OBJECTIVES: Transient elastography (TE) is adequate for a diagnosis of cirrhosis,but its accuracy for milder stages of fibrosis is much less satisfactory. Theobjective of this study was to compare the performance and the discordance rateof acoustic radiation force impulse (ARFI) and TE with liver biopsy in a cohortof chronic hepatitis C (CHC) patients.METHODS: One hundred thirty-nine consecutive patients with CHC were enrolled intwo tertiary centers, and evaluated for histological (Metavir score) andbiochemical features. All patients underwent TE and ARFI.RESULTS: TE was unreliable in nine patients (6.5%), while in no cases (0%) wereARFI invalid measurements recorded (P=0.029). By area under receiver operatingcharacteristic curve (AUROC), the best cutoff values for TE and ARFI forsignificant fibrosis (≥F2) were ≥6.5 kPa (AUROC: 0.78) and ≥1.3 m/s (AUROC:0.86), respectively. For severe fibrosis (F3-F4), these cutoff values were8.8 kPa (AUROC: 0.83) for TE and 1.7 m/s (AUROC: 0.94) for ARFI. For cirrhosis,TE had its best cutoff at ≥11 kPa (AUROC: 0.80) and ARFI at ≥2.0 m/s (AUROC:0.89). By pairwise comparison of AUROC, ARFI was significantly more accurate thanTE for a diagnosis of significant and severe fibrosis (P=0.024 and P=0.002,respectively), while this difference was only marginal for cirrhosis (P=0.09). Bypartial AUROC analysis, ARFI performance results significantly higher for allthree stages of fibrosis. The average concordance rates of TE and ARFI vs. liver biopsy were 45.4 and 54.7%, respectively. By multivariate analysis, ARFI was not associated with alanine aminotransferase (ALT), body mass index, Metavir grade,and liver steatosis, while TE was significantly correlated with the ALT value(P=0.027).CONCLUSIONS: In a cohort of patients with CHC, ARFI imaging was more accuratethan TE for the non-invasive staging of both significant and severe classes ofliver fibrosis.

Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic hepatitis C

CACOPARDO, Bruno Santi;Nunnari G;
2011-01-01

Abstract

OBJECTIVES: Transient elastography (TE) is adequate for a diagnosis of cirrhosis,but its accuracy for milder stages of fibrosis is much less satisfactory. Theobjective of this study was to compare the performance and the discordance rateof acoustic radiation force impulse (ARFI) and TE with liver biopsy in a cohortof chronic hepatitis C (CHC) patients.METHODS: One hundred thirty-nine consecutive patients with CHC were enrolled intwo tertiary centers, and evaluated for histological (Metavir score) andbiochemical features. All patients underwent TE and ARFI.RESULTS: TE was unreliable in nine patients (6.5%), while in no cases (0%) wereARFI invalid measurements recorded (P=0.029). By area under receiver operatingcharacteristic curve (AUROC), the best cutoff values for TE and ARFI forsignificant fibrosis (≥F2) were ≥6.5 kPa (AUROC: 0.78) and ≥1.3 m/s (AUROC:0.86), respectively. For severe fibrosis (F3-F4), these cutoff values were8.8 kPa (AUROC: 0.83) for TE and 1.7 m/s (AUROC: 0.94) for ARFI. For cirrhosis,TE had its best cutoff at ≥11 kPa (AUROC: 0.80) and ARFI at ≥2.0 m/s (AUROC:0.89). By pairwise comparison of AUROC, ARFI was significantly more accurate thanTE for a diagnosis of significant and severe fibrosis (P=0.024 and P=0.002,respectively), while this difference was only marginal for cirrhosis (P=0.09). Bypartial AUROC analysis, ARFI performance results significantly higher for allthree stages of fibrosis. The average concordance rates of TE and ARFI vs. liver biopsy were 45.4 and 54.7%, respectively. By multivariate analysis, ARFI was not associated with alanine aminotransferase (ALT), body mass index, Metavir grade,and liver steatosis, while TE was significantly correlated with the ALT value(P=0.027).CONCLUSIONS: In a cohort of patients with CHC, ARFI imaging was more accuratethan TE for the non-invasive staging of both significant and severe classes ofliver fibrosis.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/57480
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