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Эластометрия с применением форсированного импульса акустической радиации (ARFI-эластометрия) при хронических вирусных гепатитах

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Цель исследования: определить информативность эластометрии с применением форсированного импульса акустической радиации (ARFI-эластометрия) в выявлении стадий фиброза печени у пациентов с хроническими вирусными гепатитами (ХВГ). Материал и методы. В исследование вошло 135 человек, которые были разделены на 2 группы. Для определения возможностей ARFI-эластометрии при ХВГ обследовано 103 (76,3%) пациента (основная группа) (мужчин - 52 (50,4%), женщин - 51 (49,5%)); среди них с вирусным гепатитом В 11 пациентов, с вирусным гепатитом С 87 пациентов, с вирусным гепатитом В+D 5 пациентов. Биопсия печени с последующим гистологическим исследованием биоптата и определением стадии фиброза по шкале METAVIR выполнялась в течение 1-2 дней после выполнения ультразвукового исследования. В контрольную группу для определения жесткости паренхимы печени в норме вошло 32 (23,7%) здоровых пациента (20 (62,5%) добровольцев и 12 (37,5%) потенциальных доноров фрагмента печени). Средний возраст пациентов составил 26,9 ± 5,3 года. У добровольцев в анамнезе отсутствовали заболевания печени, поджелудочной железы, желчевыводящих путей; они имели нормальные показатели по данным общего и биохимического анализов крови. Результаты. Выявлена сильная корреляция (r = 0,74, р 0,001) между стадиями фиброза по гистологии и жесткостью печени. При использовании ROC-анализа было выявлено, что при пороговом значении скорости сдвиговой волны ?1,36 м/с при стадиях фиброза F ? 2 диагностическая точность составила 77%, чувствительность - 65,9%, специфичность - 79,0%; при пороговом значении ? 1,41 м/с при стадиях фиброза F ? 3 диагностическая точность - 95%, чувствительность - 95,5%, специфичность - 81,5%; при пороговом значении >1,66 м/с для стадии фиброза F = 4 диагностическая точность - 97%, чувствительность - 93,3%, специфичность - 100%. Значения жесткости паренхимы печени при стадиях F0-F2 достоверно отличались от стадий F3-F4 (1,25 ± 0,18 м/с против 2,0 ± 0,52 м/с, р 0,05). Выводы. ARFI-эластометрия является достаточно точным инструментальным методом определения фиброза печени при стадиях F ? 2. По мере увеличения степени фиброза диагностическая точность ARFI-эластометрии возрастает и достигает наилучших значений при циррозе печени.

Ключевые слова:
ультразвуковая диагностика, ARFI-эластометрия, жесткость печени, фиброз печени, хронические вирусные гепатиты, биопсия печени, ultrasound diagnostics, acoustic radiation force impulse elastometry (ARFI elastometry), liver stiffness, liver fibrosis, chronic viral hepatitis, liver biopsy

Литература:
1.Постановление Главного государственного санитарного врача Российской Федерации от 11 марта 2013 г. № 9 г. Москва “О мероприятиях, направленных на стабилизацию заболеваемости парентеральными вирусными гепатитами в Российской Федерации”. Российская газета - Федеральный выпуск №6103 (127). https://rg.ru/2013/06/14/gepatit-dok.html
2.Stanaway J.D., Flaxman A.D., Naghavi M., Fitzmaurice C., Vos T., Abubakar I., Abu-Raddad L.J., Assadi R., Bhala N., Cowie B., Forouzanfour M.H., Groeger J., Khayriyyah Mohd Hanafi ah, Jacobsen K., James S., MacLachlan J., Malekzadeh R., Martin N., Mokdad A., Murray C., Plass D., Rana S., Rein D., Richardus J.H., Sanabria J., Saylan M., Shahraz S., Samuel So, Vlassov V., Weiderpass E., Wiersma S., Younis M., Chuanhua Yu, Maysaa El Sayed Zaki, Cooke G. The global burden of viral hepatitis from 1990 to 2013: findings from global Burden of Disease Study. Lancet. 2016; 388 (10049): 1081-1089. DOI: 10.1016/S0140-6736(16)30579-7.
