Value of Acoustic Radiation Force Impulse Imaging Elastography for Non-invasive Evaluation of Patients with Nonalcoholic Fatty Liver Disease

The goals of the work described here were to evaluate the clinical utility of acoustic radiation force impulse (ARFI) elastography in differentiating non-alcoholic fatty liver disease (NAFLD) histologic subtypes and to determine if ARFI elastography measurements correlate with the severity of liver fibrosis. We compared ARFI elastography measurements with clinical, biologic and histologic features (simple steatosis or steatohepatitis) in 64 patients with histologically proven NAFLD. ARFI elastography is suitable for distinguishing patients with non-alcoholic steatohepatitis from those with simple steatosis, with an area under the receiver operating characteristic curve (AUROC) of 0.867 (95% confidence interval = 0.782–0.953). There was a highly significant correlation (r = 0.843) between ARFI elastography measurements and fibrosis (p < 0.001). In patients with non-alcoholic steatohepatitis, the diagnostic performance of ARFI elastography in predicting significant fibrosis (F ≥ 2) had an AUROC of 0.944. ARFI elastography better predicted F = 4 fibrosis (AUROC = 0.984). In conclusion, ARFI elastography is a promising method for differentiating patients with non-alcoholic steatohepatitis from patients with simple steatosis and can also predict significant fibrosis in these patients.