Evaluation of acoustic radiation force impulse (ARFI) elastography in patients with non-viral cholestatic liver disease / Mira Atef Shafik ; Supervsied Iman Ismail Ramzy , Naglaa Ali Zayed , Samar Kamal Darweesh

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Tropical Medicine

Background: Transient elastography (TE) and acoustic radiation force impulse (ARFI) imaging are non-invasive tools to measure liver stiffness (LS), which may be influenced by cholestasis. Aim: The aim of our study was to evaluate the performance of TE and ARFI in cholestatic diseases and to correlate serial changes in LS with biochemical activity. Materials and Methods: Fifty patients with intrahepatic cholestasis and 38 patients with extrahepatic cholestasis were prospectively enrolled and underwent TE and ARFI. Liver biopsy was done for 35 patients to detect the etiology of intrahepatic cholestasis. Serial changes in LS were evaluated after medical treatment or biliary drainage and correlated with biochemical activity. Analyses to determine the optimal ARFI cut-off values were performed according to stages of clinical interest. Results: In extrahepatic cholestasis, biliary drainage led to a reduction of bilirubin by 7.7 to 2.2 mg/dL which was significantly correlated with a reduction of LS by TE from 10.30 kPa to 6.80 kPa (P <0.001) and by ARFI from 1.70 m/sec to 1.38 m/s (P=0.014). In intrahepatic cholestasis, the median value of LS changed from 13 Kpa to 9.5 Kpa by TE (P<0.001) and from 2.11 m/sec to 1.49 m/s by ARFI (P<0.001). The cut off values of liver stiffness using ARFI for F2 is from 1.53-1.76 m/s with sensitivity and specificity 92.6% and 50% respectively (AUROC=0.72), F3 is from 1.77-2.42 m/s with sensitivity and specificity 70.6% and 66.7% (AUROC=0.72) and F4 is >2.43 m/s with sensitivity and specificity 90% and 100% AUROC=0.93

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