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Parlati L, Aubé C, Lewin M, Boursier J, Ronot M, Paisant A. SIAD (Societé d'Imagerie Abdominale et Digestive) and AFEF (Association Française pour l'Etude du Foie) best practice position paper on the implementation of ultrasound elastography in clinical practice. Diagn Interv Imaging 2025:S2211-5684(25)00070-1. [PMID: 40210513 DOI: 10.1016/j.diii.2025.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Revised: 03/31/2025] [Accepted: 03/31/2025] [Indexed: 04/12/2025]
Abstract
PURPOSE The diagnosis of liver fibrosis is critical in managing chronic liver diseases. The EASL guidelines now recognize ultrasound elastography as a valuable, non-invasive method for assessing liver fibrosis. However, there is a lack of uniform use and reporting of the technique. The purpose of this position paper was to provide guidance on using ultrasound elastography techniques and interpreting results in clinical practice. MATERIALS AND METHODS A French national consensus panel of experts in radiology and hepatology, convened by SIAD (Société d'Imagerie Abdominale et Digestive) and AFEF (Association Française pour l'Etude du Foie), developed a position statement paper on best practices in ultrasound elastography. They were established using an online Delphi methodology that included an online panel discussion and item preparation. Consensus was achieved when ≥ 80 % of the participants agreed with a specific recommendation. RESULTS The accuracy and reliability of ultrasound elastography results could be significantly affected by a variety of operator-related and patient-related factors. Standard recommendations have been established in two areas, including recommendations for measurements and factors affecting results and reliability, and guidelines for standardized reporting of ultrasound elastography results. CONCLUSION This position paper is a comprehensive and accessible guide for clinicians that outlines best practices and standardized protocols to improve the reliability of ultrasound elastography assessments.
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Affiliation(s)
- Lucia Parlati
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris 75014, France; Department of Hepatology, Hôpital Cochin, AP-HP, Paris 75014, France.
| | - Christophe Aubé
- Laboratoire HIFIH, Université d'Angers, SFR ICAT 4208, Angers 49000, France; Department of Radiology, CHU Angers, Angers 49000, France
| | - Maïté Lewin
- Department of Radiology, Hôpital Paul Brousse, AP-HP, Villejuif 94804, France; Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre 94270, France
| | - Jérôme Boursier
- Laboratoire HIFIH, Université d'Angers, SFR ICAT 4208, Angers 49000, France; Department of Hepato-Gastroenterology and Digestive Oncology, CHU Angers, Angers 49000, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, Clichy 92118, France; Université Paris-Cité, UMR 1149, CRI, Paris 75018, France
| | - Anita Paisant
- Laboratoire HIFIH, Université d'Angers, SFR ICAT 4208, Angers 49000, France; Department of Radiology, CHU Angers, Angers 49000, France
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Dajti E, Huber AT, Ferraioli G, Berzigotti A. Advances in imaging-Elastography. Hepatology 2025:01515467-990000000-01227. [PMID: 40178430 DOI: 10.1097/hep.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 03/23/2025] [Indexed: 04/05/2025]
Abstract
Chronic liver disease affects over a billion people worldwide. Liver fibrosis is the key driver of liver-related complications and mortality. Elastography has been a transformative tool in hepatology, allowing for the diagnosis and staging of liver fibrosis noninvasively, and is evolving beyond these purposes into a prognostication tool. By measuring tissue stiffness, elastography techniques such as shear-wave and magnetic resonance elastography offer critical insights into liver fibrosis, portal hypertension, and the progression of disease. Magnetic resonance elastography stands out for its reliability across fibrosis stages and robustness in obese patients affected by metabolic liver disease. Spleen stiffness measurement complements liver assessments, enhancing the identification of portal hypertension and refining patient risk stratification. This review covers current clinical applications but also anticipates future innovations such as artificial intelligence-based algorithms that could expand elastography's clinical impact, thereby improving patient outcomes.
