Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
Aliment Pharmacol Ther. 2016 Aug;44(4):366-79. doi: 10.1111/apt.13710. Epub 2016 Jun 30.
Obesity and overweight are global health problems.
To evaluate the diagnostic accuracy of liver stiffness measurement (LSM) using acoustic radiation force impulse (ARFI) elastography in overweight and obese patients for staging liver fibrosis.
Ninety-seven patients (mean age: 50 years, 50% male) with body mass index (BMI) ≥25 kg/m(2) (mean BMI: 31 kg/m(2) ) were prospectively enrolled. All patients underwent ARFI elastography and liver biopsy. In 87/97 patients, transient elastography (TE) was performed (M- and XL-probes). Patients were divided into two groups respectively: overweight: BMI <30 kg/m(2) (n = 61); and obese: BMI ≥30 kg/m(2) (n = 26).
Acoustic radiation force impulse elastography correlated with liver fibrosis in overweight (r = 0.84, P < 0.0001) and obese patients (r = 0.85, P < 0.0001), while no correlation was observed with steatosis, steatohepatitis and BMI. Area under the curve detecting liver cirrhosis for ARFI and TE were 0.97 in overweight and 0.94 and 0.92 in obese patients. In both groups, the failure rate was lower for ARFI than TE. ARFI of liver segment 8 showed a lower discordance than TE in both groups (overweight: 3% vs. 12%, P = 0.002; obese: 8% vs. 27%, P = 0.034). Steatosis and steatohepatitis were neither predictors of discordance nor of performance in LSM by ARFI or TE in both groups.
In overweight and obese patients, acoustic radiation force impulse can diagnose liver cirrhosis and significant fibrosis with high diagnostic accuracy. Liver stiffness measurement using the XL-probe reduces the influence of BMI, steatosis and steatohepatitis. The failure and discordance rates were lower for acoustic radiation force impulse than transient elastography in both patients groups.
肥胖和超重是全球性健康问题。
评估声辐射力脉冲（ARFI）弹性成像技术测量肝脏硬度（LSM）在超重和肥胖患者中诊断肝纤维化分期的准确性。
97 例患者（平均年龄：50 岁，50%为男性）BMI≥25kg/m²（平均 BMI：31kg/m²），前瞻性入组。所有患者均行 ARFI 弹性成像和肝活检。87/97 例患者行瞬时弹性成像（M 和 XL 探头）。患者分为两组：超重组：BMI＜30kg/m²（n=61）；肥胖组：BMI≥30kg/m²（n=26）。
ARFI 与超重（r=0.84，P＜0.0001）和肥胖患者（r=0.85，P＜0.0001）的肝纤维化均相关，而与脂肪变性、脂肪性肝炎和 BMI 无关。ARFI 和 TE 检测肝硬化的曲线下面积在超重组分别为 0.97 和 0.94、0.92。两组中 ARFI 的失败率均低于 TE。两组中 ARFI 检测肝 8 段的不一致性均低于 TE（超重组：3%比 12%，P=0.002；肥胖组：8%比 27%，P=0.034）。两组中脂肪变性和脂肪性肝炎既不是 ARFI 或 TE 检测 LSM 不一致的预测因子，也不是其检测性能的预测因子。
在超重和肥胖患者中，ARFI 可诊断肝硬化和显著纤维化，具有较高的诊断准确性。使用 XL 探头测量肝脏硬度可以降低 BMI、脂肪变性和脂肪性肝炎的影响。在两组患者中，ARFI 的失败率和不一致率均低于 TE。
