Acoustic Radiation Force Impulse (ARFI) Elastography for non‑invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis

Abstract

Aim: The purpose of the study was to assess the effect of Acoustic Radiation Force Impulse (ARFI) elastography in the diagnosis of liver fibrosis in chronic hepatitis B and C patients through Meta-analysis. Material and methods: Four databases (PubMed, the Cochrane Library, WanFang data, and CNKI) were searched. The key words were: (“ARFI” or “acoustic radiation force impulse”) combined with “liver fibrosis” and (“chronic hepatitis” or “HBV HCV”). Heterogeneity (I2) was assessed, and its source was analyzed through meta-regression. Results: 21 articles with 2,691 patients were included. The compositeSe=0.79 (95% CI: 0.76-0.83) and Sp=0.86 (95% CI: 0.85-0.88). ARFI elastography showed a better ability to evaluate higherstage liver fibrosis and liver cirrhosis (F=3 and F=4, respectively). For F≥3, Se=0.84 (95% CI: 0.80-0.88, I2=61.37), Sp=0.90 (95% CI: 0.86-0.92, I2=65.10), and AUROC=0.94 (95% CI: 0.91-0.95). Se and Sp and AUROC of F=4 were 0.86 (95% CI: 0.80-0.91, I2=70.67), 0.84 (95% CI: 0.80–0.88, I2=78.94) and 0.91 (95% CI: 0.89-0.94), respectively. Besides, the combined RFI values indicate that CHC patients had higher ARFI values especially in the F3 stage (1.87 [95% CI: 1.67-2.06] and 2.31[95% CI: 2.09-2.52] for CHB and CHC, respectively). Conclusion: ARFI elastography is accurate and reliable in the diagnosis of CHB- and CHC-induced liver fibrosis and is especially suitable for the evaluation of stages F≥3 and F=4. CHC patients manifest higher ARFI values than CHB patients especially in the F3 stage.

Liver fibrosis markers as assessed by ultrasound elastography and serum samples: A large comparative study in hepatitis virus B and C liver diseases

“…In our ROC analyses, AUCs of VTQ for LF in the CHB cohort and the CHC cohort ranged from 0.75 to 0.90 and 0.78 to 0.88, respectively. Virtual touch quantification had strong P ‐values for predicting the severity of LF in most of the multivariate analyses, which were in line with previous reports . A recent study compared three elastographic methods, transient elastography, 2‐D shear wave elastography, and ARFI‐VTQ, in CLD patients and no notable differences in diagnostic accuracy were observed among them for the severity of LF .…”

“…Currently, one of the major ultrasound‐based assessment methods for LF using shear wave velocity is acoustic radiation force impulse (ARFI) . Several meta‐analyses and systematic reviews confirmed clinical utility of ARFI for the evaluation of the severity of LF . Usefulness of ARFI elastography is reported in not only CLDs but also chronic kidney diseases .…”

“…Usefulness of ARFI elastography is reported in not only CLDs but also chronic kidney diseases . Acoustic radiation force impulse is a reliable and reproducible assessment method with favorable intra‐ and interobserver levels of agreement, although there are some limitations . The Fibrosis‐4 (Fib‐4) index and aspartate aminotransferase to platelet ratio index (APRI), which are non‐invasive and accessible serum LF markers, were originally proposed for assessing the severity of LF in CHC patients .…”

The diagnostic accuracy of liver fibrosis in non-viral liver diseases using acoustic radiation force impulse elastography: A systematic review and meta-analysis

“…Therefore, compared with conventional elastographic techniques, ARFI elastography provide quantitative measurements of SWV, which might be superior in evaluating the grade of hepatic fibrosis [14,17]. The effects of ARFI elastography in staging hepatic fibrosis have been extensively studied with several meta analyses been published, especially regarding chronic hepatitis [1,6,[17][18][19]. However, limited data are available on the performance of ARFI in staging liver fibrosis in non-alcoholic fatty/alcoholic liver diseases (NAFLD/ALD), non-alcoholic steatohepatitis (NASH), patients with liver transplantation or other autoimmune-related diseases (such as primary biliary cirrhosis, PBC), etc.…”

Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy

“…It can be performed in a periodic follow-up and is generally superior to other serological modalities [12][13][14]. In a meta-analysis study, ARFI demonstrated a satisfactory ability to predict higher-stage liver fibrosis (F = 3) and liver cirrhosis (F = 4) [15]. However, inflammation, variation, and other factors have significant impacts on the interpretation [16][17][18][19][20][21][22].…”