Application of acoustic radiation force impulse elastography combined with serum markers in Child-Pugh grading

Abstract

OBJECTIVES: Acoustic radiation force impulse (ARFI) elastography, the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 (FIB-4) index are widely used to assess liver fibrosis. However, efficacies of these methods in the evaluation of hepatic functional reserve remain unclear. In this study, we investigated the relationship between ARFI elastography combined with either AAR, APRI, or FIB-4 index and Child-Pugh (CP) class for the evaluation of hepatic functional reserve in patients with chronic hepatitis B (CHB)-related cirrhosis. METHODS: The shear wave velocities of 104 patients with clinically confirmed CHB-related cirrhosis were determined using the ARFI; and clinical serum markers (e.g. ALT, AST, PLT) were used to calculate the AAR, APRI, and FIB-4 index. Cirrhosis patients were scored according to their CP class. The ARFI, AAR, APRI, and FIB-4 index were compared with the CP class. The efficacy of each indicator in diagnosis was analyzed using the receiver operating characteristic (ROC) curve and the ARFI combined with either the AAR, APRI, or FIB-4 index, which is used to predict decompensated cirrhosis. RESULTS: No significant differences were observed in gender and age among CP classes A, B, and C patients ( p >0.05). The ARFI values and the AAR, APRI, and FIB-4 index of patients with CP classes A, B, and C were significantly different ( p <0.05). With an increasing CP class, the ARFI, AAR, APRI, and FIB-4 values increased. The correlation between the ARFI and the CP class was stronger than that between the AAR, APRI, and FIB-4 index and the CP class. The area under the ROC curve for the diagnosis of decompensated cirrhosis using the ARFI was 0.841, which was higher than that for the AAR, APRI, and FIB-4 index. According to the area under the curve results, no significant differences were found when the ARFI was combined with either the AAR, APRI, or FIB-4 index and when the ARFI alone was used. CONCLUSIONS: The ARFI value has a strong correlation with the CP class. Therefore, ARFI elastography complements CP class in the assessment of the hepatic functional reserve in patients with CHB-related cirrhosis.

Tomoelastography based on multifrequency MR elastography predicts liver function reserve in patients with hepatocellular carcinoma: a prospective study

“…Moderate correlations between tomoelastography parameters and serum markers revealed that biomechanical parameters were indicative of liver function. Associations between hepatic stiffness and liver function reserve have been reported previously [ 15 – 18 , 33 , 44 ] (Additional file 1 : Table S1) and were largely explained by excessive deposition of ECM elements during fibrogenesis. This caused liver lobule structural changes, hepatocellular injuries, and altered hepatic vascular structure and resistance, thus disrupting and compromising liver function.…”

“…As a common outcome of various hepatic diseases, liver cirrhosis, developed from liver fibrosis, is characterized by the accumulation of extracellular matrix (ECM) proteins and formation of fibrous scarring, leading to replacement and distortion of hepatic parenchymal tissue, thus resulting in loss of liver function [ 14 ]. Studies have found that liver stiffness measured by transient elastography (TE) [ 15 ], point shear wave elastography (pSWE) [ 16 ], and acoustic radiation force impulse (ARFI) elastography [ 17 , 18 ] are well correlated with liver function test results, such as Child–Pugh grades or ICG-R15, but with varying correlation coefficients ranging from 0.342 to 0.862. Wei et al [ 18 ] reported that the area under the curve (AUC) of the ARFI for diagnosing patients who were at least Child–Pugh class B was 0.841 (95% confidence interval [CI] 0.756–0.905).…”

“…Studies have found that liver stiffness measured by transient elastography (TE) [ 15 ], point shear wave elastography (pSWE) [ 16 ], and acoustic radiation force impulse (ARFI) elastography [ 17 , 18 ] are well correlated with liver function test results, such as Child–Pugh grades or ICG-R15, but with varying correlation coefficients ranging from 0.342 to 0.862. Wei et al [ 18 ] reported that the area under the curve (AUC) of the ARFI for diagnosing patients who were at least Child–Pugh class B was 0.841 (95% confidence interval [CI] 0.756–0.905). In a recent study, liver stiffness quantified by 2D time-harmonic elastography was also found to be correlated with liver function as measured by the 13C-methacetin Liver MAximum capacity test during fibrogenesis [ 19 ].…”

AST to ALT ratio as a prospective risk predictor for liver cirrhosis in patients with chronic HBV infection

“…Consequently, it is accomplished with abnormal liver function at the most time. Hepatic function produces a marked effect on predicting the development and prognosis of patients with cirrhosis and other liver diseases [8,9]. Serum ALT and AST are two common liver enzymes that are routinely detected in the clinical setting, which was originated from damaged hepatocytes [10].…”