Correlation Between Fibroscan and ARFI with Metavir Liver Fibrosis Score

Abstract

Non-invasive assessment of liver fibrosis with Fibroscan and acoustic radiation force impulse (AFRI) imaging are two most popular modalities to measure liver fibrosis. Fibroscan is a well-established modality which measure both liver fibrosis and steatosis. However, there is considerable failure rate, and without image quidding the data may be misleading in the present of focal lesion in R hepatic lobe. ARFI may select an optimal location for measurement but there are concerns on the inter-observer and inter-location variations. We try to decrease the variation by measuring ARFI at two different locations. In a consecutive series of patients who received liver histology study were prospectively enrolled. All participant received hemogram, liver biochemistry, viral markers, ARFI and Fibroscan within 4 weeks of histology study. A standardized protocol was used to both Fibroscan and ARFI on the same day by a single technologist. Then both data from Fibroscan and ARFI were correlated with liver histology. Additional series of non-biopsy cases with chronic hepatitis B, chronic hepatitis C and non-alcoholic liver disease were also included for validation analysis. A total of 83 patients with liver histology study were included. This series included 34 NonB and NonC, 8 autoimmune liver diseases, 29 chronic hepatitis B and 12 hepatitis C. We excluded patients with alcoholism, dual HBV and HCV infection and unknown etiology. The correlation between Fibroscan and ARFI two-location measurement is good (R2=0.589, P<0.001). The area under the curve for Metavir 4 fibrosis are 0.877 and 0.919 for Fibroscan and ARFI respectively. A relatively lower value in Fibroscan than in ARFI is noted in the present of severe steatosis (CAP≥293, P<0.001). Similar situation was found in non-biopsy patients received both studies. The phenomenon of lower slope in patients with high CAP value are presented in all HBV, HCV or NBNC non-biopsy groups. We conclude that the correlation between Fibroscan and ARFI two location measurement is good. ARFI tends to have a better linearity with histology fibrosis grades than Fibroscan in patients with severe steatosis.