3.Tatsumi C., Kudo M., Ueshima K., Kitai S., Takahashi S., Inoue T., Minami Y., Chung H., Maekawa K., Fujimoto K., Akiko T., Takeshi M. Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan) and real-time tissue elastography. Intervirology. 2008; 51 (Suppl.1): 27-33. DOI: 10.1159/000122602.
4.Павлов Ч.С. Фиброз печени при хронических вирусных гепатитах: Автореф. дисс. ... д-ра мед. наук. М., 2009. 46 с.
5.Tchelepi H., Ralls Ph.W., Radin R., Grant E. Sonography of Diffuse Liver Disease. J. Ultrasound Med. 2002; 21: 1023-1032.
6.Frulio N., Trillaud H. Ultrasound elastography in liver. Diagn. Interv. Imaging. 2013; 94 (5): 515-534. DOI: 10.1016/j.diii.2013.02.005.
7.Rockey D.C., Caldwell S.H., Goodman Z.D., Nelson R.C., Smith A.D. American association for the study of liver diseases. Liver biopsy. Hepatology. 2009; 49 (3): 1017-1044. DOI: 10.1002/hep.22742.
8.Bedossa O., Dargere D., Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003; 38: 1449-1457. DOI: 10.1016/j.hep.2003.09.022.
9.Friedrich-Rust M., Ong M.F., Herrmann E., Dries V., Samaras P., Zeuzem S., Sarrazin C. Real-time elastography for non-invasive assessment of liver fibrosis in chronic viral hepatitis. Am. J. Roentgenol. 2007; 188: 758-764. DOI: 10.2214/AJR.06.0322.
10.Ochi H., Hirooka M., Koizumi Y., Miyake T., Tokumoto Y., Soga Y, Tada F., Abe M., Hiasa Y., Onji M. Real-time tissue elastography for evaluation of hepatic fibrosis and portal hypertension in non-alcoholic fatty liver diseases. Hepatology. 2012; 56: 1271-1278. DOI: 10.1002/hep.25756.
11.Castera L. Non-invasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology. 2012; 142 (6): 1293e4-302e4. DOI: 10.1053/j.gastro.2012.02.017.
12.Imbert-Bismut F., Ratziu V., Pieroni L., Charlotte F., Benhamou Y., Poynard T. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet. 2001; 357 (9262): 1069-1075. DOI: 10.1016/S0140-6736(00)04258-6.
13.Adams L.A., Bulsara M., Rossi E., DeBoer B., Speers D., George J., Farrell G., McCaughan G.W., Jeffrey G.P. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin. Chem. 2005; 51 (10): 1867-1873. DOI: 10.1373/clinchem.2005.048389.
14.Cales P., Oberti F., Michalak S., Hubert-Fouchard I., Rousselet M.C., Konate A., Gallois Y., Ternisien C., Chevailler A., Lunel F. A novel panel of blood markers to assess the degree of liver fibrosis. Hepatology. 2005; 42 (6): 1373-1381. DOI: 10.1002/hep.20935.
15.Bamber J., Cosgrove D., 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 recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med. 2013; 34: 169-184. DOI: 10.1055/s-0033-1335205.
16.Cosgrove D., Piscaglia F., Bamber J., Bojunga J., Correas J.M., Gilja O.H., Klauser A.S., Sporea I., Calliada F., Cantisani V., D''Onofrio M., Drakonaki E.E., Fink M., Friedrich-Rust M., Fromageau J., Havre R.F., Jenssen C., Ohlinger R., Saftoiu A., Schaefer F., Dietrich C.F. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med. 2013; 34: 238-253. DOI: 10.1055/s-0033-1335375.
17.Dietrich C., Bamber J., Berzigotti A., Bota S., Cantisani V., Castera L, Cosgrove D., Ferraioli G., Friedrich-Rust M., Odd Helge Gilja, Goertz R., Karlas T., Knegt R., Ledinghen V., Piscaglia F., Procopet B., Saftoiu A., Paul S. Sidhu, Sporea I., Thiele M. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultra sound Elastography, Update 2017. Ultraschall Med. 2017; 38 (04): e16-e47. DOI: 10.1055/s-0043-103952.
18.Piscaglia F., Salvatore V., Mulazzani L., Cantisani V., Schiavone C. Ultrasound shear wave elastography for liver disease. A clinical appraisal of the many actors on the stage. Ultrashall Med. 2016; 37: 1-5. DOI: 10.1055/s-0035-1567037.
19.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.
