Liver Stiffness Measurement by Acoustic Radiation Force Impulse Is Useful in Predicting the Presence of Esophageal Varices or High-Risk Esophageal Varices Among Patients With HCV-related Cirrhosis

J Gastroenterol. 2014 Jul;49(7):1175-82. doi: 10.1007/s00535-013-0877-z. Epub 2013 Sep 5.


Background: Screening and periodic surveillance for esophageal varices (EVs) by esophagogastroduodenoscopy (EGD) are recommended for cirrhotic patients. We investigated non-invasive liver stiffness measurement using acoustic radiation force impulse (ARFI) for the diagnosis of EV presence and high-risk EVs among patients with HCV-related cirrhosis.

Methods: Among 181 consecutive patients with HCV-related cirrhosis, we studied 135 patients who had received EGD and ARFI. Serum fibrosis markers [platelet count, FIB-4, and aspartate aminotransferase-to-platelet ratio index (APRI)] were measured in a training set of 92 patients and compared with ARFI in the diagnostic performance for EV presence and high-risk EVs. Furthermore, the obtained optimal cutoff values of ARFI were prospectively examined in a validation set of 43 patients.

Results: In the training set, the ARFI value increased with the EV grade (p < 0.001). The ARFI value for high-risk EVs was significantly higher than that for low-risk EVs (p < 0.001). AUROC values for diagnosis of EV presence and high-risk EVs by ARFI were 0.890 and 0.868, which had the highest diagnostic performance among factors including serum fibrosis markers. The optimal cutoff value of ARFI for EV presence was 2.05 m/s with good sensitivity (83%), specificity (76%), PPV (78%), and NPV (81%), and that for high-risk EVs was 2.39 m/s with good sensitivity (81%), specificity (82%), PPV (69%), and NPV (89%). These cutoff values obtained in the training cohort also showed excellent performance in the validation set.

Conclusions: Liver stiffness measurement by ARFI is useful in predicting EV presence or high-risk EVs among patients with HCV-related cirrhosis.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Disease Progression
  • Elasticity Imaging Techniques
  • Esophageal and Gastric Varices / diagnosis
  • Esophageal and Gastric Varices / diagnostic imaging*
  • Esophageal and Gastric Varices / etiology
  • Esophagoscopy
  • Female
  • Hepatitis C, Chronic / complications*
  • Humans
  • Liver / diagnostic imaging
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / virology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Reproducibility of Results
  • Severity of Illness Index


  • Biomarkers