Acoustic Radiation Force Impulse Elastometry (ARFI Elastometry) of the Liver in Normal Subjects, after Food Intake and Physical Effort

Purpose: the aim of this study was to assess the values of ARFI elastometry in normal subjects and effects of food intake and physical effort.
Material and methods. ARFI elastometry measurements were done in 32 patients (20 (62.5%) volunteers and 12 (37.5%) potential liver fragment donors). Mean age of patients was 26.9 ± 5.3 years. The study was performed in fasting condition in right intercostals approach, while the patients were asked to stop normal breathing for a moment lying in supine position with the right hand placed above the head. For 20 volunteers ARFI elastometry was performed at 30 minutes after food intake (about 350 kcal) and at next day immediately after physical effort (20 squats). The study was performed using Siemens Acuson S2000 ultrasound system with a 6C1 transducer.
Results. The stiffness of the right liver lobe in 32 healthy subjects was 1.16 ± 0.12 m/s (95% CI 0.92 ± 1.38), the mean liver stiffness values of 20 volunteers in fasting condition were 1,21±0,09 m/s (95% CI 1.06 ± 1.38), 30 minutes after the meal – 1.22 ± 0.12 m/s (95% CI 1.01 ± 1.43) (р > 0.05). Physical effort didn’t make significant influence on the liver stiffness measurements (1.16 ± 0.12 m/s vs 1.20 ± 0.07 m/s, р > 0.05).
Conclusion. Liver stiffness value in healthy subjects was 1.16 ± 0.12 m/s (95% CI 0.92 ± 1.38). There was no significant influence of food intake and physical effort on the liver stiffness measurements.

1. Sandrin L., Fourquet B., Hasquenoph J.M., Yon S., Fournier C., Mal F., Christidis C., Ziol M., Poulet B., Kazemi F., Beaugrand M., Palau R. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med. Biol. 2003; 29: 1705–1713.

2. Yin M., Talwalkar J.A., Glaser K.J., Manduca A., Grimm R.C., Rossman P.J., Fidler J.L., Ehman R.L. Assessment of hepatic fibrosis with magnetic resonance elastography. Clin. Gastroenterol. Hepatol. 2007; 5: 1207–1213. DOI: 10.1016/j.cgh.2007.06.012.

3. Castéra L., Foucher J., Bernard P.H., Carvalho F., Allaix D., Merrouche W., Couzigou P., Lédinghen V. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010; 51: 828–835. DOI: 10.1002/hep.23425.

4. Friedrich-Rust M., Wunder K., Kriener S., Sotoudeh F., Richter S., Bojunga J., Herrmann E., Poynard T., Dietrich C.F., Vermehren J., Zeuzem S., Sarrazin C. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology. 2009; 252: 595–604. DOI: 10.1148/radiol.2523081928.

5. Bamber J., Cosgrove D., Dietrich C.F., Fromageau J., Bojunga J., Calliada F., Cantisani V., Correas J.-M., D’Onofrio M., Drakonaki E.E., Fink M., Friedrich-Rust M., Gilja O.H., Havre R.F., Jenssen C., Klauser A.S., Ohlinger R., Saftoiu A., Schaefer F., Sporea I., Piscaglia F. EFSUMB guidelines and recommendation clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med. 2013; 34: 169–184. DOI: 10.1055/s-0033-1335205.

6. Cosgrove D., Piscaglia F., Bamber J., Bojunga J., Correas J.-M., Gilja O.H., Klauser A.S., Sporea I., Calliada F., Cantisani F., D’Onofrio M., Drakonaki E.E, Fink M., Friedrich-Rust M., Fromageau J., Havre R.F., Jenssen C., Ohlinger R., Săftoiu A., Schaefer F., Dietrich C. F. EFSUMB guidelines and recommendation clinical use of ultrasound elastography. Part 2. Clinical applications. Ultraschall Med. 2013; 34: 238–253. DOI http://dx.doi.org/10.1055/s-0033-1335375.

7. Kuroda H., Kakisaka K., Tatemichi Y., Sawara K., Miyamoto Y., Oikawa K., Miyasaka A., Takikawa Y., Masuda T., Suzuki K. Non-invasive evaluation of liver fibrosis using acoustic radiation force impulse imaging in chronic hepatitis patients with hepatitis C virus infection. Hepatogastroenterology. 2010; 57: 1203–1207.

8. Popescu A., Sporea I., Sirli R., Bota S., Focşa M., Dănilă M., Nicoliţă D., Martie A., Sendroiu M., Juchiş A. The mean values of liver stiffness assessed by Acoustic Radiation Force Impulse elastography in normal subjects. Med. Ultrason. 2011; 13(1): 33–37.

