Liver Stiffness Assessed by Acoustic Radiation Force Impulse (ARFI) Technology Is Considerably Increased in Patients with Cholestasis

Purpose: To explore the impact of cholestasis on liver stiffness assessed by acoustic radiation force impulse (ARFI) technology. Materials and Methods: Over a period of four months, patients with sonographic cholestasis and increased cholestatic blood values (Bilirubin, gamma GT, AP > 2 times ULN) scheduled for endoscopic therapy were recruited. Exclusion criteria were: known liver disease; signs of cirrhosis at ultrasound (irregular liver veins and/or surface); heart insufficiency (NYHA III-VI). ARFI (Siemens S2000), ultrasound and blood examinations were performed before and in a subgroup after successful biliary drainage. Results: In total, 21 patients with cholestasis were included in the study. ARFI measurements were above the cut-off for cirrhosis (1.8 m/s) in all patients with a mean of 2.91 m/s +/- 0.89 m/s without a history or signs of cirrhosis. Bilirubin, gamma GT and AP were elevated on average to 9.7 +/- 5.3 mg/dl, 1192 +/- 960 U/l and 730 +/- 389 U/l. A subgroup of 10 patients was measured after successful drainage. ARFI measurements declined in all patients of that subgroup on average by 0.76 m/s at a mean time interval of 4.5 days (p < 0.001). Conclusion: Cholestasis significantly increases liver stiffness assessed by ARFI. Therefore, it is important to exclude profound cholestasis when using ARFI for evaluating patients for liver fibrosis.