Central Middlesex Hospital creates rapid assessment service for liver disease diagnosis


Innovative Siemens Healthcare ultrasound technology enabling patients to have a full liver assessment in a single hospital visit

Central Middlesex Hospital, part of London North West Healthcare NHS Trust, is leading the way in providing rapid liver disease diagnosis by using innovative technology to deliver full liver assessments in one day.

The hospital has reduced the number of liver biopsies, the current gold standard method for assessing liver disease, by utilising Acoustic Radiation Force Impulse (ARFI) technology on an ACUSON S2000 ultrasound system from Siemens Healthcare.

The technology has enabled patients to have a full liver assessment in a single hospital visit, whereas previous pathways could take up to three visits. Its main use has been in viral hepatitis, which has been recently endorsed by NICE guidelines. Its use has also been extended to a wider range of liver damage and patient groups as well as the identification of portal hypertension.

“Liver disease is on the rise far more than any other major disease group and is one of the biggest killers amongst working age adults. Therefore the need for a faster, safer and more-effective diagnosis is more important than ever,” said Dr Phillip Shorvon, consultant radiologist at Central Middlesex Hospital.

“As one of the first sites in the UK to identify the use of ARFI in evaluating and observing the increased liver stiffness in patients with acute liver disease, we are advocating its use to avoid the necessity of liver biopsy in some cases.”

Once liver disease is suspected, a rapid and accurate diagnosis is the key to developing treatment strategies, monitoring those strategies and then providing long-term follow-up. The ARFI technique uses ultrasound to gently displace tissue for quantitative evaluation of liver tissue stiffness properties and takes less than five minutes to complete.

Along with a traditional ultrasound examination of the liver performed in the same sitting, ARFI enables the non-invasive exclusion of significant liver diseases in patients referred with abnormal liver blood tests. This enables a one-stop approach and provides advantages over alternative methods due to a higher success rate. As a result, this has increased the examination speed for patients at Central Middlesex and the safe and painless method has improved their overall experience.

Dr Shorvon said: “A liver biopsy is an expensive and potentially-risky invasive procedure for patients and can be avoided in some patients by using the alternative ARFI method on the Siemens ultrasound system. This has helped us to improve patient safety and increased efficiency and patient throughput. There are also a number of cost-efficiencies associated with reducing the number of visits.

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“We have worked in close collaboration with our clinical and pathology colleagues and all are keen to share our evidence and best practice around ARFI techniques and liver disease diagnosis with other sites. We expect its use to become common practice and benefit liver disease patients throughout the UK. Patient satisfaction with ARFI has been high and the technique has many future prospects including the detection of undiagnosed liver disease, long-term monitoring of patients and selection of patients for new drug treatments.”