9. Karlas T., Pfrepper C., Wiegand J., Wittekind C., Neuschulz M., Mössner J., Berg T., Tröltzsch M., Keim V. Acoustic radiation force impulse imaging (ARFI) for noninvasive detection of liver fibrosis: examination standards and evaluation of interlobe differences in healthy subjects and chronic liver disease. Scand. J. Gastroenterol. 2011; 46: 1458–1467. DOI: 10.3109/00365521.2011.610004.

10. Sporea I., Sirli R., Bota S., Fierbinţeanu-Braticevici C., Petrişor A., Badea R., Lupşor M., Popescu A., Dănilă M. Is ARFI elastography reliable for predicting fibrosis severity in chronic HCV hepatitis? Wld J. Radiol. 2011; 3: 188–193. DOI: 10.4329/wjr.v3.i7.188.

11. Rifai K., Cornberg J., Mederacke I., Bahr M.J., Wedemeyer H., Malinski P., Bantel H., Boozari B., Potthoff A., Manns M.P., Gebel M. Clinical feasibility of liver elastography by acoustic radiation force impulse imaging (ARFI). Dig. Liver Dis. 2011; 43: 491–497. DOI: 10.1016/j.dld.2011.02.011.

12. Popescu A., Sporea I., Sirli R., Bota S., Focşa M., Dănilă M., Nicoliţă D., Martie A., Sendroiu M., Juchiş A. The mean values of liver stiffness assessed by Acoustic Radiation Force Impulse elastography in normal subjects. Med. Ultrason. 2011; 13(1): 33–37.

13. Sporea I., Bota S., Peck-Radosavljevic M., Sirli R., Tanaka H., Iijima H., Badea R., Lupsor M., FierbinteanuBraticevici C., Petrisor A., Saito H., Ebinuma H., FriedrichRust M., Sarrazin C., Takahashi H., Ono N., Piscaglia F., Borghi A., D'Onofrio M., Gallotti A., Ferlitsch A., Popescu A., Danila M. Acoustic Radiation Force Impulse elastography for fibrosis evaluation in patients with chronic hepatitis C: an international multicenter study. Eur. J. Radiol. 2012; 81: 4112–4118. DOI: 10.1016/j.ejrad.2012.08.018.

14. Eiler J., Kleinholdermann U., Albers D., Dahms J., Hermann F., Behrens C., Luedemann M., Klingmueller V., Alzen G.F. Standard value of ultrasound elastography using acoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents. Ultraschall Med. 2012; 33: 474–479. DOI: 10.1055/s-0032-1313145.

15. Sporea I., Sirli R., Bota S., Popescu A., Sendroiu M., Jurchis A. Comparative study concerning the value of acoustic radiation force impulse elastography (ARFI) in comparison with transient elastography (TE) for the assessment of liver fibrosis in patients with chronic hepatitis B and C. Ultrasound Med. Biol. 2012; 38: 1310–1316. DOI: 10.1016/j.ultrasmedbio.2012.03.011.

16. Karlas T., Hempel M., Tröltzsch M., Huster D., Günther P., Tenckhoff H., Mössner J., Berg T., Keim V., Wiegand J. Noninvasive evaluation of hepatic manifestation in Wilson disease with transient elastography, ARFI, and different fibrosis scores. Scand. J. Gastroenterol. 2012: 47: 1353–1361. DOI: 10.3109/00365521.2012.719924.

17. Jaffer O.S., Lung P.F., Bosanac D., Patel V.M., Ryan S.M., Heneghan M.A., Quaglia A., Sidhu P.S. Acoustic radiation force impulse quantification: repeatability of measurements in selected liver segments and influence of age, body mass index and liver capsule-to-box distance. Br. J. Radiol. 2012; 85: 858–863. DOI: 10.1259/bjr/74797353.

18. Marginean C.O., Marginean C. Elastographic assessment of liver fibrosis in children: A prospective single center experience. Eur. J. Radiol. 2012; 81: 870–874. DOI: 10.1016/j.ejrad.2012.04.014.

19. Crespo G., Fernández-Varo G., Mariño Z., Casals G., Miquel R., Martínez S.M., Gilabert R., Forns X., Jiménez W., Navasa M. ARFI, FibroScan, ELF, and their combinations in the assessment of liver fibrosis: a prospective study. J. Hepatol. 2012; 57: 281–287. DOI: 10.1016/j.jhep.2012.03.016.

