High inter-observer reliability has been reported,

and routine practice is to rely on one measurement set taken by a selleck screening library single operator. Limited information exists however regarding factors associated with inter-operator discordance, or the potential value of using multiple independent operators in routine clinical practice. Method: Our cohort included 321 patients with mixed etiology chronic liver disease, who had ARFI measurements taken independently by two or more blinded operators. ARFI results were analyzed against clinical information obtained from medical records, and histopathologic fibrosis scores in patients who had undergone liver biopsy within 6 months of ARFI (n = 50). Operators were deemed concordant, if median measurements were within one F score. Results: The overall rate of inter-operator discordance was

12.3% (95%CI 10.0–15.0%). On multivariate analysis, discordance rates were significantly higher in patients HDAC inhibitor with a BMI > 30 (28.1%, p = 0.009), an IQR:median ratio >0.3 (22.15%, p = 0.005) and in patients with F2 or F3 disease based on ARFI measurement (p < 0.001). Older age (p = 0.841), male gender (p = 0.841) and presence of diabetes (p = 0.592) did not significantly reduce inter-operator concordance. When a single operator's result was interpreted in isolation, only 72.0% of measurements correlated with biopsy (95%CI: 63.5–79.15%). This improved to 77.9% (95%CI: 70.5–83.8%) and 84.8% (95%CI: 71.5–92.7%) when inter-operator concordance was observed between two and three operators respectively. Conclusion: Inter-operator discordance rates for ARFI are significant, particularly in patients with a BMI > 30, IQR:median >0.3, or F2/F3 disease. The routine clinical use of multiple independent operators allows for the validity of ARFI measurements to be gauged, and improves accuracy 上海皓元医药股份有限公司 when interpreting results. E HEE,1 W KEMP,2 B DE BOER,3 JM HAMDORF,4 G MACQUILLAN,5 G GARAS,5 H CHING,1,5

R MACNICHOLAS,5 S ROBERTS,2 M KITSON,2 GP JEFFREY,1,5 LA ADAMS1,5 1School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia, 2Department of Gastroenterology, The Alfred, Melbourne, Australia, 3Department of Anatomical Pathology, PathWest, Perth, Australia, 4School of Surgery, The University of Western Australia, Perth, Australia, 5Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia Background and Aims: Sequential use of noninvasive methods of predicting fibrosis has been proposed to evaluate fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) however, the accuracy of this approach has not been validated.