Prospective Evaluation of Acoustic Radiation Force Impulse (ARFI) Elastography and High-Frequency B-Mode Ultrasound in Compensated Patients for the Diagnosis of Liver Fibrosis/Cirrhosis in Comparison to Mini-Laparoscopic Biopsy

Abstract

Purpose: Ultrasound is a well-established noninvasive test for assessing patients with liver disease. This study aims to prospectively compare ultrasound to the new technique elastography (ARFI) for the assessment of liver fibrosis/cirrhosis.

Materials and Methods: High-frequency B-mode ultrasound (liver surface/vein irregularity, liver homogeneity, spleen size), ARFI quantification, mini-laparoscopic liver evaluation including biopsy were prospectively obtained in compensated patients scheduled for liver biopsy. For the diagnosis of cirrhosis, a combined gold standard (cirrhosis at histology and/or at macroscopic liver evaluation) was used.

Results: Out of 157 patients, 35 patients were diagnosed cirrhotic. Ultrasound (combination of liver vein and/or surface irregularity) showed no significant difference compared to ARFI quantification for the diagnosis of significant liver fibrosis (Ishak> = 3) and cirrhosis. Diagnosis of cirrhosis had a sensitivity/specificity/PPV/NPV of 83 %(± 12) / 82 %(± 7) / 57 %(± 14) / 94 %(± 4), respectively, with ultrasound and 86 %(± 12) / 81 %(± 7) / 57 %(± 13) / 95 %(± 4), respectively, with ARFI quantification. The sensitivity/specificity/PPV/NPV for the detection of significant fibrosis were 68 %(± 13) / 86 %(± 7) / 71 %(± 13) / 84 %(± 7), respectively, for ultrasound and 70 %(± 12) / 84 %(± 7) / 69 %(± 12) / 84 %(± 7), respectively, for ARFI quantification.

Conclusion: ARFI elastography and high-frequency B-mode ultrasound show similar and good results for the diagnosis of compensated liver cirrhosis and high-grade fibrosis. A key benefit of both methods is the high NPV suggesting them as noninvasive exclusion tests.

Zusammenfassung

Ziel: Die Ultraschalluntersuchung ist ein etabliertes, nichtinvasives Verfahren bei der Abklärung von Lebererkankungen. Diese Studie soll prospektiv den Nutzen der Ultraschalluntersuchung im Vergleich zur ARFI-Elastografie als neue Methode zur Beurteilung der Leberfibrose/-zirrhose untersuchen.

Material und Methoden: Hochfrequenter B-Bild-Ultraschall (Leberoberflächen-/Venenirregularität, Leberhomogenität, Milzgröße), ARFI-Quantifzierung, Minilaparoskopie mit makroskopischer Beurteilung und Leberbiopsie wurden prospektiv bei kompensierten Patienten mit geplanter Leberbiopsie durchgeführt. Zur Diagnose einer Zirrhose wurde ein kombinierter Goldstandard (Histologie und/oder makroskopische Beurteilung) verwendet.

Ergebnisse: Von 157 Patienten hatten 35 eine Leberzirrhose. Die Ultraschalluntersuchung (Kombination von Oberflächen- und/oder Venenirregularität) zeigte keinen signifikanten Unterschied zur ARFI-Quantifizierung bei der Diagnose einer signifikanten Fibrose (Ishak> = 3) und einer Leberzirrhose. Die Sensitivität/Spezifität/PPV/NPV bei Frage nach Leberzirrhose betrug 83 %(± 12) / 82 %(± 7) / 57 %(± 14) / 94 %(± 4) mit dem Ultraschall und 86 %(± 12) / 81 %(± 7) / 57 %(± 13) / 95 %(± 4) mit der ARFI – Quantifizierung. Die Sensitivität/Spezifität/PPV/NPV für die Detektion einer signifikanten Fibrose bertrug 68 %(± 13) / 86 %(± 7) / 71 %(± 13) / 84 %(± 7) mit dem Ultraschall und 70 %(± 12) / 84 %(± 7) / 69 %(± 12) / 84 %(± 7) mit der ARFI-Quantifizierung.

Zusammenfassung: Die ARFI-Elastografie und der hochfrequente B-Bild-Ultraschall zeigen ähnliche gute Ergebnisse für die Diagnose einer kompensierten Leberzirrhose und höhergradigen Leberfibrose. Ein wesentlicher Vorteil beider Verfahren ist das hohe NPV, welches beide Methoden insbesondere als nichtinvasive Ausschlussverfahren interessant macht.

Key words

liver fibrosis - liver cirrhosis - B-mode ultrasound - ARFI elastography - mini-laparascopy

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