Fadhyl Zuhry Lubis1, Ristari Okvaria2, Moh. Habib3

1Sumpal Clinic, Sekayu, Indonesia, 2Charitas Hospital, Palembang, Indonesia, 3Mahyuzahra Hospital, Inderalaya, Indonesia

Background/Aims: The prognosis and management strategy of patient with chronic hepatitis C (CHC) are affected greatly by the assessment of the degree of liver fibrosis. Recently, non-invasive methods of assessing liver fibrosis have been developed in order to reduce the need for biopsies, but this method remains to be explored. This study aimed to assess the accuracy of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) as non-invasive methods in the assessment of liver fibrosis for CHC patients.

Methods: We systematically searched PubMed, Cochrane, and Google scholar databases for all relevant studies. The Revised Quality Assessment for Studies of Diagnostic Accuracy tool (QUADAS-2) was used to assess the methodological quality of the included studies. A bivariate regression model was conducted to calculate the pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) between ARFI and TE.

Results: Twenty-five studies with a total of 7577 patients were included in the analysis. Inability to obtain reliable measurements was more than ten times as high for TE as that of ARFI (10.0% vs. 1.1%). The summary AUC values using ARFI and TE for detecting significant fibrosis, advanced fibrosis and cirrhosis were 0.87 vs. 0.84 (p<0.001), 0.91 vs. 0.93 (p<0.001), and 0.94 vs. 0.94 (p<0.001). The pooled sensitivity and specificity using ARFI for the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis were 79% and 82%, 87% and 84%, 88% and 89%, respectively. The pooled sensitivity and specificity using TE for the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis were 79% and 79%, 84% and 88%, 83% and 93%, respectively.

Conclusion: In summary, ARFI & TE exerted satisfactory diagnostic performance in staging of liver fibrosis in patients with CHC. ARFI provided more convenient evaluation of liver condition and showed diagnostic accuracy similar to TE.

Keywords: Acoustic radiation force impulse, transient elastography, liver fibrosis, Chronic hepatitis C