Measurement of Liver Elasticity with Acoustic Radiation Force Impulse (ARFI) Technology: An Alternative Noninvasive Method for Staging Liver Fibrosis in Viral Hepatitis

Goertz, Ruediger S.; Zopf, Yurdagül; Jugl, V; Heide, R.; Janson, Christopher M.; Strobel, D; Bernatik, T.; Haendl, T.

doi:10.1055/s-0029-1245244

Cited by 109 publications

(90 citation statements)

References 13 publications

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“…15,17 Conventional US devices include ARFI; therefore, B mode information and the elastography measurement can be performed quickly using a single device, as in TE. 11,18 The US-guided device makes it possible to identify the most appropriate place for the elastographic measurements, for instance avoiding nearby interfering structures, such as hepatic vessels and ascites. 19 In nontransplant patients, regarding the accuracy of ARFI imaging in cirrhotic liver disease, several studies have reported that ARFI imaging provides good diagnostic performance and excellent accuracy, with ARFI values increasing in parallel with fibrosis stage.…”

Section: Discussionmentioning

confidence: 99%

“…The propagation speed (measured in meters per second) increases with the stage of the fibrosis. 6 It has been shown that ARFI is a reliable technique for diagnosing or excluding liver cirrhosis [9][10][11] and shows similar predictive value for significant fibrosis and cirrhosis compared with TE. 6 However, the standard cut off value of the ARFI technique is not yet well established in the clinical care of liver transplant patients.…”

Section: Introductionmentioning

confidence: 99%

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Liver Stiffness Measurements Using Acoustic Radiation Force Impulse in Recipients of Living-Donor and Deceased-Donor Orthotopic Liver Transplant

Haberal

Turnaoğlu²,

Özdemır³

et al. 2021

Exp Clin Transplant

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Objectives: The aim of this study was to evaluate the diagnostic efficiency of the acoustic radiation force impulse (Siemens Medical Solutions, Erlangen, Germany) elastography in assessment of fibrosis in orthotopic liver transplant patients. Materials and Methods:We enrolled 28 orthotopic liver transplant patients (deceased and living donors), whose biopsy decision had been prospectively given clinically. Ten acoustic radiation force impulse elastographic measurements were applied before the biopsy or within 3 days after the biopsy by 2 radiologists. After the core tissue needle biopsy, specimens of all patients were analyzed according to the modified Ishak scoring system. Measurements of acoustic radiation force impulse elastography and pathology specimen results were compared. Key words: Liver biopsy, Liver fibrosis, Metavir, Transient elastography, Ultrasonography IntroductionLiver transplant is the only treatment option for advanced liver disease. However, after liver transplant, acute complications (including primary dysfunction, hepatic artery thrombosis, portal vein thrombosis, hepatic venous obstruction, bile leak, and biliary stricture) or chronic complications (including chronic rejection, disease recurrence, and drug-induced complications) may occur. 1-3 Posttransplant liver dysfunction can have various causes; evaluation of the causes, which can lead to diffuse parenchymal damage, including fibrosis, is of clinical importance.Postoperative B-mode and Doppler ultrasonography (US) are standard procedures for the assessment of graft complications. From US findings, clinical symptoms, and abnormal laboratory findings, a liver biopsy may be required. 4 Although liver biopsy is the standard method for the assessment of morphologic liver changes and fibrosis, it is an invasive procedure that may cause complications. 5 Transient elastography (TE) is currently the most widely used and endorsed method for the asses sment of liver fibrosis in many conditions, such as chronic hepatitis B and C, nonalcoholic steatohepatitis, and nonalcoholic fatty liver disease, as well as in posttransplant patients. 6 Insufficient performance in detecting mild fibrosis, failure to measure liver elasticity in patients with obesity, ascites, and narrow intercostal space, and inability to target liver parenchyma by direct visualization are problems that remain a considerable adversity of this tool. 7,8 Acoustic radiation force impulse (ARFI; Siemens Medical Solutions, Erlangen, Germany) elastography is a new technology to measure liver stiffness and

