Skin-Liver Distance And Interquartile Range-Median Ratio As Determinants Of Interoperator Concordance In Acoustic Radiation Force Impulse Imaging

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.