Role of liver ARFI (acoustic radiation force impulse) to predict esophageal varices in chronic parenchymal liver disease

Abstract

Abstract Background Liver cirrhosis is a significant cause of morbidity and mortality in individuals worldwide, with esophageal varices being a major complication in more than half of the cirrhotic population. Invasive investigation such as upper gastrointestinal (UGI) endoscopy is the standard modality to investigate the presence of esophageal varices. However, UGI endoscopy is an invasive procedure and is associated with dreaded complications and therefore leads to poor compliance in routine screening. Acoustic radiation force impulse (ARFI) imaging is an ultrasound-based method for the non-invasive assessment of liver fibrosis and cirrhosis. In the study, we therefore aim to study the correlation of liver ARFI and presence of esophageal varices; evaluate the efficiency of liver ARFI in delineating low-grade and high-grade esophageal varices; and analyze the changes in liver stiffness based on ARFI in chronic parenchymal liver disease patients. Results This prospective observational study was conducted involving 100 chronic liver disease patients who underwent upper gastrointestinal endoscopy. Liver ARFI technique was utilized to assess liver stiffness. Statistical analysis was performed to assess for correlation between liver ARFI and presence of esophageal varices alongside Child–Pugh and MELD-Na classifications. The Receiver Operating Characteristics (ROC) curve was plotted for the obtained ARFI values. Patients with esophageal varices (n = 50) exhibited significantly higher liver ARFI values compared to those without varices (n = 50) (p < 0.001). The area under the ROC curve for ARFI was 0.90 (95% CI 0.83–0.97), with a sensitivity of 90.1% and specificity of 86.5% at a cut-off of 2.05 m/s. However, there was no significant correlation between liver ARFI and esophageal varices grading (p = 0.832). Clinical severity, as assessed by Child–Pugh and MELD-Na scores, correlated significantly with ARFI (p < 0.001). Conclusions Liver ARFI serves as a promising non-invasive tool for predicting the presence of esophageal varices in chronic liver disease patients. Although it does not correlate with variceal grading, its correlation with established clinical scoring systems highlights its potential utility in clinical risk stratification. Future research should focus on validating ARFI thresholds across diverse etiologies, exploring its prognostic value for hepatocellular carcinoma surveillance, and incorporating ARFI into decision-making frameworks for transplant prioritization.

Keywords

• Esophageal varices
• ARFI
• Acoustic radiation force impulse
• Chronic parenchymal liver disease
• Liver cirrhosis
• Ultrasonography