20.Yun M.H., Seo Y.S., Kang H.S., Lee K.G., Kim J.H., An H., Yim H.J., Keum B., Jeen Y.T., Lee H.S., Chun H.J., Um S.H., Kim C.D., Ryu H.S. The effect of the respiratory cycle on liver stiffness values as measured by transient elastography. J. Viral. Hepat. 2011; 18(9): 631-636. DOI: 10.1111/j.1365-2893.2010.01376.x.
21.Millonig G., Friedrich S., Adolf S., Fonouni H., Golriz M., Mehrabi A., Stiefel P., Poschl G., Buchler M.W., Seitz H.K., Mueller S. Liver stiffness is directly influenced by central venous pressure. J. Hepatol. 2010; 52 (2): 206-210. DOI: 10.1016/j.jhep.2009.11.018.
22.Castera L., Foucher J., Bernard P.H., Carvalho F., Allaix D., Merrouche W., Couzigou P., de Ledinghen V. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010; 51 (3): 828-835. DOI: 10.1002/hep.23425.
23.Cohen E.B., Afdhal N.H. Ultrasound-based hepatic elastography origins, limitations, and applications. J. Clin. Gastroenterol. 2010; 44 (9): 637-645. DOI: 10.1097/MCG.0b013e3181e12c39.
24.Frulio N., Laumonier H., Balabaud C., Trillaud H., Bioulac-Sage P. Hepatic congestion plays a role in liver stiffness. Hepatology. 2009; 50 (5): 1674-1675. DOI: 10.1002/hep.23109.
25.Kim J.E., Lee J.Y., Bae K.S., Han J.K., Choi B.I. Acoustic radiation force impulse elastography for focal hepatic tumors: usefulness for differentiating hemangiomas from malignant tumors. Korean J. Radiol. 2013; 14 (5): 743-753.
26.Bavu E., Gennisson J.L., Couade M., Bercoff J., Mallet V., Fink M., Badel A., Vallet-Pichard A., Nalpas B., Tanter M., Pol S. Noninvasive in vivo liver fibrosis evaluation using supersonic shear imaging: a clinical study on 113 hepatitis C virus patients. Ultrasound Med. Biol. 2011; 37 (9): 1361-1373. DOI: 10.1016/j.ultrasmedbio.2011.05.016.
27.Rizzo L., Calvaruso V., Cacopardo B., Alessi N., Attanasio M., Petta S., Fatuzzo F., Montineri A., Mazzola A., L’abbate L., Nunnari G., Bronte F., Di Marco V., Craxi A., Camma C. Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic hepatitis C. Am. J. Gastroenterol. 2011; 106 (12): 2112-2120. DOI: 10.1038/ajg.2011.341.
28.Sporea I., Bota S., Peck-Radosavvlijevich M., Sirli R., Tanaka H., Iijima H., Badea R., Lupsor M., Fierbinteanu-Braticevici C., Petrisor A., Saito H., Ebinuma H., Friedrich-Rust 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 (12): 4112-4118. DOI: 10.1016/j.ejrad.2012.08.018.
29.Ferralioli G., Tinelli C., Lissandrin R., Zicchetti M., Dal Bello B., Filice G., Filice C. Point shear wave elastography method for assessing liver stiffness. Wld J. Gastro enterol. 2014; 20 (16): 4787-4796. DOI: 10.3748/wjg.v20.i16.4787.
30.Friedrich-Rust M., Nierhoff J., Lupsor M., Sporea I., Fierbinteanu-Braticevici C., Strobel D., Takahashi H., Yoneda M., Suda T., Zeuzem S., Herrmann E. Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J. Viral Hepat. 2012; 19: e212-e219. DOI: 10.1111/j.1365-2893.2011.01537.x.
31.Ferralioli G., Filice C., Castera L., Choi B., 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.
32.Bedossa P., Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996; 24 (2): 289-293. DOI: 10.1002/hep.510240201.
33.Poynard T., Ratziu V., Benmanov Y., Di Martino V., Bedossa P., Opolon P. Fibrosis in patients with chronic hepatitis C: detection and significance. Semin. Liv. Dis. 2000; 20: 47-55.
34.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.
35.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; Chapter 21: 335-342. DOI: 10.5772/20795.
36.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.
37.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.
