Published Online:

US-based acoustic radiation force impulse elastography could be used as a noninvasive method for assessing liver fibrosis in patients with nonalcoholic fatty liver disease.


To investigate the clinical usefulness of ultrasonography-based acoustic radiation force impulse (ARFI) elastography (ie, ARFI sonoelastography) in patients with a diagnosis of nonalcoholic fatty liver disease (NAFLD) and compare ARFI sonoelastography results with transient sonoelastography and serum fibrosis marker test results.

Materials and Methods

Written informed consent was obtained from all subjects, and the local ethics committee approved the study. Fifty-four patients with a liver biopsy–confirmed diagnosis of NAFLD (mean age, 50.6 years ± 13.7) were examined. All patients with NAFLD and healthy volunteers underwent ARFI sonoelastography, transient sonoelastography, and serum liver fibrosis marker testing (hyaluronic acids, type IV collagen 7 S domain). Ten healthy volunteers underwent ARFI sonoelastography. ARFI sonoelastography results were compared with liver biopsy findings, the reference standard. ARFI sonoelastography findings were compared with liver biopsy, transient sonoelastography, and serum fibrosis marker test results. Student t testing was used for univariate comparisons; Kruskal-Wallis testing, for assessments involving more than two independent groups; and areas under the receiver operating characteristic curve (Az), to assess the sensitivity and specificity of ARFI sonoelastography for detection of stage 3 and stage 4 fibrosis.


Median velocities in the patients with NAFLD were 1.040 m/sec for those with stage 0 fibrosis, 1.120 m/sec for those with stage 1, 1.130 m/sec for those with stage 2, 1.780 m/sec for those with stage 3, and 2.180 m/sec for those with stage 4. The Az for the diagnosis of hepatic fibrosis stages 3 or higher was 0.973 (optimal cutoff value, 1.77 m/sec; sensitivity, 100%; specificity, 91%), while that for the diagnosis of stage 4 fibrosis was 0.976 (optimal cutoff value, 1.90 m/sec; sensitivity, 100%; specificity, 96%). Significant correlations between median velocity measured by using ARFI sonoelastography and the following parameters were observed: liver stiffness measured with transient sonoelastography (r = 0.75, P < .0001), serum level of hyaluronic acid(r = 0.459, P = .0009), and serum level of type IV collagen 7 S domain (r = 0.445, P = .0015).


There is a significant positive correlation between median velocity measured by using ARFI sonoelastography and severity of liver fibrosis in patients with NAFLD. The results of ARFI sonoelastography were similar to those of transient sonoelastography.

