Clinical value of acoustic radiation force impulse elastography in the prediction of hepatocellular carcinoma in chronic hepatitis C patients

Background and purpose of the study Acoustic radiation force impulse elastography (ARFI) represents an innovative non-invasive tool for the evaluation of liver fibrosis, cirrhosis, and early identification of neoplastic nodules during the follow-up of cirrhotic patients; however, its diagnostic accuracy in the prediction of hepatocellular carcinoma (HCC) is still controversial. Purpose of the study To assess the potential role of ARFI elastography as a non-invasive tool for the prediction of HCC development among chronic hepatitis C (CHC) patients with advanced hepatic fibrosis and liver cirrhosis. Methods The present study recruited 440 patients: 349 CHC patients with advanced hepatic fibrosis and cirrhosis and 91 patients with HCC-related hepatitis C virus (HCV). ARFI-imaging of the liver and transient elastography (TE) was carried out in all patients. ARFI imaging indices include the mean shear wave velocity of HCC, peritumoral parenchyma, and hepatic parenchyma in non-HCC patients. The area under the receiver operating characteristic curve (AUROC) and optimal cutoff values were obtained using a receiver operating characteristic curve analysis to assess the diagnostic performance of ARFI elastography in the predication of HCC. Results The mean hepatic shear wave velocities by ARFI elastography of peri-tumoral cirrhotic hepatic parenchyma were significantly higher than in hepatic parenchyma in non-HCC patients (3.09 vs. 2.26 m/s, p <0.001). The AUROC for the identification of HCC was 0.8, 0.76, 0.76, 0.66, 0.72, and 0.7 for hepatic ARFI elastography, TE, fibrosis-4 score (FIB-4), AST to Platelet Ratio Index (APRI), AST/ALT ratio (AAR), and Age platelets index (API), respectively. Moreover, univariate regression analysis revealed that hepatic ARFI has the highest odd ratio in the prediction of HCC. Conclusion ARFI elastography had a superior diagnostic performance in the prediction of HCC compared to TE and non-invasive markers in CHC patients with advanced fibrosis and cirrhosis, thus putting such patients on the top of the HCC screening list.