Research ArticleARFI, FibroScan®, ELF, and their combinations in the assessment of liver fibrosis: A prospective study

Background & AimsOur aim was to evaluate a serologic marker (ELF) and two ultrasound-based methods (FibroScan® and ARFI), as well as their combinations, in the assessment of liver fibrosis.MethodsOne-hundred and forty-six patients (87 liver transplant recipients, 59 non-transplant patients) who underwent liver biopsy were prospectively included. We evaluated the diagnostic accuracy of FibroScan®, ARFI, ELF and the combination of ELF with either ARFI or FibroScan®. After analyzing in separate transplant and non-transplant patients, the whole cohort was divided into a training set and a validation set.ResultsARFI imaging was successfully performed across the whole cohort, while FibroScan® failed in 16 (11%) patients. The three methods showed similar AUROCs and best cut-off values in transplant and non-transplant patients. In the training set, differences between the AUROCs of ARFI, FibroScan® and ELF to diagnose F ⩾2 (0.879, 0.861, and 0.764, respectively) and cirrhosis (0.936, 0.918, and 0.841) were not statistically significant, although both ultrasound-based methods showed higher accuracy than ELF. The combination of ELF with ARFI or FibroScan® increased the negative and positive predictive values of single tests for the diagnosis of F ⩾2 and cirrhosis. Similar results were obtained when the methods were tested in the validation set.ConclusionsARFI is as effective as either FibroScan® or ELF in the non-invasive assessment of liver fibrosis, and its inclusion in an ultrasound device could facilitate its incorporation into routine clinical practice. The combination of ARFI or FibroScan® with ELF may help better identify patients with or without significant fibrosis or cirrhosis.