Can acoustic radiation force impulse elastography be a substitute for liver biopsy in predicting liver fibrosis?

• Our study included healthy volunteer with 28 males and 8 females in a ratio of 3:1 with mean SWV of 1.2±0.20m/s.
• A high positive correlation was found between the SWV on ARFI and fibrosis scores.
• There was a significantly higher mean SWV noted in mild fibrosis group (i.e. F1–2) as compared to no fibrosis group (F0) and in the cirrhotic (F5–6 + cirrhotic) group as compared to non cirrhotic fibrosis group (F1–4).
• Our best cutoff SWV by using area under ROC are 1.347m/s for detection of significant fibrosis (≥F3).

AimTo evaluate the clinical feasibility and accuracy of acoustic radiation force impulse (ARFI) elastography for the detection of liver fibrosis in patients with chronic viral hepatitis.Materials and methodsARFI-based ultrasound elastography was performed in 69 patients with chronic liver disease (CLD) of viral aetiology and 36 healthy volunteers. Fifty-eight patients with CLD also underwent liver biopsy.ResultsARFI was feasible in all 36 healthy volunteers and all 69 CLD patients, while valid measurements were obtained in 65 patients (95.6%) and all healthy volunteers. The mean shear-wave velocity (SWV) in healthy volunteers was 1.12±0.2 m/s. A gradual increase in mean SWV was noted from fibrosis of Grade F0 to F6 (Ishak's score) and a high positive correlation was found between the mean SWV on ARFI and fibrosis scores at liver biopsy (rho=0.789). The difference between the mild (F1 and F2) versus significant fibrosis (F3 and F4) was also statistically significant (p<0.001). The difference in the SWV measurements obtained from consecutive groups (i.e., F1 versus F2, F2 versus F3, and F3 versus F4) was not statistically significant. Using the area under the receiver operating characteristic curve (AUROC), the best calculated cut-off SWVs for the presence of fibrosis (≥F1), significant fibrosis (≥F3), severe fibrosis (≥F4), and cirrhosis (F6) were found to be 1.207, 1.347, 1.513, and 1.92 m/s, respectively. ARFI values were significantly higher in cirrhotic patients than in other patients (p<0.001).ConclusionsARFI elastography allows valid non-invasive evaluation of liver stiffness and may help to distinguish between no/mild fibrosis and significant fibrosis and guide management decisions.