Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
Dig Dis Sci. 2012 Jun;57(6):1682-91. doi: 10.1007/s10620-012-2044-4.
Acoustic radiation force impulse (ARFI) elastography can be used to assess the degree of liver fibrosis.
We evaluated the performance of ARFI elastography in assessment of liver fibrosis and compared it with the performance of aspartate aminotransferase-to-platelet ratio index (APRI) and transient elastography with Fibroscan (FS).
We prospectively analyzed 250 consecutive patients who underwent liver biopsy and ARFI from June 2010 to May 2011. Reliable FS values were obtained for 97 (38.8%) patients.
The mean age of patients (147 male and 103 female) was 46.6 years. Liver stiffness values obtained by use of ARFI elastography significantly correlated with histological fibrosis stage (R = 0.575, P < 0.001). Area under the receiver operating characteristics curves (AUROCs) of ARFI elastography for predicting significant fibrosis (≥F2) and cirrhosis (F4) was 0.74 (95% confidence interval [CI], 0.64-0.86, P = 0.001) and 0.79 (95% CI, 0.67-0.91, P = 0.001), respectively, and those for APRI were 0.69 (95% CI, 0.58-0.79, P = 0.001) and 0.76 (95% CI, 0.64-0.85, P < 0.001), respectively. The optimum cutoff values for ARFI elastography were 1.13 m/s for ≥F2 and 1.98 m/s for F4; these decreased to 1.09 m/s for ≥F2 and 1.81 m/s for F4 when 131 patients with normal alanine aminotransferase (ALT) were selected. In the sub-group of 97 patients with reliable FS values, the performance in predicting ≥F2 or F4 was equivalent between ARFI elastography and FS.
ARFI elastography is a reliable surrogate marker of liver fibrosis, if its relationship with biochemical markers, for example ALT level, is taken into account.
声辐射力脉冲（ARFI）弹性成像可用于评估肝纤维化程度。
我们评估 ARFI 弹性成像在评估肝纤维化中的性能，并将其与天门冬氨酸氨基转移酶血小板比值指数（APRI）和 Fibroscan（FS）的瞬时弹性成像进行比较。
我们前瞻性分析了 2010 年 6 月至 2011 年 5 月期间接受肝活检和 ARFI 的 250 例连续患者。为 97 例（38.8%）患者获得了可靠的 FS 值。
患者的平均年龄为 46.6 岁（147 名男性和 103 名女性）。ARFI 弹性成像获得的肝硬度值与组织学纤维化分期显著相关（R = 0.575，P < 0.001）。ARFI 弹性成像预测显著纤维化（≥F2）和肝硬化（F4）的受试者工作特征曲线下面积（AUROCs）分别为 0.74（95%置信区间 [CI]，0.64-0.86，P = 0.001）和 0.79（95% CI，0.67-0.91，P = 0.001），APRI 的 AUROCs 分别为 0.69（95% CI，0.58-0.79，P = 0.001）和 0.76（95% CI，0.64-0.85，P < 0.001）。ARFI 弹性成像的最佳截断值为 1.13 m/s 用于≥F2，1.98 m/s 用于 F4；当选择 131 例丙氨酸氨基转移酶（ALT）正常的患者时，该值分别降低至 1.09 m/s 用于≥F2 和 1.81 m/s 用于 F4。在 97 例具有可靠 FS 值的患者亚组中，ARFI 弹性成像在预测≥F2 或 F4 方面的性能与 FS 相当。
如果考虑到其与生化标志物（例如 ALT 水平）的关系，ARFI 弹性成像可能是肝纤维化的可靠替代标志物。
