACOUSTIC RADIATION FORCE IMPULSE ELASTROGRAPHY AND REAL TIME ELASTOGRAPHY FOR THE EVALUATION OF LIVER FIBROSIS

Abstract

BACKGROUND: Several imaging modalities and biomarkers as noninvasive methods for the evaluation of liver fibrosis have been used during the last few years. However, the clinical usefulness of its use was not fully documented. We evaluated the accuracy of the FibroScan®, acoustic radiation force impulse (ARFI) and real time elastography (RTE) to predict liver fibrosis. METHODS: FibroScan®, ARFI and RTE were performed simultaneously at the same day in 74 patients with various liver diseases who underwent liver biopsy from October 2010 to March 2011. ARFI was performed with SIEMENS ACUSON S2000 ultrasound system, and RTE with HITACHI HI VISION-Preirus and EUP-L52 linear probe (3-7MHz). The median values of 10 measurements in ARFI and RTE were calculated, respectively. We used platelet count for predicting more accurately liver fibrosis. We defined Vs/PLT as [Velocity of sheer wave(m/s)]/[platelet count(x109/L)]x102 in ARFI, and Es/PLT as [elasticity score]/[platelet count(x109/L)]x102 in RTE. RESULTS: From 74 patients, 11 had METAVIR scoring system[F]0, 4 had F1, 22 had F2, 14 had F3 and 23 had F4. Positive correlations between each methods and fibrosis were found in FibroScan® (r=0.518, p<0.001), in ARFI (r=0.555; p<0.001), in Vs/PLT (r=0.667; p<0.001), in RTE (r=0.298; p<0.001), in Es/PLT (r=0.609; p<0.001). The area under the receiver-operating characteristic curve (AUROC)s by FibroScan® were 0.712 for the diagnosis of significant fibrosis (≥F2), 0.821 for severe fibrosis (≥F3), and 0.747 for cirrhosis. By ARFI, AUROCs were 0.701, 0.822 and 0.811, respectively. By Vs/PLT, AUROCs were 0.872, 0.850 and 0.822, respectively. By RTE, AUROCs were 0.521, 0.668 and 0.754, respectively. By Es/PLT, AUROCs were 0.783, 0.817 and 0.835, respectively. Comparing with AUROC of each methods for predicting fibrosis (≥F2), FibroScan® is superior to RTE (p=0.037), Vs/PLT vs ARFI (p=0.001), Es/PLT vs RTE (p<0.001) and Vs/PLT vs Es/PLT (p=0.026), but ARFI vs FibroScan® is not significantly different (p=0.893). CONCLUSION: Both FibroScan® and ARFI are useful as modalities for the assessment of liver fibrosis noninvasively. Vs/PLT and Es/PLT can be more helpful for predicting liver fibrosis than elastography alone.