Acoustic radiation force impulse (ARFI) elastography compared with biopsy for evaluating hepatic fibrosis after liver transplantation
a cross-sectional diagnostic study
Keywords:
Elasticity imaging techniques, Liver transplantation, Fibrosis, Liver cirrhosis, UltrasonographyAbstract
CONTEXT AND OBJECTIVE: Biopsies are used after liver transplantation to evaluate fibrosis. This study aimed to evaluate the elasticity of transplanted livers by means of a non-invasive examination, acoustic radiation force imaging (ARFI) elastography, correlating the results with the histological analysis. DESIGN AND SETTING: Cross-sectional study in a public university hospital. METHODS: All patients consecutively operated between 2002 and 2010 with an indication for biopsy were evaluated by means of elastography. The radiologist evaluating ARFI and the pathologist doing anatomopathological examinations were blinded to each other’s evaluations. RESULTS: During the study period, 33 patients were included. The indication for transplantation was cirrhosis due to hepatitis C in 21 cases (63%). Liver biopsies showed absence of fibrosis (F0) in 10 patients, F1 in 11, F2 in 8 and F3 in 4. There were no cases of F4 (cirrhosis). The difference in ARFI values (degree of fibrosis) was 0.26 (95% confidence interval, CI: 0.07-0.52) between the groups F0-F1 and F2-F4 (P = 0.04). An area under the curve of 0.74 (CI: 0.55-0.94) and a cutoff of 1.29 m/s between the groups resulted in the best relationship between sensitivity and specificity. Sensitivity (0.66; CI: 0.50-0.83) was lower than specificity (0.85; CI: 0.72-0.97). There was no significant difference in ARFI between patients with hepatitis C and those with other diseases. CONCLUSIONS: The values obtained from elastography were not affected by inflammatory reaction or anatomical alterations. A cutoff point of 1.29 m/s separating patients with or without significant fibrosis was identified.
Downloads
References
Hübscher SG. What is the long-term outcome of the liver allograft? J Hepatol. 2011;55(3):702-17.
Sebagh M, Rifai K, Féray C, et al. All liver recipients benefit from the protocol 10-year liver biopsies. Hepatology. 2003;37(6):1293-301.
Shiroma RK, Chaib E, Amed-Filho AM, et al. Transplante de fígado de acordo com os critérios de Milão: revisão dos últimos 10 anos. [Liver transplantation according to Milan criteria: an overview of the past ten years]. Rev Med (São Paulo). 2012;91(2):120-4.
Meirelles Júnior RF, Salvalaggio P, Rezende MB, et al. Transplante de fígado: história, resultados e perspectivas [Liver transplantation: history, outcomes and perspectives]. Einstein (São Paulo). 2015;13(1):149-52.
Evans HM, Kelly DA, McKiernan PJ, Hübscher S. Progressive histological damage in liver allografts following pediatric liver transplantation. Hepatology. 2006;43(5):1109-17.
Ekong UD, Melin-Aldana H, Seshadri R, et al. Graft histology characteristics in long-term survivors of pediatric liver transplantation. Liver Transpl. 2008;14(11):1582-7.
Castéra L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343-50.
Piscaglia F, Cucchetti A, Terzi E, Gianstefani A. Validation of noninvasive methods for the assessment of liver fibrosis in patients with recurrent hepatitis C after transplantation. Liver Transpl. 2010;16(8):1006-7.
J S Cross T, Jothimani D, Heneghan MA, Harrison PM. Non-invasive assessment of fibrosis in liver grafts due to hepatitis C virus recurrence. Clin Transplant. 2011;25(3):345-51.
Friedrich-Rust M, Nierhoff J, Lupsor M, et al. Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat. 2012;19(2):e212-9.
Cholongitas E, Tsochatzis E, Goulis J, Burroughs AK. Noninvasive tests for evaluation of fibrosis in HCV recurrence after liver transplantation: a systematic review. Transpl Int. 2010;23(9):861-70.
Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology. 1994;20(1 Pt 1):15-20.
Silva Junior RG, Schmillevitch J, Nascimento Mde F, et al. Acoustic radiation force impulse elastography and serum fibrosis markers in chronic hepatitis C. Scand J Gastroenterol. 2014;49(8):986-92.
Huwart L, Peeters F, Sinkus R, et al. Liver fibrosis: non-invasive assessment with MR elastography. NMR Biomed. 2006;19(2):173-9.
Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas E, et al. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol. 2008;7(4):350-7.
Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-26.
Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705-13.
Rifai K, Bahr MJ, Mederacke I, et al. Acoustic radiation force imaging (ARFI) as a new method of ultrasonographic elastography allows accurate and flexible assessment of liver stiffness. Journal of Hepatology. 2009;50(Supplement 1):S88 [abstract 217]. Available from: http://www.journal-of-hepatology.eu/article/S0168-8278%2809%2960219-1/pdf. Accessed in 2016 (Sep 1).
LupsorM,BadeaR,StefanescuH,etal.Performanceofanewelastographic method (ARFI technology) compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results. J Gastrointestin Liver Dis. 2009;18(3):303- 10.
Fierbinteanu-Braticevici C, Andronescu D, Usvat R, et al. Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis. World J Gastroenterol. 2009;15(44):5525-32.
Donato MF, Rigamonti C, Colombo M. Can protocol liver biopsy be avoided to evaluate post-transplant hepatitis C recurrence? Transient elastography makes it possible. Dig Liver Dis. 2010;42(4):307.
Adebajo CO, Talwalkar JA, Poterucha JJ, Kim WR, Charlton MR. Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation: a systematic review and meta-analysis. Liver Transpl. 2012;18(3):323-31.
Nierhoff J, Chávez Ortiz AA, Herrmann E, Zeuzem S, Friedrich- Rust M. The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol. 2013;23(11):3040- 53.
Pinto J, Matos H, Nobre S, et al. Comparison of acoustic radiation force impulse/serum noninvasive markers for fibrosis prediction in liver transplant. J Pediatr Gastroenterol Nutr. 2014;58(3):382-6.
Crespo G, Fernández-Varo G, Mariño Z, et al. ARFI, FibroScan, ELF, and their combinations in the assessment of liver fibrosis: a prospective study. J Hepatol. 2012;57(2):281-7.
Wildner D, Strobel D, Konturek PC, et al. Impact of acoustic radiation force impulse imaging in clinical practice of patients after orthotopic liver transplantation. Med Sci Monit. 2014;20:2027-35.