© RSNA, 2010


  • 1 Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346(16):1221–1231. Crossref, MedlineGoogle Scholar
  • 2 Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980;55(7):434–438. MedlineGoogle Scholar
  • 3 Liou I, Kowdley KV. Natural history of nonalcoholic steatohepatitis. J Clin Gastroenterol 2006;40(suppl 1):S11–S16. MedlineGoogle Scholar
  • 4 Mori S, Yamasaki T, Sakaida I, et al.. Hepatocellular carcinoma with nonalcoholic steatohepatitis. J Gastroenterol 2004;39(4):391–396. Crossref, MedlineGoogle Scholar
  • 5 National Institutes of Health. National Institutes of Health Consensus Development Conference statement: management of hepatitis C, 2002—June 10-12, 2002. Hepatology 2002;36(5 suppl 1):S3–S20. Crossref, MedlineGoogle Scholar
  • 6 Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999;30(6):1356–1362. Crossref, MedlineGoogle Scholar
  • 7 Cadranel JF. Good clinical practice guidelines for fine needle aspiration biopsy of the liver: past, present and future. [in French]. Gastroenterol Clin Biol 2002;26(10):823–824. MedlineGoogle Scholar
  • 8 Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38(6):1449–1457. Crossref, MedlineGoogle Scholar
  • 9 Maharaj B, Maharaj RJ, Leary WP, et al.. Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. Lancet 1986;1(8480):523–525. Crossref, MedlineGoogle Scholar
  • 10 Yoneda M, Yoneda M, Fujita K, et al.. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut 2007;56(9):1330–1331. Crossref, MedlineGoogle Scholar
  • 11 Yoneda M, Yoneda M, Mawatari H, et al.. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis 2008;40(5):371–378. Crossref, MedlineGoogle Scholar
  • 12 Nightingale KR. Shear wave velocity estimation using acoustic radiation force impulsive examination in liver in vivo. Proceedings of Institute of Electrical and Electronics Engineers Ultrasonics Symposium 2006. Vancouver, British Columbia, Canada: Institute of Electrical and Electronics Engineers, 2006; 1156–1160. Google Scholar
  • 13 Sanyal AJ; American Gastroenterological Association. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology 2002;123(5):1705–1725. Crossref, MedlineGoogle Scholar
  • 14 Nightingale KR, Palmeri ML, Nightingale RW, Trahey GE. On the feasibility of remote palpation using acoustic radiation force. J Acoust Soc Am 2001;110(1):625–634. Crossref, MedlineGoogle Scholar
  • 15 Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999;116(6):1413–1419. Crossref, MedlineGoogle Scholar
  • 16 Brunt EM. Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 2001;21(1):3–16. Crossref, MedlineGoogle Scholar
  • 17 Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999;94(9):2467–2474. Crossref, MedlineGoogle Scholar
  • 18 Sandrin L, Tanter M, Gennisson JL, Catheline S, Fink M. Shear elasticity probe for soft tissues with 1-D transient elastography. IEEE Trans Ultrason Ferroelectr Freq Control 2002;49(4):436–446. Crossref, MedlineGoogle Scholar
  • 19 Sandrin L, Fourquet B, Hasquenoph JM, et al.. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003;29(12):1705–1713. Crossref, MedlineGoogle Scholar
  • 20 Schlesselman JJ. Case-control studies New York, NY: Oxford University Press, 1982. Google Scholar
  • 21 Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999-2004. Gastroenterology 2007;133(6):1814–1820. Crossref, MedlineGoogle Scholar
  • 22 Charlton M. Nonalcoholic fatty liver disease: a review of current understanding and future impact. Clin Gastroenterol Hepatol 2004;2(12):1048–1058. Crossref, MedlineGoogle Scholar
  • 23 Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology 2001;33(1):196–200. Crossref, MedlineGoogle Scholar
  • 24 Poynard T, Ratziu V, Bedossa P. Appropriateness of liver biopsy. Can J Gastroenterol 2000;14(6):543–548. Crossref, MedlineGoogle Scholar
  • 25 Regev A, Berho M, Jeffers LJ, et al.. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002;97(10):2614–2618. Crossref, MedlineGoogle Scholar
  • 26 Soloway RD, Baggenstoss AH, Schoenfield LJ, Summerskill WH. Observer error and sampling variability tested in evaluation of hepatitis and cirrhosis by liver biopsy. Am J Dig Dis 1971;16(12):1082–1086. Crossref, MedlineGoogle Scholar
  • 27 Abdi W, Millan JC, Mezey E. Sampling variability on percutaneous liver biopsy. Arch Intern Med 1979;139(6):667–669. Crossref, MedlineGoogle Scholar
  • 28 Ratziu V, Charlotte F, Heurtier A, et al.; LIDO Study Group. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 2005;128(7):1898–1906. Crossref, MedlineGoogle Scholar
  • 29 Friedrich-Rust M, Wunder K, Kriener S, et al.. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology 2009;252(2):595–604. LinkGoogle Scholar

Article History

Received September 7, 2009; revision requested October 13; revision received November 4; accepted November 19; final version accepted February 9, 2010.
Published online: Aug 2010
Published in print: Aug 2010