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Affiliation(s)
- Elton Dajti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
- Medical-Surgical Department of Digestive, Hepatic, and Endocrine-Metabolic Diseases Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Adrian T Huber
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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Liu HC, Zeng Y, Gong C, Chen X, Kijanka P, Zhang J, Genyk Y, Tchelepi H, Wang C, Zhou Q, Zhao X. Wearable bioadhesive ultrasound shear wave elastography. SCIENCE ADVANCES 2024; 10:eadk8426. [PMID: 38335289 PMCID: PMC10857377 DOI: 10.1126/sciadv.adk8426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
Acute liver failure (ALF) is a critical medical condition defined as the rapid development of hepatic dysfunction. Conventional ultrasound elastography cannot continuously monitor liver stiffness over the course of rapidly changing diseases for early detection due to the requirement of a handheld probe. In this study, we introduce wearable bioadhesive ultrasound elastography (BAUS-E), which can generate acoustic radiation force impulse (ARFI) to induce shear waves for the continuous monitoring of modulus changes. BAUS-E contains 128 channels with a compact design with only 24 mm in the azimuth direction for comfortable wearability. We further used BAUS-E to continuously monitor the stiffness of in vivo rat livers with ALF induced by d-galactosamine over 48 hours, and the stiffness change was observed within the first 6 hours. BAUS-E holds promise for clinical applications, particularly in patients after organ transplantation or postoperative care in the intensive care unit (ICU).
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Affiliation(s)
- Hsiao-Chuan Liu
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA 02139, USA
| | - Yushun Zeng
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Chen Gong
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Xiaoyu Chen
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA 02139, USA
| | - Piotr Kijanka
- Department of Robotics and Mechatronics, AGH University of Krakow, Krakow 30059, Poland
| | - Junhang Zhang
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Yuri Genyk
- Division of Hepatobiliary, Pancreatic and Abdominal Organ Transplant Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Hisham Tchelepi
- Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Chonghe Wang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA 02139, USA
| | - Qifa Zhou
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA 02139, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Boston, MA 02139, USA
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Mercado LA, Gil-Lopez F, Chirila RM, Harnois DM. Autoimmune Hepatitis: A Diagnostic and Therapeutic Overview. Diagnostics (Basel) 2024; 14:382. [PMID: 38396421 PMCID: PMC10887775 DOI: 10.3390/diagnostics14040382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Autoimmune hepatitis is an immune-mediated inflammatory condition of the liver of undetermined cause that affects both sexes, all ages, races, and ethnicities. Its clinical presentation can be very broad, from having an asymptomatic and silent course to presenting as acute hepatitis, cirrhosis, and acute liver failure potentially requiring liver transplantation. The diagnosis is based on histological abnormalities (interface hepatitis), characteristic clinical and laboratory findings (increased aspartate aminotransferase, alanine aminotransferase, and serum IgG concentration), and the presence of one or more characteristic autoantibodies. The large heterogeneity of these clinical, biochemical, and histological findings can sometimes make a timely and proper diagnosis a difficult task. Treatment seeks to achieve remission of the disease and prevent further progression of liver disease. First-line therapy includes high-dose corticosteroids, which are later tapered to decrease side effects, and azathioprine. In the presence of azathioprine intolerance or a poor response to the standard of care, second-line therapy needs to be considered, including mycophenolate mofetil. AIH remains a diagnostic and therapeutic challenge, and a further understanding of the pathophysiological pathways of the disease and the implementation of randomized controlled trials are needed.