20. Kircheis G., Sagir A., Vogt C., Vom Dahl S., Kubitz R., Häussinger D. Evaluation of acoustic radiation force impulse imaging for determination of liver stiffness using transient elastography as a reference. Wld J. Gastroenterol. 2012; 18: 1077–1084. DOI: 10.3748/wjg.v18.i10.1077.

21. Yoon K.T., Lim S.M., Park J.Y., Kim do Y., Ahn S.H., Han K.H., Chon C.Y., Cho M., Lee J.W., Kim S.U. Liver stiffness measurement using acoustic radiation force impulse (ARFI) elastography and effect of necroinflammation. Dig. Dis. Sci. 2012; 57: 1682–1691. DOI: 10.1007/s10620-012-2044-4.

22. Son C.Y., Kim S.U., Han W.K., Choi G.H., Park H., Yang S.C., Han K.H. Normal liver elasticity values using acoustic radiation force impulse imaging: a prospective study in healthy living liver and kidney donors. J. Gastroenterol. Hepatol. 2012; 27: 130–136. DOI: 10.1111/j.1440-1746.2011.06814.x.

23. D’Onofrio M., Crosara S., De Robertis R., Canestrini S., Demozzi E., Gallotti A., Pozzi Mucelli R. Acoustic radiation force impulse of the liver. Wld J. Gastroenterol. 2013; 19 (30): 4841–4849. DOI: 10.3748/wjg.v19.i30.4841.

24. Goertz R.S., Egger C., Neurath M.F., Strobel D. Impact of food intake, ultrasound transducer, breathing maneuvers and body position on acoustic radiation force impulse (ARFI) elastometry of the liver. Ultraschall Med. 2012; 33: 380–385. DOI: 10.1055/s-0032-1312816.

25. Popescu A., Bota S., Sporea I., Sirli R., Danila M., Racean S., Suseanu D., Gradinaru O., Ivascu Siegfried C. The influence of food intake on liver stiffness values assessed by acoustic radiation force impulse elastographypreliminary results. Ultrasound Med. Biol. 2013; 39 (4): 579–584. DOI: 10.1016/j.ultrasmedbio.2012.11.013.

26. Piscaglia F., Salvatore V., Di Donato R., D'Onofrio M., Gualandi S., Gallotti A., Peri E., Borghi A., Conti F., Fattovich G., Sagrini E., Cucchetti A., Andreone P., Bolondi L. Accuracy of Virtual Touch Acoustic Radiation Force Impulse (ARFI) imaging for the diagnosis of cirrhosis during liver ultrasonography. Ultraschall Med. 2011; 32 (2): 167–175. DOI: 10.1055/s-0029-1245948.

27. Takahashi H., Naofumi O., Yuichiro E., Mizuta T., Anzai K., Miyoshi A., Yoneda M., Nakajima A., Fujimoto K. Acoustic Radiation Force Impulse Elastography A Non-Invasive Alternative to Liver Biopsy. Liver Biopsy; Saga, Japan, InTech. 2011; 21: 335–342. DOI: 10.5772/20795.

28. Kaminuma C., Tsushima Y., Matsumoto N., Kurabayashi T., Taketomi-Takahashi A., Endo K. Reliable measurement procedure of virtual touch tissue quantification with acoustic radiation force impulse imaging. J. Ultrasound Med. 2011; 30 (6): 745–751.

29. Ferraioli G., Filice C., Castera L., Choi B.I., Sporea I., Wilson S.R., Cosgrove D., Dietrich C.F., Amy D., Bamber J.C., Barr R., Chou Y.H., Ding H., Farrokh A., Friedrich-Rust M., Hall T.J., Nakashima K., Nightingale K.R., Palmeri M.L., Schafer F., Shiina T., Suzuki S., Kudo M. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: Liver. Ultrasound. Med. Biol. 2015; 41(5): 1161–1179. DOI: 10.1016/j.ultrasmedbio.2015.03.007.

30. Palmeri M.L., Wang M.H., Dahl J.J., Frinkley K.D., Nightingale K.R. Quantifying hepatic shear modulus in vivo using acoustic radiation force. Ultrasound Med. Biol. 2008; 34: 546–558. DOI: 10.1016/j.ultrasmedbio.2007.10.009.

31. Bota S., Sporea I., Sirli R., Popescu A., Dănilă M., Sendroiu M. Factors that influence the correlation of acoustic radiation force impulse (ARFI), elastography with liver fibrosis. Med. Ultrason. 2011; 13: 135–140.

