Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany.
J Viral Hepat. 2013 Apr;20(4):240-7. doi: 10.1111/j.1365-2893.2012.01646.x. Epub 2012 Jul 31.
Acoustic radiation force impulse (ARFI) imaging is a novel ultrasound-based elastography method that is integrated in a conventional ultrasound machine. It might provide an alternative method to transient elastography for the noninvasive assessment of liver fibrosis. While previous studies have shown comparable diagnostic accuracy of ARFI to transient elastography in chronic hepatitis C, the aim of the present prospective multicenter study was to evaluate ARFI for the assessment of liver fibrosis in chronic hepatitis B. ARFI imaging involves the mechanical excitation of tissue using short-duration acoustic pulses to generate localized displacements in tissue. The displacements result in shear-wave propagation which is tracked using ultrasonic, correlation-based methods and recorded in m/s. In the present international prospective study, patients infected with chronic hepatitis B received ARFI imaging, blood tests and if available transient elastography. The results were compared to liver biopsy as reference method analysed by a central pathologist. In 92 of 114 patients, a comparison of ARFI with transient elastography was possible. ARFI imaging and transient elastography correlated significantly with histological fibrosis stage. The diagnostic accuracy expressed as areas under ROC curves for ARFI imaging and transient elastography was 0.75 and 0.83 for the diagnosis of significant fibrosis (F ≥ 2), 0.93 and 0.94 for the diagnosis of severe fibrosis (F ≥ 3), and 0.97 and 0.93 for the diagnosis of liver cirrhosis, respectively. No significant difference was found between ARFI and transient elastography. ARFI imaging is a reliable ultrasound-based method for the assessment of advanced stages of liver fibrosis in chronic hepatitis B.
声辐射力脉冲（ARFI）成像技术是一种新型的超声弹性成像方法，可集成在常规超声仪中。该技术可能为慢性丙型肝炎患者提供一种非侵入性评估肝纤维化的方法，以替代瞬时弹性成像技术。尽管之前的研究表明 ARFI 对慢性丙型肝炎的诊断准确性与瞬时弹性成像相当，但本前瞻性多中心研究的目的是评估 ARFI 对慢性乙型肝炎患者肝纤维化的评估价值。ARFI 成像技术通过短持续时间的声脉冲对组织进行机械激励，从而在组织中产生局部位移。这些位移导致剪切波传播，然后使用超声相关方法进行跟踪，并以 m/s 记录。在本国际前瞻性研究中，感染慢性乙型肝炎的患者接受了 ARFI 成像、血液检查，如果可行，还接受了瞬时弹性成像。结果与以中心病理学家分析的肝活检作为参考方法进行了比较。在 114 名患者中的 92 名中，ARFI 与瞬时弹性成像的比较是可能的。ARFI 成像和瞬时弹性成像与组织学纤维化分期显著相关。ARFI 成像和瞬时弹性成像的诊断准确性（以 ROC 曲线下面积表示）分别为 0.75 和 0.83，用于诊断显著纤维化（F ≥ 2），0.93 和 0.94，用于诊断严重纤维化（F ≥ 3），0.97 和 0.93，用于诊断肝硬化。ARFI 成像和瞬时弹性成像之间没有发现显著差异。ARFI 成像技术是一种可靠的基于超声的方法，可用于评估慢性乙型肝炎患者的晚期肝纤维化。
