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Comparison of acoustic radiation force impulse imaging with transient elastography for the detection of complications in patients with cirrhosis



Mireen Friedrich-Rust, MD, Medizinische Klinik 1, Klinikum der J. W. Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany

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Acoustic radiation force impulse (ARFI) imaging is a new non-invasive, ultrasound-based method for the evaluation of liver fibrosis and cirrhosis.


To determine the diagnostic accuracy of ARFI imaging, transient elastography (TE) and Fibrotest for the evaluation of complications in patients with cirrhosis.


A total of 166 patients (109 male, mean age: 54 ± 11 years) with chronic liver disease and established cirrhosis were included in this study. ARFI-imaging of the liver and spleen, TE and Fibrotest were performed in all patients. In addition, clinical, laboratory and morphological parameters, including MELD/Child–Pugh scores, presence of oesophageal varices and hepatocellular carcinoma, history of variceal bleeding and history of hepatic encephalopathy were recorded.


Acoustic radiation force impulse liver was significantly correlated with ARFI spleen (= 0.48, < 0.001), TE (= 0.75, < 0.001) and Fibrotest (r = 0.21, = 0.006). The diagnostic accuracy (AUROC) for the diagnosis of large oesophageal varices was 0.58 (95% CI: 0.48–0.67), 0.58 (0.49–0.67), 0.53 (0.44–0.63) and 0.50 (0.41–0.59) for ARFI liver, spleen, TE and Fibrotest respectively (> 0.20). The AUROC for the detection of hepatocellular carcinoma (HCC) was 0.54 (0.39–0.70), 0.58 (0.44–0.73), 0.56 (0.40–0.73) and 0.72 (0.60–0.84) respectively (> 0.20). Multiple logistic regression analysis showed that ARFI spleen better predicted the presence of large oesophageal varices and HCC compared with ARFI liver.


The diagnostic accuracy of ARFI liver and spleen was comparable to TE and Fibrotest for the detection of complications in patients with cirrhosis.