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Affiliation(s)
- Lydia A. Mercado
- Department of Liver Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Fernando Gil-Lopez
- Department of Liver Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Razvan M. Chirila
- Department of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Denise M. Harnois
- Department of Liver Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
- Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
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Trovato FM, Artru F, Miquel R, Pirani T, McPhail MJW. Liver Elastography in Acute Liver Failure: A Pilot Study. Crit Care Explor 2024; 6:e1048. [PMID: 38343443 PMCID: PMC10857654 DOI: 10.1097/cce.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2024] Open
Abstract
OBJECTIVES We aimed to assess the feasibility and reliability of sequential ultrasonographic and elastographic monitoring in acute liver failure (ALF). DESIGN Observational study. SETTING ALF is a rare, life-threatening disease that requires intensive care admission and often liver transplant, where the accurate selection of patients is crucial. Liver elastography is a noninvasive tool that can measure hepatic stiffness, but previous results have been inconclusive in ALF. PATIENTS Patients admitted between October 2021 and March 2023 to the Liver Intensive Therapy Unit at King's College Hospital with ALF were recruited, with healthy control (HC) individuals and acute-on-chronic liver failure (ACLF) used as controls. INTERVENTION None. MEASUREMENTS Average shear wave velocity was recorded with ElastPQ on the right and left liver lobes and the spleen. Portal vein flow, hepatic artery resistive index, and peak systolic velocity were also recorded. Physiologic and histologic data were used for comparison. MAIN RESULTS Forty patients with ALF, 22 patients with ACLF, and 9 HC individuals were included in the study. At admission, liver stiffness measurement (LSM) of the right lobe was statistically different between HC individuals (5.6 ± 2 kPa), ALF (31.7 ± 17 kPa), and ACLF (76.3 ± 71 kPa) patients (ALF vs. ACLF, p = 0.0301). Spleen size and stiffness discriminated between ALF (10.4 ± 2 cm and 21.4 ± 16.6 kPa) and ACLF (14 ± 2.3 cm and 42.6 ± 26 kPa). At admission, LSM was not different between ALF patients who spontaneously survived versus patients who died or were transplanted in the following 90 days. However, the trend over the first 10 days of admission was different with a peak of LSM at day 5 in spontaneous survivors followed by reduction during the recovery phase. ALF patients with poor prognosis showed a persistently increased LSM. CONCLUSIONS In ALF stiffness peaks at day 5 of admission with subsequent reduction in patients spontaneously surviving, showing significant difference according to the prognosis at day 7 of admission. LSM might be useful in distinguishing acute from acute-on-chronic liver failure together with spleen volume and stiffness.
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Affiliation(s)
- Francesca M Trovato
- School of Immunology and Microbial Sciences, Department of Inflammation Biology, Kings College London, London, United Kingdom
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom
| | - Florent Artru
- School of Immunology and Microbial Sciences, Department of Inflammation Biology, Kings College London, London, United Kingdom
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom
| | - Rosa Miquel
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom
| | - Tasneem Pirani
- School of Immunology and Microbial Sciences, Department of Inflammation Biology, Kings College London, London, United Kingdom
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom
| | - Mark J W McPhail
- School of Immunology and Microbial Sciences, Department of Inflammation Biology, Kings College London, London, United Kingdom
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom
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Wu L, Jin J, Zhou T, Wu Y, Li X, Li X, Zeng J, Wang J, Ren J, Chong Y, Zheng R. A Prognostic Nomogram with High Accuracy Based on 2D-SWE in Patients with Acute-on-chronic Liver Failure. J Clin Transl Hepatol 2022; 10:803-813. [PMID: 36304504 PMCID: PMC9547255 DOI: 10.14218/jcth.2021.00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Acute-on-chronic liver failure (ACLF) is associated with very high mortality. Accurate prediction of prognosis is critical in navigating optimal treatment decisions to improve patient survival. This study was aimed to develop a new nomogram integrating two-dimensional shear wave elastography (2D-SWE) values with other independent prognostic factors to improve the precision of predicting ACLF patient outcomes. METHODS A total of 449 consecutive patients with ACLF were recruited and randomly allocated to a training cohort (n=315) or a test cohort (n=134). 2D-SWE values, conventional ultrasound features, laboratory tests, and other clinical characteristics were included in univariate and multivariate analysis. Factors with prognostic value were then used to construct a novel prognostic nomogram. Receiver operating curves (ROCs) were generated to evaluate and compare the performance of the novel and published models including the Model for End-Stage Liver Disease (MELD), MELD combined with sodium (MELD-Na), and Jin's model. The model was validated in a prospective cohort (n=102). RESULTS A ACLF prognostic nomogram was developed with independent prognostic factors, including 2D-SWE, age, total bilirubin (TB), neutrophils (Neu), and the international normalized ratio (INR). The area under the ROC curve (AUC) was 0.849 for the new model in the training cohort and 0.861 in the prospective validation cohort, which were significantly greater than those for MELD (0.758), MELD-Na (0.750), and Jin's model (0.777, all p <0.05). Calibration curve analysis revealed good agreement between the predicted and observed probabilities. The new nomogram had superior overall net benefit and clinical utility. CONCLUSIONS We established and validated a 2D-SWE-based noninvasive nomogram to predict the prognosis of ACLF patients that was more accurate than other prognostic models.
