Background: Staging of liver fibrosis is an essential part in the management of chronic liver disease. Invasive screening tests like liver biopsy, hepatic venous pressure gradient (HVPG) measurement and Upper-GI-Endoscopy have a significant burden on patients. We compared two different noninvasive methods of liver stiffness measurement (LSM), Transient Elastography (TE; FibroScan®) and Acoustic Radiation Force Impulse Imaging (ARFI; ACUSON Siemens 2000®), with HVPG and histology. Methods: Forty-eight patients (mean age 53±13) with different etiologies of chronic liver diseases were included. Liver cirrhosis (F4) and fibrosis (≥F1) was histologically diagnosed in 75.0% and 22.9%, respectively. Clinically significant portal hypertension (CSPH; HVPG≥10mmHg) was present in 56.2%. Results: Invalid results of TE and ARFI were obtained in 14 patients (29.2%) and 1 patient (2.1%), respectively, because of ascites and obesity (BMI 29.00 vs. BMI 25.57; p<0.05) HVPG correlated significantly with TE (r=0.754; p<0.01) and ARFI (r=0.709; p<0.01). Furthermore, TE correlated significantly to ARFI (r=0.757, p<0.01). Patients with CSPH had significantly higher LSM via TE (47.03kPa vs. 15.92kPa; r=0.649; p<0.01) and via ARFI (2.92m/s vs. 1.91m/s; r=0.497; p<0.01) Area under the receiver operating curve (AUROC) for diagnosis of CSPH was 0.896 (CI 0.791-1.001; p<0.01) for TE and 0.874(CI 0.7480.999; p<0.01) for ARFI. Patients with cirrhosis had significantly higher LSM with TE (42.6kPa vs. 8.0kPa; r=0.806; p<0.01) and with ARFI (2.75m/s vs. 1.48m/s; r=0.536; p<0.01) than patients with fibrosis. AUROC for diagnosis of cirrhosis was 0.955 (CI 0.891-1.018; p<0.01) for TE and 0.849 (CI 0.703-0.995; p<0.01) for ARFI. Mean HVPG in cirrhosis was 16.32±8.81mmHg compared to 3.00±1.63mmHg in non-cirrhotic patients. For diagnosing cirrhosis, a cut-off value of 16.0kPa for TE shows a sensitivity of 86% , a specificity of 100% (PPV 100%; NPV 69%). A cut-off value of 1.71m/s for ARFI shows a sensitivity of 91%, a specificity of 82% (PPV 94%; NPV 80%). Conclusion: Both TE and ARFI correlated with HVPG and showed a similar performance for the evaluation of CSPH. TE may be superior to ARFI for the diagnosis of liver cirrhosis. Possible advantages of ARFI are superior feasibility in obese patients and patients with ascites.
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