Evaluation of Portal Hypertension and Varices by Acoustic Radiation Force Impulse Imaging of the Liver Compared to Transient Elastography and AST to Platelet Ratio Index

Abstract

Background: Acoustic radiation force impulse imaging (ARFI) is a new method of liver stiffness measurement (LSM). The aim was to compare ARFI, transient elastography (TE) and AST to platelet ratio index (APRI) for the noninvasive diagnosis of clinically significant portal hypertension (CSPH, hepatic venous pressure gradient; HVPG ≥ 10 mmHg) and esophageal varices (EV).

Materials and Methods: LSM via ARFI and TE was performed in 88 consecutive patients with cirrhosis prior to HVPG measurement. The mean liver stiffness for ARFI was calculated out of 5 measurements for each lobe.

Results: LSM by TE and ARFI was not successful in 22 (25 %) patients and 1 (1 %) patient, respectively, due to ascites or obesity. Both TE (r = 0.765; p < 0.001) and ARFI (r = 0.646; p < 0.001) correlated significantly with HVPG. At the optimal cut-off (16.8kPa), TE (area under the curve, AUC 0.870) yielded a sensitivity and specificity of 89.7 % and 75 %, respectively, for predicting CSPH. At the optimal cut-off (2.58 m/s), the sensitivity and specificity for ARFI (AUC 0.855) were 71.4 % and 87.5 %, respectively. Using an APRI (AUC 0.838), the sensitivity and specificity were 69 % and 87.5 %, respectively. The AUC for the diagnosis of EV was 0.802 for TE (cut-off: 27.9kPa), 0.743 for ARFI (cut-off: 2.74 m/s), and 0.805 for APRI (cut-off: 1.90).

Conclusion: ARFI shows a higher applicability particularly in obese and ascitic patients. All three investigated methods show a high diagnostic accuracy for CSPH. Notably, APRI performed not significantly different compared to ARFI for the diagnosis of CSPH.

Zusammenfassung

Ziel: „Acoustic Radiation Force Impulse Imaging“ (ARFI) ist eine neue Methode zur Messung der Lebersteifigkeit. Ziel war es die Wertigkeit von ARFI und Transienter Elastografie (TE, Fibroscan(R)) sowie „AST to Platelet Ratio“ (APRI) für die Diagnose von klinisch signifikanter portaler Hypertension (CSPH = Lebervenendruckgradient über ≥ 10 mmHg) und Ösophagusvarizen (EV) zu evaluieren, welcher einen wesentlichen Prädiktor für den Krankheitsverlauf darstellt.

Material und Methoden: Bei 88 Patienten mit Leberzirrhose wurde ein Lebervenendruckgradient (HVPG), sowie die Lebersteifigkeit mittels TE und ARFI gemessen. Für ARFI wurde der Mittelwert aus jeweils 5 Messungen aus dem rechten und linken Leberlappen errechnet. Zudem wurde jeweils der APRI errechnet.

Ergebnisse: Die Messung der Lebersteifigkeit mittels TE konnte bei 22 Patienten (25 %) nicht durchgeführt werden, während nur bei einem Patienten mit Übergewicht und Aszites die Messung der Lebersteifigkeit mittels ARFI nicht möglich war. Sowohl TE (r = 0,765; p < 0,001) als auch ARFI (r = 0,646; p < 0,001) korrelierten mit den gemessenen Lebervenendruckgradienten. Sensitivität und Spezifität von TE (area under the curve (AUC 0,870) für die Diagnose einer CSPH bei einem Cut-off von 16,8 kPa waren 89,7 % und 75 %. Sensitivität und Spezifität für ARFI (AUC 0,855) bei einem Cut-off von (2,58 m/s) war 71,4 % und 87,5 %. Die AUC von APRI war 0,838, mit einer Sensitivität und Spezifität von 69 % und 87,5 % bei einem Cut-off von 1,48. Cut-offs und AUC für die Diagnose von Varizen waren 27,9 kPa (AUC 0,802) für TE, 2,74 m/s (AUC 0,743) für ARFI und ein Cut-off von 1,90 (AUC 0,805) für APRI.

Schlussfolgerung: ARFI kann im Gegensatz zu TE auch bei adipösen Patienten und Patienten mit Aszites erfolgreich durchgeführt werden. Es zeigt sich eine hohe Sensitivität und Spezifität für ARFI für die Diagnose einer klinisch signifikanten portalen Hypertension. Die Berechnung des APRI ist den nichtinvasiven Messmethoden der Lebersteifigkeit nicht unterlegen.

Key words

abdomen - ultrasound - ARFI - TE - liver stiffness

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