Open Access Highly Accessed Research article

Acoustic Radiation Force Impulse (ARFI) and Transient Elastography (TE) for evaluation of liver fibrosis in HIV-HCV co-infected patients

Nora Frulio1*, Hervé Trillaud1, Paul Perez2, Julien Asselineau2, Marianne Vandenhende3, Mojgan Hessamfar3, Fabrice Bonnet3, Florent Maire1, Jean Delaune3, Victor De Ledinghen45 and Philippe Morlat3

Author Affiliations

1 Department of Diagnostic and Interventional Imaging, Saint-André hospital, CHU de Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France

2 Unité de Soutien Méthodologique à la Recherche Clinique (USMR), CHU Bordeaux Pôle de Santé Publique, place Amélie Rabat-Leon, 33000 Bordeaux, France

3 Department of internal medicine and infectious diseases, Saint-André hospital, CHU de Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France

4 INSERM U1053, Bordeaux university, Bordeaux, France

5 Centre d’investigation de la fibrose hépatique, Haut-Lévêque hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33604 Pessac, France

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BMC Infectious Diseases 2014, 14:405  doi:10.1186/1471-2334-14-405

Published: 21 July 2014

Abstract

Background

Transient elastography (TE) is widely used for non-invasive assessment of liver fibrosis in HIV-HCV co-infected patients. TE, however, cannot determine liver morphology. Acoustic radiation force impulse (ARFI) imaging is a novel procedure enabling assessment of liver fibrosis during a conventional ultrasonographic examination. This study evaluated the correlation between liver fibrosis measurements by TE and ARFI.

Methods

Each of 46 HIV-HCV patients underwent both ARFI and TE within 6 months. Patients were evaluated by the “equivalent METAVIR” scoring system, using previously established cut-off values. Agreements between the ARFI and TE scores were estimated by Kappa coefficients, with Kappa values ≥0.40, ≥0.60, and ≥0.80 defined as moderate, good and very good agreement, respectively.

Results

ARFI and TE yielded "Equivalent Metavir" fibrosis scores of F1 in 26 and 31 patients, respectively; F2 in nine and seven, respectively; F3 in three and two, respectively; and F4 in eight and six, respectively. The two methods showed very good agreement in predicting overall stages [Kappa = 0.82] and for F ≥3 [Kappa = 0.80] and moderate agreement in predicting significant fibrosis F ≥2 [Kappa = 0.50]. Morphologic ultrasound analysis concomitant to ARFI detected two hepatocarcinomas.

Conclusions

ARFI showed promising results in the non-invasive assessment of liver fibrosis in HIV-HCV patients, with liver fibrosis staging similar to that of TE. Moreover, ARFI can assess morphology and fibrosis during the same session.

Keywords:
ARFI elastography; Liver fibrosis; HIV-HCV co-infected patients; Transient elastography