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Year : 2019  |  Volume : 27  |  Issue : 4  |  Page : 177-180

Skin-liver distance and interquartile range-median ratio as determinants of interoperator concordance in acoustic radiation force impulse imaging

1 Department of Radiology, Royal Melbourne Hospital, Victoria, Australia
2 Department of Gastroenterology, Royal Melbourne Hospital, Victoria, Australia
3 Melbourne Epicentre, Royal Melbourne Hospital; Department of Radiology, University of Melbourne, Victoria, Australia
4 Department of Radiology, Royal Melbourne Hospital; Department of Radiology, University of Melbourne, Victoria, Australia

Correspondence Address:
Dr. Shu Su
Department of Radiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria, 3050
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JMU.JMU_124_18

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Context and Aims: The accuracy of acoustic radiation force impulse (ARFI) ultrasound compared to liver biopsy is higher when there is concordance between F-scores of two or more operators. We hypothesized that when the first operator interquartile range/median-velocity ratio (IMR) is <0.3 and skin-liver distance (SLD) is <2.5 cm, there is greater interoperator concordance and a second operator is not necessary. Subjects and Methods: Two-operator ARFI ultrasound measurements (F-score, SLD, and IMR) were recorded for 927 consecutive patients. Chi-squared testing compared interoperator concordance for SLD <2.5 cm versus SLD ≥2.5 cm and IMR <0.3 versus IMR ≥0.3 when SLD <2.5 cm, in each of the F-score groups of 0/1, 2, 3, and 4. Results: Statistically significant differences were demonstrated between SLD <2.5 cm and SLD ≥2.5 cm groups for F-scores 0/1 or 4 (P = 0.005) and F-scores 2 or 3 (P < 0.001). Concordance, when SLD measured <2.5 cm, was more than 85% for all F-score groups. In the SLD <2.5 cm group, concordance fell below 85% when IMR ≥0.3, for all F-scores except F2. Specifically, P values comparing IMR <0.3 and IMR ≥0.3 in the various first operator F-score groups were P = 0.040 for F0/F1, P = 0.580 for F2, P = 0.342 for F3, and P < 0.001 for F4. Conclusions: ARFI measurements from one operator can be considered acceptable when SLD <2.5 cm and IMR <0.3. Otherwise, adding a second operator can improve confidence in the result.

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