Liver stiffness assessed by acoustic radiation force impulse (ARFI) technology is considerably increased in patients with cholestasis.

ABSTRACT

PURPOSE: To explore the impact of cholestasis on liver stiffness assessed by acoustic radiation force impulse (ARFI) technology. MATERIALS AND METHODS: Over a period of four months, patients with sonographic cholestasis and increased cholestatic blood values (Bilirubin, γGT, AP > 2 times ULN) scheduled for endoscopic therapy were recruited. Exclusion criteria were known liver disease; signs of cirrhosis at ultrasound (irregular liver veins and/or surface); heart insufficiency (NYHA III-VI). ARFI (Siemens S2000), ultrasound and blood examinations were performed before and in a subgroup after successful biliary drainage. RESULTS: In total, 21 patients with cholestasis were included in the study. ARFI measurements were above the cut-off for cirrhosis (1.8  m/s) in all patients with a mean of 2.91  m/s ±â€Š0.89  m/s without a history or signs of cirrhosis. Bilirubin, γGT and AP were elevated on average to 9.7 ±â€Š5.3  mg/dl, 1192 ±â€Š960  U/l and 730 ±â€Š389  U/l. A subgroup of 10 patients was measured after successful drainage. ARFI measurements declined in all patients of that subgroup on average by 0.76  m/s at a mean time interval of 4.5 days (p < 0.001). CONCLUSION: Cholestasis significantly increases liver stiffness assessed by ARFI. Therefore, it is important to exclude profound cholestasis when using ARFI for evaluating patients for liver fibrosis.