Evaluation of Transient Elastography, Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients

Abstract

BackgroundLiver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients.Patients and Methods41 patients (median BMI 47 kg/m2) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).ResultsValid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6–75 and 6.7/2.9–21.3 kPa) and ARFI (2.1/0.7–3.7 and 2.0/0.7–3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients.ConclusionIn bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.

Usefulness of virtual touch quantification for staging liver fibrosis in patients with hepatitis C, and factors affecting liver stiffness measurement failure compared with liver biopsy

“…Karlas et al . reported that ARFI overestimated the severity of liver fibrosis in the most obese patients . However, Nishikawa et al .…”

“…In obese patients, measurement failures have occurred using the FibroScan (Echosens, Paris, France) M probe, which has standard specifications, and the usefulness of the XL probe has been reported . Recently, measurement failures using ARFI were shown to occur in obese patients . Several reports have examined the reliability of LSM methods using US in obese patients.…”

Feasibility of liver stiffness measurement in morbidly obese patients undergoing bariatric surgery using XL probe

“…Our data are in agreement with previous studies in less obese patients that have shown that the skin-to-liver capsule distance plays an important role in failure of liver stiffness measurement. [17,[28][29][30][31] From these data, the M probe is currently recommended for patients with a skin-capsular distance of less than 25 mm, whereas for all other patients, the XL probe should be used. [17] In our cohort, we could also demonstrate that patients with reliable Fibroscan V R measurements had a significantly lower mean distance between skin and liver capsule compared to those patients with not valid and not successful measurements.…”

Systematic review and meta‐analysis: non‐invasive detection of non‐alcoholic fatty liver disease related fibrosis in the obese

“…Nine of these recruited patients from obese‐only cohorts. Five bariatric surgical studies reported liver biopsies on all bariatric surgical patients . In all studies, one or two dedicated pathologists scored all liver biopsies.…”