Acoustic Radiation Force Impulse (ARFI) Elastography for non‑invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis

Med Ultrason. 2017 Jan 31;19(1):23-31. doi: 10.11152/mu-942.


Aim: The purpose of the study was to assess the effect of Acoustic Radiation Force Impulse (ARFI) elastography in the diagnosis of liver fibrosis in chronic hepatitis B and C patients through Meta-analysis.

Material and methods: Four databases (PubMed, the Cochrane Library, WanFang data, and CNKI) were searched. The key words were: ("ARFI" or "acoustic radiation force impulse") combined with "liver fibrosis" and ("chronic hepatitis" or "HBV HCV"). Heterogeneity (I2) was assessed, and its source was analyzed through meta-regression.

Results: 21 articles with 2,691 patients were included. The compositeSe=0.79 (95% CI: 0.76-0.83) and Sp=0.86 (95% CI: 0.85-0.88). ARFI elastography showed a better ability to evaluate higherstage liver fibrosis and liver cirrhosis (F=3 and F=4, respectively). For F≥3, Se=0.84 (95% CI: 0.80-0.88, I2=61.37), Sp=0.90 (95% CI: 0.86-0.92, I2=65.10), and AUROC=0.94 (95% CI: 0.91-0.95). Se and Sp and AUROC of F=4 were 0.86 (95% CI: 0.80-0.91, I2=70.67), 0.84 (95% CI: 0.80-0.88, I2=78.94) and 0.91 (95% CI: 0.89-0.94), respectively. Besides, the combined RFI values indicate that CHC patients had higher ARFI values especially in the F3 stage (1.87 [95% CI: 1.67-2.06] and 2.31[95% CI: 2.09-2.52] for CHB and CHC, respectively).

Conclusion: ARFI elastography is accurate and reliable in the diagnosis of CHB- and CHC-induced liver fibrosis and is especially suitable for the evaluation of stages F≥3 and F=4. CHC patients manifest higher ARFI values than CHB patients especially in the F3 stage.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Elasticity Imaging Techniques / methods*
  • Female
  • Hepatitis B, Chronic / complications*
  • Hepatitis C, Chronic / complications*
  • Humans
  • Liver / diagnostic imaging
  • Liver / pathology
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnostic imaging*
  • Male
  • Middle Aged
  • ROC Curve
  • Reproducibility of Results