Point shear wave Acoustic radiation force impulse elastography (pSW-ARFI) is A Noninvasive Tool to Diagnose Acute and Chronic Hepatic Graft-Versus-Host Disease in adult Patients Undergoing allogeneic HSCT

The gold standard method of diagnosis of hepatic graft versus host disease (GVHD) is liver biopsy. However, liver biopsy is an invasive procedure with risk of complications especially bleeding.

Therefore, in the current study, we used acoustic radiation force impulse (ARFI) imaging that is a non-invasive, sensitive, and accurate tool for the assessment of liver fibrosis during routine conventional ultrasonography (US) evaluations.

The study was conducted prospectively on 30 adult patients undergoing allogeneic Hematopoietic stem cell transplantation (HSCT). Point shear wave Acoustic radiation force impulse (pSW-ARFI) elastography (stiffness and score) was performed for all patients: pre-transplant, within 3- and 6-months post-transplant.

Overall, ARFI score and stiffness were higher in patients who developed acute hepatic GVHD in comparison to those who did not develop acute GVHD (P=0.028 and P=0.03, respectively). Furthermore, the mean ARFI stiffness during the first 3 months post-transplant was directly correlated to the grade of acute hepatic GVHD (P=0.012). Moreover; ARFI score and stiffness within 6 months post-transplant were higher in patients who developed chronic hepatic GVHD in comparison to those who did not develop (P=0.020 and P=0.018, respectively).

pSW-ARFI is a reliable non-invasive tool for the early diagnosis of acute and chronic hepatic GVHD, especially if a liver biopsy is not feasible. It can also be used in the grading of acute hepatic GVHD.