Using ARFI to evaluate liver stiffness in 80 diabetic patients at Medic Center, HCMC, Vietnam.

1. Liver Stiffness Evaluation by
ARFI imaging in Type 2
Diabetes Mellitus Patients
Nguyễn Thị Hồng Anh, MD
Nguyễn Thiện Hùng, MD
Phan Thanh Hải, MD
MEDIC CENTER

2. Introduction
 NAFLD ( obesity, DM, metabolic
syndrome): one of the most common
chronic liver diseases worldwide.
 NAFLD ↔ DM
 NAFLD → (NASH) → liver cirrhosis
→ liver cancer .

3.  Accurate liver fibrosis degree assessment
→ prognosis → deciding treatment course.
 Limitations of liver biopsy → noninvasive
and reliable tests.
 Ultrasound elastography:
◦ Non-invasive
◦ Convenient
◦ Precise
◦ Measuring liver stiffness → liver fibrosis.

4. Background & Aims
 Evaluate a population of OPD diabetic
patients regarding the severity of liver
steatosis and liver fibrosis by ARFI
imaging.

5. Materials and method
 Descriptive cross-section statistics
 Assess liver steatosis (B mode
transabdominal US), liver fibrosis (ARFI
imaging) (SIEMENS S2000)
 Operators: Nguyễn Thiện Hùng et al.
 Inclusive criteria:
◦ DM patients > 18 yrs and euthyroid.
 Exclusive criteria
◦ Consumption beer / alcohol >20g/day
◦ HBV, HCV
◦ Drug induced hepatitis
◦ Autoimmune hepatitis
◦ Pregnancy, breast-feeding period.

6. Staging liver steatosis and fibrosis
 Steatosis severity:semi-quantitative
scale/ B mode
◦ S0 = no steatosis
◦ S1 = mild steatosis
◦ S2 = moderate steatosis
◦ S3 = severe steatosis
 Stages of liver fibrosis (ARFI technique)
◦ F0 = 0.99 - 1.16 m/s
◦ F1 = 1.16 - 1.25 m/s
◦ F2 = 1.25 - 1.32 m/s
◦ F3 = 1.32 - 1.56 m/s
◦ F4 = 1.56 - 4.15 m/s

7. S1- mild steatosis (bright
liver with
discrete posterior
attenuation).
S2 - moderate steatosis
(bright liver with
obvious posterior
attenuation).
S3 - Severe steatosis
(bright liver with
intense posterior
attenuation that makes it
impossible to visualize
the diaphragm).

9. Results
 Nov 2016-Feb 2017.
 80 type 2 diabetic patients (27 M, 53F).
 Age=28-79.
 Duration of acquired DM= first onset -
20years.
 4 obese patients (5%), 23 overweight
patients (28.75%)

10. Results(80 cases)
 Significant fibrosis (F2-F3):
23/80=28.75% (
steatosis)
 Severe fibrosis (F4):
12/80= 15% ( steatosis)
 100% severe steatosis
(S3): significant /severe
fibrosis.
 5.0%(4/20) significant
fibrosis (F2-F3) without
steatosis: long time DM (7-
15 y)
S0 S1 S2 S3 ∑
F0 5 6 6 0 17
F1 4 18 6 0 28
F2 2 3 6 1 12
F3 2 4 4 1 11
F4 0 5 4 3 12
∑ 13 36 26 5 80

11. Discussion 1
 4/80 obese +23/80 over weight #33.75%
 Lower percentage of male DM patient
(27/80 #33.75%)
 Liver steatosis :
◦ 67/80#83.75%
◦ Severe+moderate : 31/80 #38.75%

12. Discussion 2
 Liver stiffness ≥ F2: ≥ 40% of DM patients,
not correspondence with steatosis
severity. Fibrosis seemed to depend on
acquired DM duration.
 Severe steatosis (S3) → significant
/severe fibrosis.
 ARFI technique: fast, useful, valuable,
comparable as transient elastography.

13. Discussion 3
ARFI TECHNIQUE:
 The best accuracy: distinguish between
patients with fibrosis ≤ F2 and those with
severe fibrosis or cirrhosis (F3-F4).
 Less interference from obesity, ascites or
narrow intercostal space .

14. Conclusions
1. Significant increase in liver stiffness:
≥ 40% of DM patients.
2. Systematically assess liver stiffness in
type 2 diabetic patients → identify liver
fibrosis.
3. ARFI technique is comparable with TE
and more convenient in liver stiffness
assessment.

15. References
 1.Liver Stiffness Evaluation by Transient Elastography
in Type 2 Diabetes Mellitus Patients with Ultrasound-
proven Steatosis -Ioan Sporea1, Ruxandra Mare1,
Raluca Lupușoru1, Alexandra Sima2, Roxana Șirli1,
Alina Popescu1, Romulus Timar2, J Gastrointestin
Liver Dis, June 2016 Vol. 25 No 2: 167-174.
 2.Liver Stiffness in Nonalcoholic Fatty Liver
Disease:A Comparison of Supersonic Shear
Imaging,FibroScan, and ARFI With Liver Biopsy.
HEPATOLOGY, Month 2015
 3.Principles and clinical application of ultrasound
elastography for diffuse liver disease-Woo Kyoung
Jeong1, Hyo K. Lim1, Hyoung-Ki Lee2, Jae Moon Jo2,
Yongsoo Kim3. Ultrasonography 33(3), July 2014

16. Thanks for attention !