Abdominal Radiology

, Volume 44, Issue 2, pp 464–472 | Cite as

Evaluation of acoustic radiation force impulse (ARFI) elastography as non-invasive diagnostic tool in living donor liver transplantation

  • Hanan Abdelhaleem
  • Hadeel Gamal EldeenEmail author
  • Mohammed Mahmoud Nabeel
  • Reham Abdelmoniem
  • Wafaa Elakel
  • Naglaa Zayed
  • Zeinab Abdellatif
  • Bahaa Monir
  • Mohamed Said Abdelaziz
  • Sherif Mogawer
  • Mona Elamir
  • Mostafa Elshazli
  • Ayman Salah
  • Adel Hosny
  • Ayman Yosry


Background and aims

Role of acoustic radiation force impulse (ARFI) elastography, in transplant setting, is not well established. We aimed to define the normal mean values of the liver stiffness by ARFI Elastography in healthy liver donors and to evaluate ARFI elastography as predictor of graft fibrosis post living donor liver transplant (LDLT) in comparison to other non-invasive methods (transient elastography [TE], APRI and FIB4).

Patients and methods

A total of 100 subjects (70 recipients and 30 donors) were recruited. APRI and FIB4 scores were calculated for all recipients. TE and ARFI elastography (Siemens Acuson S2000 Ultrasound System, Germany) were performed to all subjects. All donors and only 30 recipients had liver biopsy. Significant fibrosis was defined as ≥ F2.


The mean ARFI velocity among the donors was 1.05 ± 0.09 m/s. Regarding the recipients: mean age was 49.5 ± 8.49 years, 85.7% males, fibrosis stages < F2 were the most frequent stages by liver biopsy (86.7%) and TE (67.1%). ARFI median was significantly correlated with TE median, APRI and FIB-4 (r = 0.888, p = 0.000; r = 0.62, p = 0.000, and r = 0.585, p = 0.000, respectively). ARFI performed well in discriminating patients with ≥ F2 (AUROC = 0.93, 95% CI 0.86–0.99, p < 0.01) with best cutoff median value of 1.34 m/s (sensitivity 90%, specificity 82%).


ARFI can be used as a reliable method in assessment of significant fibrosis post-LDLT.


LDLT Non-invasive ARFI elastography Graft fibrosis 



Acoustic radiation force impulse


Area under roc curve


Liver biopsy


Liver stiffness measurement


Liver transplantation


Living donor liver transplantation


Transient elastography



Very special thanks to Cairo University Center of Hepatic Fibrosis (CUC-HF) funded through Scientific Technology and development Fund (STDF fund: project ID 5274) where this work was accomplished.

Author contributions

HAH, MD: study design, conception and manuscript revision. HGE, MD, MRCP: performed ARFI elastography, data analysis, manuscript writing. MMN, MD: study design and manuscript revision. RAE, MD: performed Fibroscan, data collection. WE, MD: performed statistics and statistical analysis. NZ, MD: study design and manuscript revision. ZA, MD: statistical analysis. BM, MD: histopathology reading. MSA, MD: data analysis. SM, MD: data analysis. ME, MD: manuscript writing. ME, MD: data analysis. AS, MD: manuscript writing. AH, MD: study design, conception and manuscript revision. AY, MD: study design, conception and manuscript revision.

Compliance with ethical standards


Scientific Technology and development Fund (STDF Fund: Project ID 5274).

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

The current study was approved by the ethical committee of the institution. It was done in accordance with the 1964 Helsinki declaration and its later amendments.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hanan Abdelhaleem
    • 1
  • Hadeel Gamal Eldeen
    • 1
    Email author
  • Mohammed Mahmoud Nabeel
    • 1
  • Reham Abdelmoniem
    • 1
  • Wafaa Elakel
    • 1
  • Naglaa Zayed
    • 1
  • Zeinab Abdellatif
    • 1
  • Bahaa Monir
    • 2
  • Mohamed Said Abdelaziz
    • 1
  • Sherif Mogawer
    • 3
  • Mona Elamir
    • 3
  • Mostafa Elshazli
    • 4
  • Ayman Salah
    • 4
  • Adel Hosny
    • 4
  • Ayman Yosry
    • 1
  1. 1.Department of Endemic Medicine and Liver Unit, Faculty of MedicineKasr Al-Aini Hospital, Cairo UniversityCairoEgypt
  2. 2.Department of Pathology, Faculty of MedicineCairo UniversityCairoEgypt
  3. 3.Department of Internal Medicine, Faculty of MedicineCairo UniversityCairoEgypt
  4. 4.Department of Surgery and Liver Transplantation, Faculty of MedicineCairo UniversityCairoEgypt

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