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Affiliation(s)
- Lili Wu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, China
| | - Jieyang Jin
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, China
| | - Taicheng Zhou
- Department of Gastroenterological Surgery and Hernia Center, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, Guangzhou, Guangdong, China
| | - Yuankai Wu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xinhua Li
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiangyong Li
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jie Zeng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, China
| | - Jinfen Wang
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, China
| | - Jie Ren
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, China
| | - Yutian Chong
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, China
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Yuan S, Huang X, Wu X, Xu P, Zhou A. A model based on two-dimensional shear wave elastography for acute-on-chronic liver failure development in patients with acutely decompensated hepatitis B cirrhosis. Quant Imaging Med Surg 2022; 12:2732-2743. [PMID: 35502396 PMCID: PMC9014136 DOI: 10.21037/qims-21-871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/14/2022] [Indexed: 10/27/2023]
Abstract
BACKGROUND To evaluate the accuracy of two-dimensional (2D) shear wave elastography (SWE), develop and validate a novel prognostic model in predicting acute-on-chronic liver failure (ACLF) development in patients with acutely decompensated hepatitis B cirrhosis. METHODS This prospective cohort study enrolled 221 patients in the First Affiliated Hospital of Nanchang University from September 2019 to January 2021, and randomly assigned them to the derivation and validation cohorts (7:3 ratio). Ultrasound, 2D SWE, clinical and laboratory data were collected, and outcome (ACLF developed) was recorded during a 90-day follow-up period. We evaluated the ability of 2D SWE to predict the outcome, developed a model for predicting ACLF development in the derivation cohort, and assessed the model in the validation cohort. RESULTS 2D SWE values were significantly higher in patients with ACLF development (P<0.05). The accuracy of 2D SWE in predicting the outcome was better than that of serum parameters of liver fibrosis (all P<0.05). The SWE model for ACLF development had good calibration and discrimination [concordance index (C-index): 0.855 and 0.840 respectively] in derivation and validation cohorts, outperforming serum prognostic scores (all P<0.05). CONCLUSIONS The SWE model, superior to serum prognostic scores in predicting ACLF development, could be a noninvasive tool to guide the individual management of patients with acutely decompensated hepatitis B cirrhosis.
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Affiliation(s)
- Songsong Yuan
- Department of Infectious Disease, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xingzhi Huang
- Department of Ultrasonography, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoping Wu
- Department of Infectious Disease, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pan Xu
- Department of Ultrasonography, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Aiyun Zhou
- Department of Ultrasonography, the First Affiliated Hospital of Nanchang University, Nanchang, China
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Heneghan MA, Shumbayawonda E, Dennis A, Ahmed RZ, Rahim MN, Ney M, Smith L, Kelly M, Banerjee R, Culver EL. Quantitative magnetic resonance imaging to aid clinical decision making in autoimmune hepatitis. EClinicalMedicine 2022; 46:101325. [PMID: 35340625 PMCID: PMC8943410 DOI: 10.1016/j.eclinm.2022.101325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/14/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In autoimmune hepatitis (AIH), clinical practice and treatment guidelines frequently diverge as a reflection of disease heterogeneity and challenges in achieving standardised care. We sought to explore the utility of multiparametric (mp) MR in patients with AIH, and the impact of this technology on physicians' decision making and intended patient management. METHODS 82 AIH patients, recruited from two sites between June and November 2019 as part of an observational cohort study, underwent non-contrast MRI alongside their standard clinical investigations. Correlations between iron-corrected T1 (cT1) and other markers of disease were investigated alongside the utility of imaging markers to risk stratify patients in biochemical remission. The impact of mpMR on clinical decision making was evaluated using pairwise t-tests. The discriminatory ability of the imaging markers was assessed using area under the receiver operating characteristic curves (AUCs). FINDINGS cT1 had a significant impact on clinician intended patient management (p<0.0001). cT1 correlated with ALT (p = 0.0005), AST (p<0.001), IgG (p = 0.0005), and liver stiffness (p<0.0001). Patients in deep biochemical remission (N = 11; AST/ALT <50% upper limit of normal [ULN] and IgG <12 g/L) had low cT1, while 7/34 in normal biochemical remission (AST/ALT between 50 and 100% of ULN) had high cT1 and were at risk of disease flare. cT1 measures of disease heterogeneity, ALP and bilirubin made the best predictor of those not in biochemical remission (AUC:0.85). INTERPRETATION This study investigates the impact of mpMR results on intended clinical management in a real world setting. Findings showed that mpMR demonstrated a significant impact on clinical management of AIH and has the potential to inform patient risk stratification. FUNDING This paper presents independent research supported by the Innovate UK grant (104,915).