38.Bota S., Sporea I., Sirli R., Popescu A., Danila M., Sendroiu M. Factors that influence the correlation of acoustic radiation force impulse (ARFI), elastography with liver fibrosis. Med. Ultrason. 2011; 13: 135-140.
39.DeLong E.R., DeLong D.M., Clarke-Pearson D.L. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44 (3): 837-845.
40.Millonig G., Reimann F.M., Friedrich S., Fonouni H., Mehrabi A., Buchler M.W., Seitz H.K., Mueller S. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008; 48 (5): 1718-1723. DOI: 10.1002/hep.22577.
41.Sporea I., Bota S., Jurchis A., Sirli R., Gradinaru-Tascau O., Popescu A., Ratiu I., Szilaski M. Acoustic radiation force impulse and supersonic shear imaging versus transient elastography for liver fibrosis assessment. Ultrasound Med. Biol. 2013; 39 (11): 1933-1941. DOI: 10.1016/j.ultrasmedbio.2013.05.003.
42.Guzman-Aroca F., Reus M., Berna-Serna J.D., Serrano L., Serrano C., Gilabert A., Cepero A. Reproducibility of shear wave velocity measurements by acoustic radiation force impulse imaging of the liver: a study in healthy volunteers. J. Ultrasound Med. 2011; 30 (7): 975-979.
43.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 (102-103): 1203-1207.
44.Goertz R.S., Zopf Y., Jugl V., Heide R., Janson C., Strobel D., Bernatik T., Haendl T. Measurement of liver elasticity with acoustic radiation force impulse (ARFI) technology: an alternative noninvasive method for staging liver fibrosis in viral hepatitis. Ultraschall Med. 2010; 31 (2): 151-155. DOI: 10.1055/s-0029-1245244.
45.Karlas T., Pfrepper C., Wiegand J., Wittekind C., Neuschulz M., Mossner J., Berg T., Troltzsch 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 (12): 1458-1467. DOI: 10.3109/00365521.2011.610004.
46.Sporea I., Sirli R., Bota S., Fierbinteanu-Braticevici C., Petrisor A., Badea R., Lupsor M., Popescu A., Danila M. Is ARFI elastography reliable for predicting fibrosis severity in chronic HCV hepatitis? Wld J. Radiol. 2011; 3 (7): 188-193. DOI: 10.4329/wjr.v3.i7.188.
47.Popescu A., Sporea I., Sirli R., Bota S., Focsa M., Danila M., Nicolita D., Martie A., Sendroiu M., Juchis A. The mean values of liver stiffness assessed by Acoustic Radiation Force Impulse elastography in normal subjects. Med. Ultrason. 2011; 13 (1): 33-37.
48.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 (6): 491-497. DOI: 10.1016/j.dld.2011.02.011.
49.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 (5): 474-479. DOI: 10.1055/s-0032-1313145.
50.Karlas T., Hempel M., Troltzsch M., Huster D., Gunther P., Tenckhoff H., Mossner 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 (11): 1353-1361. DOI: 10.3109/00365521.2012.719924.
51.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.
52.Marginean C.O., Marginean C. Elastographic assessment of liver fibrosis in children: A prospective single center experience. Eur. J. Radiol. 2012; 81 (8): e870-874. DOI: 10.1016/j.ejrad.2012.04.014.
53.Crespo G., Fernandez-Varo G., Marino Z., Casals G., Miquel R., Martinez S.M., Gilabert R., Forns X., Jimenez W., Navasa M. ARFI, FibroScan, ELF, and their combinations in the assessment of liver fibrosis: a prospective study. J. Hepatol. 2012; 57 (2): 281-287. DOI: 10.1016/j.jhep.2012.03.016.
54.Kircheis G., Sagir A., Vogt C., Vom Dahl S., Kubitz R. Haussinger 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.
55.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.
56.Son C.Y., Kim S.U., Han W.K., Choi G.H., Park H., Yang S.C., Choi J.S., Park J.Y., Kim do Y., Ahn S.H., Chon C.Y., 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 (1): 130-136. DOI: 10.1111/j.1440-1746.2011.06814.x.
57.D’Onofrio M., Crosara S., De Robertis R., Canestrini S., Demozzi E., Gallotti A., Mucelli R.P. Acoustic radiation force impulse of the liver. Wld J. Gastroenterol. 2013; 19 (30): 4841-4849. DOI: 10.3748/wjg.v19.i30.4841.
