Acoustic radiation force impulse elastography of liver as a screening tool for liver fibrosis in alcoholic liver disease

Context: Acoustic radiation force impulse (ARFI) elastography is a noninvasive and quantitative technique for diagnosis of liver fibrosis. To the best of our knowledge, there are only two studies reported in literature for evaluation of alcoholic liver disease using ARFI. Aims: The aim of this study was to evaluate the diagnostic performance of ARFI elastography for assessing liver fibrosis in alcoholic liver disease and compare it with biochemical indices aspartate transaminase-to-platelet ratio index (APRI) and fibrosis-4 Index (FIB-4) using histopathology as the reference standard. Settings and Design: Institutional cross-sectional study. Methods and Materials: The patients visiting our hospital over a period of 2 years with a high-risk consumption of alcohol (>40 g/day for men and >20 g/day for women for a cumulative period of more than 5 years) were subjected to ARFI elastography of liver, Liver Function Tests (to calculate APRI and FIB-4 indices), and liver biopsy. Statistical Analysis Used: Area under the receiver operating characteristic (AUROC) curve analysis, Kruskal--Wallis test for ANOVA. Results: A total of 50 patients of chronic alcoholic liver disease were evaluated with ARFI elastography, which performed better than the biochemical indices in distinguishing cirrhosis of the liver (F = 4) from the severe fibrosis (F >= 3) with area under the receiver operating characteristic of 0.97, whereas for significant fibrosis (F >= 2) and severe fibrosis (F >= 3), it was comparable to the biochemical indices with AUROC of 0.65 and 0.70. In our study, the median shear wave velocity cutoff values were 1.37 m/s, 1.51 m/s, and 1.87 m/s for F >= 2, F >= 3, and F = 4 fibrosis stages, respectively. Conclusions: ARFI elastography is a noninvasive, reliable, and repeatable diagnostic test for grading of liver fibrosis. It performs better than the biochemical indices to differentiate severe fibrosis and cirrhosis of liver.