Study of hepatic stiffness in hepatitis C virus-related liver diseases by acoustic radiation force impulse imaging

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Hepatitis C virus (HCV) infection is a worldwide problem, where liver cirrhosis and hepatocellular carcinoma (HCC) are consequences of HCV-related chronic liver disease. Acoustic radiation force impulse (ARFI) imaging is a new imaging technology for the noninvasive assessment of hepatic fibrosis. The present work aimed to study the degree of hepatic stiffness in HCV-related liver diseases including chronic hepatitis, liver cirrhosis, and cirrhotic patients who developed HCC using ARFI.

Patients and methods

Ninety patients were included in the study; they were divided equally into three groups: chronic HCV patients who were candidate for standard antiviral therapy, cirrhotic patients, and cirrhotic patients with HCC. Also, the study included 60 healthy individuals as a control group. Evaluation of hepatic stiffness using ARFI was performed in all studied groups in correlation with liver biopsy (performed only in chronic HCV patients who were candidates to receive standard antiviral therapy in the form of pegylated interferon and ribavirin).


A positive correlation was found between the different studied groups in hepatic stiffness. Also, a positive correlation was detected between cirrhotic and HCC patients, indicating the importance of ARFI as a predictor for transformation from the cirrhotic to the malignant state.


ARFI is a new reliable, noninvasive tool to assess hepatic stiffness, where increased stiffness is associated with increased ARFI readings. The ARFI value is statistically significantly higher in cirrhotic patients with HCC than in cirrhotic non-HCC patients; thus, ARFI can predict the development of HCC. ARFI at the best cutoff value of 1.48 m/s can differentiate between patients of F2 or less (F0, F1, F2) and those greater than F2.

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