Acoustic Radiation Force Impulse Elastography for fibrosis evaluation in patients with chronic hepatitis C: An international multicenter study

Ioan Sporea, Simona Bota, Markus Peck-Radosavljevic, Roxana Sirli, Hironori Tanaka, Hiroko Iijima, Radu Badea, Monica Lupsor, Carmen Fierbinteanu-Braticevici, Ana Petrisor, Hidetsugu Saito, Hirotoshi Ebinuma, Mireen Friedrich-Rust, Christoph Sarrazin, Hirokazu Takahashi, Naofumi Ono, Fabio Piscaglia, Alberto Borghi, Mirko D'Onofrio, Anna GallottiArnulf Ferlitsch, Alina Popescu, Mirela Danila

Research output: Contribution to journalArticlepeer-review

145 Citations (Scopus)


Aim: The aim of this international multicenter study was to evaluate the reliability of Acoustic Radiation Force Impulse (ARFI) elastography for predicting fibrosis severity, in patients with chronic hepatitis C. Patients and methods: We compared ARFI to liver biopsy (LB) in 914 patients (10 centers, 5 countries) with chronic hepatitis C. In each patient LB (evaluated according to the METAVIR score) and ARFI measurements were performed (median of 5-10 valid measurements, expressed in meters/second - m/s). In 400 from the 914 patients, transient elastography (TE) was also performed (median of 6-10 valid measurements, expressed in kiloPascals - kPa). Results: Valid ARFI measurements were obtained in 911 (99.6%) of 914 cases. On LB 61 cases (6.7%) had F0, 241 (26.4%) had F1, 202 (22.1%) had F2, 187 (20.4%) had F3, and 223 (24.4%) had F4 fibrosis. A highly significant correlation (r = 0.654) was found between ARFI measurements and fibrosis (p < 0.0001). The predictive values of ARFI for various stages of fibrosis were: F ≥ 1 - cut-off > 1.19 m/s (AUROC = 0.779), F ≥ 2 - cut-off > 1.33 m/s (AUROC = 0.792), F ≥ 3 - cut-off > 1.43 m/s (AUROC = 0.829), F = 4 - cut-off > 1.55 m/s (AUROC = 0.842). The correlation with histological fibrosis was not significantly different for TE in comparison with ARFI elastography: r = 0.728 vs. 0.689, p = 0.28. TE was better than ARFI for predicting the presence of liver cirrhosis (p = 0.01) and fibrosis (F ≥ 1, METAVIR) (p = 0.01). Conclusion: ARFI elastography is a reliable method for predicting fibrosis severity in chronic hepatitis C patients.

Original languageEnglish
Pages (from-to)4112-4118
Number of pages7
JournalEuropean Journal of Radiology
Issue number12
Publication statusPublished - 2012 Dec
Externally publishedYes


  • Acoustic Radiation Force Impulse Elastography (ARFI)
  • Chronic hepatitis C
  • Liver fibrosis
  • Liver stiffness

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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