58.Gallotti A., D’Onofrio M., Macelli 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.
59.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.
60.Данзанова Т.Ю. Стратегия ультразвуковых диагностических технологий в хирургической гепатологии: Дисс. … д-ра мед. наук. М., 2015. 257 с.
61.Lupsor M., Badea R., Stefanescu H., Sparchez Z., Branda H., Serban A., Maniu A.. Performance of a new elastographic method (ARFI technology) compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results. J. Gastrointest. Liver. Dis. 2009; 18 (3): 303-310.
62.Fierbinteanu-Braticevici C., Andronescu D., Usvat R., Cretoiu D., Baicus C., Marinoschi G. Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis. Wld J. Gastroenterol. 2009; 15: 5525-5532.
63.Takahashi H., Ono N., Eguchi Y., Eguchi T., Kitajima Y., Kawaguchi Y., Nakashita S., Ozaki I., Mizuta T., Toda S., Kudo S., Miyoshi A., Miyazaki K., Fujimoto K. Evaluation of acoustic radiation force impulse elastography for fibrosis staging of chronic liver disease: a pilot study. Liver Int. 2010; 30: 538-545. DOI: 10.1111/j.1478-3231.2009.02130.x.
64.Haque M., Robinson C., Owen D., Yoshida E.M., Harris A. Comparison of acoustic radiation force impulse imaging (ARFI) to liver biopsy histologic scores in the evaluation of chronic liver disease: A pilot study. Ann. Hepatol. 2010; 9: 289-293.
65.Sporea I., Sirli R.L., Deleanu A., Popescu A., Focsa M., Danila M., Tudora A. Acoustic Radiation Force Impulse Elastography as Compared to Transient Elastography and Liver Biopsy in Patients with Chronic Hepatopathies. Ultraschall Med. 2011; 32, Suppl. 1: S46-52. DOI: 10.1055/s-0029-1245360.
66.Bota S., Herkner H., Sporea I., Salzl P., Sirli R., Neghina A.M., Peck-Radosavljevic M. Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int. 2013; 33 (8): 1138-1147.

Acoustic Radiation Force Impulse Elastometry (ARFI Elastometry) in Chronic Viral Hepatitis

Purpose: the aim of this study was to evaluate the reliability of ARFI elastometry for diagnosis of fibrosis severity stages in patients with chronic viral hepatitis. Material and methods. ARFI elastometry measurements were done in 103 patients. Mean age of patients was 39.2 ± 10.8 years. The study included 11 patients with HBV chronic hepatitis, 87 patients with HCV chronic hepatitis and 5 patients with В+D chronic hepatitis. Liver stiffness was measured using ARFI elastometry with following liver biopsy which was made 1-2 after US study and assessed according to the METAVIR score. Control group included 32 patients (20 (62.5%) volunteers and 12 (37.5%) potential liver fragment donors). Mean age of patients was 26.9 ± 5.3 years. None of the healthy subjects had a history of gastrointestinal, pancreatic or hepatic disease; all patients had a normal results of laboratory tests. Results. Significant correlation (r = 0.74, р 0.001) was found between ARFI measurements and liver fibrosis stages. The values of ARFI elastometry for various stages of fibrosis were: F ? 2 - cut-off > 1.36 m/s (AUROC - 77%, sensitivity - 65.9%, specificity - 79%), F ? 3 - cut-off > 1.36 m/s (AUROC = 95%, sensitivity - 95,5%, specificity - 81.5%), F = 4 - cut-off > 1.66 m/s (AUROC - 97%, sensitivity - 93.3%, specificity - 100%). Liver stiffness measurements in stages F0-F2 reliably differ from stages F3-F4 (1.25 ± 0.18 m/s vs 2.0 ± 0.52 m/s, р 0.05). Conclusion. ARFI elastometry is reliable diagnostic method for liver fibrosis detection in stages F ? 2. The best performance of this method was shown for the prediction of severe fibrosis and cirrhosis.

Keywords:
ультразвуковая диагностика, ARFI-эластометрия, жесткость печени, фиброз печени, хронические вирусные гепатиты, биопсия печени, ultrasound diagnostics, acoustic radiation force impulse elastometry (ARFI elastometry), liver stiffness, liver fibrosis, chronic viral hepatitis, liver biopsy