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Affiliation(s)
- Michael A. Heneghan
- Institute of Liver Studies, King's College Hospital, NHS Foundation Trust, Denmark Hill, London, United Kingdom
- Corresponding author.
| | | | | | - Refah Z. Ahmed
- Institute of Liver Studies, King's College Hospital, NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Mussarat N. Rahim
- Institute of Liver Studies, King's College Hospital, NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Michael Ney
- Institute of Liver Studies, King's College Hospital, NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Loren Smith
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | | | - Emma L. Culver
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Karlas T, Franke GN. [Liver stiffness in allogeneic stem cell transplantation]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:995-996. [PMID: 34507378 DOI: 10.1055/a-1538-6732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas Karlas
- Medizinische Klinik 2, Bereich Gastroenterologie, Universitätsklinikum Leipzig, Leipzig
| | - Georg-Nikolaus Franke
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig
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Arndtz K, Shumbayawonda E, Hodson J, Eddowes PJ, Dennis A, Thomaides-Brears H, Mouchti S, Kelly MD, Banerjee R, Neubauer S, Hirschfield GM. Multiparametric Magnetic Resonance Imaging, Autoimmune Hepatitis, and Prediction of Disease Activity. Hepatol Commun 2021; 5:1009-1020. [PMID: 34141986 PMCID: PMC8183180 DOI: 10.1002/hep4.1687] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Noninvasive monitoring of disease activity in autoimmune hepatitis (AIH) has potential advantages for patients for whom liver biopsy is invasive and with risk. We sought to understand the association of multiparametric magnetic resonance imaging (mpMRI) with clinical course of patients with AIH. We prospectively recruited 62 patients (median age, 55 years; 82% women) with clinically confirmed AIH. At recruitment, patients underwent mpMRI with LiverMultiScan alongside clinical investigations, which were repeated after 12-18 months. Associations between iron-corrected T1 (cT1) and other markers of disease were investigated at baseline and at follow-up. Discriminative performance of cT1, liver stiffness, and enhanced liver fibrosis (ELF) to identify those who failed to maintain remission over follow-up was investigated using the areas under the receiver operating characteristic curves (AUCs). Baseline cT1 correlated with alanine aminotransferase (Spearman's correlation coefficient [r S] = 0.28, P = 0.028), aspartate aminotransferase (r S = 0.26, P = 0.038), international normalized ratio (r S = 0.35 P = 0.005), Model for End-Stage Liver Disease (r S = 0.32, P = 0.020), ELF (r S = 0.29, P = 0.022), and liver stiffness r S = 0.51, P < 0.001). After excluding those not in remission at baseline (n = 12), 32% of the remainder failed to maintain remission during follow-up. Failure to maintain remission was associated with significant increases in cT1 over follow-up (AUC, 0.71; 95% confidence interval [CI], 0.52-0.90; P = 0.035) but not with changes in liver stiffness (AUC, 0.68; 95% CI, 0.49-0.87; P = 0.067) or ELF (AUC, 0.57; 95% CI, 0.37-0.78; P = 0.502). cT1 measured at baseline was a significant predictor of future loss of biochemical remission (AUC, 0.68; 95% CI, 0.53-0.83; P = 0.042); neither liver stiffness (AUC, 0.53; 95% CI, 0.34-0.71; P = 0.749) nor ELF (AUC, 0.52; 95% CI, 0.33-0.70; P = 0.843) were significant predictors of loss of biochemical remission. Conclusion: Noninvasive mpMRI has potential to contribute to risk stratification in patients with AIH.