32. Toshima T., Shirabe K., Takeishi K., Motomura T., Mano Y., Uchiyama H., Yoshizumi T., Soejima Y., Taketomi A., Maehara Y. New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver. J. Gastroenterol 2011; 46: 705–711. DOI: 10.1007/s00535-010-0365-7.

33. De Robertis R., D’Onofrio M., Demozzi E., Crosara S., Canestrini S., Pozzi Mucelli R. Noninvasive diagnosis of cirrhosis A review of different imaging modalities. Wld J. Gastroenterol. 2014; 20 (23): 7231–7241. DOI: 10.3748/wjg.v20.i23.7231.

34. Horster S., Mandel P., Zachoval R., Clevert D.A. Comparing acoustic radiation force impulse imaging to transient MEDICAL VISUALIZATION 2017, V. 21 , N2 59 elastography to assess liver stiffness in healthy volunteers with and without valsalva manoeuvre. Clin. Hemorheol. Microcirc. 2010; 46 (2–3): 159–168. DOI: 10.3233/CH-2010-1342.

35. Gallotti A., D’Onofrio M., Mucelli Pozzi R. Acoustic radiation force impulse (ARFI) technique in ultrasound with Virtual Touch Tissue Quantification of upper abdomen. Radiol. Med. 2010; 115 (6): 889–897. DOI: 10.1007/s11547-010-0504-5.

36. Colombo S., Buonocore M., Del Poggio A., Jamoletti C., Elia S., Mattiello M., Zabbialini D., Del Poggio P. Head-tohead comparison of transient elastography (TE), real-time ealastography (RTE) b acoustic force impulse (ARFI) imaging in the diagnosis of liver fibrosis. J. Gastroenterol. 2012; 47: 461–469. DOI: 10.1007/s00535-011-0509-4.

37. Феоктистова Е.В., Пыков М.И., Амосова А.А., Изотова О.Ю., Тарасов М.А., Дубровин М.М.. Применение ARFI-эластографии для оценки жесткости печени у детей различных возрастных групп. Ультразвуковая и функциональная диагностика. 2013; 6: 46–55. Feoktistova E.V., Pykov M.I., Amosova A.A., Izotova O.Yu., Tarasov M.A., Dubrovin M.M. Application ARFI elastography to assess liver stiffness in children of different age groups. Ultrazvukovaya i funktsionalnaya diagnostika. 2013; 6: 46–55. (in Russian)

38. Noruegas M.J., Matos H., Goncalves I., Cipriano M.A., Sanches C. Acoustic radiation force impulse imaging in the assessment of liver fibrosis in children. Pediatr. Radiol. 2012; 42 (2): 201–204. DOI: 10.1007/s00247-011-2257-2.

39. Eiler J., Kleinholdermann U., Albers D., Dahms J., Hermann F., Behrens C., Luedemann M., Klingmueller V., Alzen G.F.P. Standard value of ultrasound elastography using acoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents. Ultraschall Med. 2012; 33 (5): 474–479. DOI: 10.1055/s-0032-1313145.

40. Hanquinet S., Courvoisier D., Kanavaki A., Dhouib A., Anooshiravani M. Acoustic radiation force impulse imaging – normal values of liver stiffness in healthy children. Pediatr. Radiol. 2013; 43 (5): 539–544. DOI: 10.1007/s00247-012-2553-5.

41. Lee M.J., Kim M.J., Han K.H., Yoon C.S. Age related changes in liver, kidney, and spleen stiffness in healthy children measured with acoustic radiation force impulse imaging. Eur. J. Radiol. 2013; 82 (6): 290–294. DOI:10.1016/j.ejrad.2013.01.018.

42. Szinnai C., Mottet C., Gutzwiller J.P., Drewe J., Beglinger C., Sieber C.C. Role of gender upon basal and postprandial systemic and splanchnic haemodynamics in humans. Scand. J. Gastroenterol. 2001; 36: 540–544.

43. Dauzat M., Lafortune M., Patriquin H., Pomier-Layrargues G. Meal induced changes in hepatic and splanchnic circulation: a noninvasive Doppler study in normal humans. Eur. J. Appl. Physiol. Occup. Physiol. 1994; 68: 373–380. DOI: 10.1007/bf00843732.

44. Gersak M., Sorantin E., Windhaber J., Dudea S.M., Riccabona M. The influence of acute physical effort on the liver stiffness estimation using Virtual Touch Quantification (VTQ). Preliminary results. Med. Ultrason. 2016; 18 (2): 151–156. DOI: 10.11152/mu.2013.2066.182.vtq.