PLoS ONE (Jan 2015)

Evaluation of Transient Elastography, Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients.

  • Thomas Karlas,
  • Arne Dietrich,
  • Veronica Peter,
  • Christian Wittekind,
  • Ralf Lichtinghagen,
  • Nikita Garnov,
  • Nicolas Linder,
  • Alexander Schaudinn,
  • Harald Busse,
  • Christiane Prettin,
  • Volker Keim,
  • Michael Tröltzsch,
  • Tatjana Schütz,
  • Johannes Wiegand

DOI
https://doi.org/10.1371/journal.pone.0141649
Journal volume & issue
Vol. 10, no. 11
p. e0141649

Abstract

Read online

Liver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients.41 patients (median BMI 47 kg/m2) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).Valid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6-75 and 6.7/2.9-21.3 kPa) and ARFI (2.1/0.7-3.7 and 2.0/0.7-3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients.In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.