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Liver Stiffness Measurements Using Acoustic Radiation Force Impulse in Recipients of Living-Donor and Deceased-Donor Orthotopic Liver Transplant

Haberal

Turnaoğlu²,

Özdemır³

et al. 2021

Exp Clin Transplant

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“…From 2009, with the introduction of ARFI, the clinical research on non-invasive assessment of fibrosis rapidly progressed. As an advanced imaging technology, ARFI is capable of providing biomechanical information on the tissue stiffness and elasticity using conventional ultrasound scanning of anatomical location and structure [22,23] . However, its utility, particularly in combination with other non-invasive methods in hepatitis B, has not been adequately evaluated.…”

Section: Discussionmentioning

confidence: 99%

Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

Dong

Jia

Shan

et al. 2016

WJH

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AIM:To investigate the combined diagnostic accuracy of acoustic radiation force impulse (ARFI), aspartate aminotransferase to platelet ratio index (APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B (CHB). RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage (all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI (P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage (Z = 2.77, P = 0.006). METHODS:Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI (Z = 0.958, P = 0.338).CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.

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“…If advanced fibrosis is clinically suspected, the assessment of fibrosis should be performed by liver biopsy, abdominal ultrasonography, elastography or abdominal computed tomography [18][19][20][21][22] . If advanced fibrosis is observed, antiviral therapy should be started.…”

Section: Cirrhosismentioning

confidence: 99%

Current and future directions for treating hepatitis B virus infection

Tawada

Yokosuka

2015

WJH

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Hepatitis B virus (HBV) persistently infects approximately 350 million people, and approximately 600000 liverrelated deaths are observed per year worldwide. HBV infection is also one of the major risk factors for hepatocellular carcinoma (HCC). The persistence of serum hepatitis B e antigen (HBeAg) and high level of serum HBV DNA are thought to reflect a high HBV replication status in hepatocytes, causing cirrhosis, HCC and liver-related deaths. It has been reported that antiviral therapy, such as peginterferon and nucleos(t)ide analogues (NUCs), could suppress liver-related death by inhibiting the HBV DNA levels and inducing seroconversion from HBeAg to antibody to HBe antigen. Currently, peginterferon is widely used, but there are also several disadvantages in the use of peginterferon, such as various adverse events, the administration route and duration. It is difficult to predict the effects of treatment and interferon is contraindicated for the patients with advanced fibrosis of the liver and cirrhosis. With respect to NUCs, entecavir and tenofovir disoproxil fumarate are current the first-choice drugs. NUCs can be administered orally, and their anti-viral effects are stronger than that of peginterferon. However, because cessation of NUC administration leads to high levels of viral replication and causes severe hepatitis, they must be administered for a long time. On the other hand, the use of both interferon and NUCs cannot eliminate covalently closed circular DNA of HBV. In this review, we evaluate the natural course of chronic HBV infection and then provide an outline of these representative drugs, such as peginterferon, entecavir and tenofovir disoproxil fumarate.

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Measurement of Liver Elasticity with Acoustic Radiation Force Impulse (ARFI) Technology: An Alternative Noninvasive Method for Staging Liver Fibrosis in Viral Hepatitis

Abstract: This study underscores the usefulness of ARFI as a quick method for assessing liver fibrosis or cirrhosis in patients with HBV or HCV. ARFI measurements of the liver should be performed via an intercostal access. Increasing ARFI velocities correlate with higher degree of hepatic fibrosis.

Cited by 109 publications

References 13 publications

Liver Stiffness Measurements Using Acoustic Radiation Force Impulse in Recipients of Living-Donor and Deceased-Donor Orthotopic Liver Transplant

Liver Stiffness Measurements Using Acoustic Radiation Force Impulse in Recipients of Living-Donor and Deceased-Donor Orthotopic Liver Transplant

Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

Current and future directions for treating hepatitis B virus infection

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