Acoustic Radiation Force Elastography and Transient Elastography in Autoimmune Hepatitis: Left Liver Lobe Measurement Shows Better Accuracy for Early Detection of Fibrosis

Abstract

Autoimmune hepatitis (AIH) can cause liver fibrosis and cirrhosis. We evaluated the performance of ARFI and transient elastography (TE) for staging in AIH patients. AIH was defined according to the International Autoimmune Hepatitis Group criteria. ARFI was performed in both liver lobes (l_ARFI and r_ARFI) and TE in the right lobe. Elastography results were compared with three different clinical patterns based on histology, laboratory values, and sonomorphology: (i) cirrhosis, (ii) pathological sonomorphology, (iii) AIH in remission with normal sonomorphology. 47 AIH patients were recruited (10 males, 37 females, age 54.2 years). Patients with normal liver morphology (n = 14) had a shear-wave velocity of 1.26±0.17 m/s (l_ARFI) and 1.18 ± 0.15 m/s (r_ARFI). TE revealed a liver stiffness of 4.75 ± 2.24 kPa. Individuals with liver cirrhosis (n = 17) had a significant increase of liver stiffness: 1.91±0.5 2m/s (l_ARFI), 1.91±0.65m/s (r_ARFI) and TE 19.59±17.43 kPa (p<0.05, respectively). Diagnostic performance for cirrhosis detection was comparable: AUROC was 0.778 (l_ARFI), 0.862 (r_ARFI) and 0.884 (TE). Group II (n = 16) had an increase in l_ARFI (1.66±0.37m/s, p<0.001) while r_ARFI (1.22±1.28 m/s) and TE (6.07±2.24 kPa) showed no increase: AUROC was 0.887 (l_ARFI), 0.685 (r_ARFI) and 0.815 (TE). ARFI and TE can reliably detect liver cirrhosis in autoimmune hepatitis with comparable accuracy. l_ARFI has a better accuracy for early detection of fibrosis than r_ARFI or TE.