Acoustic radiation force impulse (ARFI) elastography in acute liver failure: necrosis mimics cirrhosis

Abstract

Acoustic radiation force Impulse (ARFI) technology correlates shear-wave velocity with fibrosis. It can differentiate between advanced fibrosis and normal tissue in chronic liver disease. However, specificity is impaired by cholestasis, inflammation or oedema in acute hepatitis. In patients with acute liver failure (ALF) necessitating liver transplantation ARFI has not been evaluated yet. We investigated 3 patients with ALF and compared their ARFI results to those of healthy controls (n = 33) and cases with liver cirrhosis (n = 21). In the 3 ALF patients shear-wave velocities were 3.0, 2.5, and 2.7 m/s, respectively. These results were significantly increased compared to those of healthy controls (median: 1.13 m/s; p < 0.001) and similar to those of cirrhotic individuals (median: 2.93 m/s). Two individuals underwent liver transplantation. Explants showed massive necrosis, but no signs of chronic liver disease. Patient 3 recovered spontaneously and showed decreasing ARFI results during follow-up. In conclusion, hepatic necrosis can mimic liver cirrhosis at ARFI evaluation in ALF patients and this impairs the specificity of ARFI.

Value of liver elastography and abdominal ultrasound for detection of complications of allogeneic hemopoietic SCT

“…8,9,26,27 These findings correspond with data of increased liver stiffness in critically ill non-cirrhotic patients. 28 Beyond that, TE could discriminate selected cases with severe complications in the later post-transplant course probably by reflecting severe acute hepatic injury in cases with liver affection 29 and cardiopulmonary distress in those without hepatic involvement.…”

“…7 Furthermore, LSM can be used for characterization of hepatic necro-inflammation and cholestasis in the absence of fibrosis. [8][9][10] In this line, preliminary data indicate a correlation of liver stiffness and liver toxicity following hematopoietic SCT. 11 We performed a prospective study to characterize the diagnostic value of B-mode, Doppler liver ultrasound and LSM for prediction and diagnosis of severe complications with and without liver involvement in SCT patients.…”

Pattern and profile of chronic liver disease in acute on chronic liver failure

“…However, the liver tissue stiffness may also increase with hepatitis, steatosis, and inflammation present in the ACLF setting [74]. Other techniques include ultrasound based acoustic radiation force impulse (ARFI) [75,76] and magnetic resonance elastography (MRE) [77,78]. MRE has an edge over fibroscan and ARFI in its ability to assess liver as a whole instead of a limited field when using probes for fibroscan and ARFI.…”

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“…Liver stiffness is increased with hepatic inflammation (often but not exclusively shown by an elevated transaminase level) [41 -44], obstructive cholestasis [45] and hepatic congestion [46,47]. Also acute toxic hepatitis (phenprocoumon-induced liver failure) increases measurements [48]. For patients with falsely elevated LSMs due to alcoholic hepatitis, liver stiffness decreases following 1 -4 weeks of abstinence [49 -51].…”