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Affiliation(s)
- Katherine Arndtz
- Centre for Liver and Gastrointestinal ResearchNational Institute for Health Research (NIHR) Birmingham Liver Biomedical Research CentreBirminghamUnited Kingdom.,University Hospitals Birmingham National Health Service (NHS) Foundation TrustBirminghamUnited Kingdom
| | | | - James Hodson
- University Hospitals Birmingham National Health Service (NHS) Foundation TrustBirminghamUnited Kingdom
| | - Peter J Eddowes
- Centre for Liver and Gastrointestinal ResearchNational Institute for Health Research (NIHR) Birmingham Liver Biomedical Research CentreBirminghamUnited Kingdom.,NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamNottinghamUnited Kingdom
| | | | | | | | | | | | | | - Gideon M Hirschfield
- Centre for Liver and Gastrointestinal ResearchNational Institute for Health Research (NIHR) Birmingham Liver Biomedical Research CentreBirminghamUnited Kingdom.,Toronto Centre for Liver DiseaseUniversity Health NetworkTorontoONCanada
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Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology 2020; 72:671-722. [PMID: 31863477 DOI: 10.1002/hep.31065] [Citation(s) in RCA: 548] [Impact Index Per Article: 109.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Cara L Mack
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - David Adams
- Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - David N Assis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Nanda Kerkar
- Golisano Children's Hospital at Strong, University of Rochester Medical Center, New York, NY
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Marlyn J Mayo
- Division of Digestive and Liver Diseases, University of Texas SW Medical Center, Dallas, TX
| | - John M Vierling
- Medicine and Surgery, Baylor College of Medicine, Houston, TX
| | | | - Mohammad H Murad
- Mayo Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, MN
| | - Albert J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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12
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Dietrich CF, Trenker C, Fontanilla T, Görg C, Hausmann A, Klein S, Lassau N, Miquel R, Schreiber-Dietrich D, Dong Y. New Ultrasound Techniques Challenge the Diagnosis of Sinusoidal Obstruction Syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2171-2182. [PMID: 30076031 DOI: 10.1016/j.ultrasmedbio.2018.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
Sinusoidal obstruction syndrome, also known as veno-occlusive disease (SOS/VOD), is a potentially life-threatening complication that can develop after hematopoietic cell transplantation. Clinically, SOS/VOD is characterized by hepatomegaly, right upper quadrant pain, jaundice and ascites, most often occurring within the first 3 wk after hematopoietic cell transplantation. Early therapeutic intervention is pivotal for survival in SOS/VOD. Thus, a rapid and reliable diagnosis has to be made. Diagnosis of SOS/VOD is based on clinical criteria, such as the Seattle, Baltimore or recently issued European Society for Blood and Marrow Transplantation criteria, to which hemodynamic and/or ultrasound evidence of SOS were added for the first time. However, to rule out major differential diagnoses and to verify the diagnosis, a reliable imaging method is needed. Ultrasound techniques have been proposed in SOS/VOD. Nevertheless, the sensitivity and specificity of transabdominal ultrasound and Doppler techniques need to be improved. Innovative ultrasound methods such as a combination of Doppler ultrasound with shear wave elastography and contrast-enhanced ultrasound techniques should be evaluated for diagnosis and follow-up of SOS/VOD. The goals of this review are to discuss currently available ultrasound techniques and to identify areas for future studies in SOS/VOD.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Corinna Trenker
- Department of Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Teresa Fontanilla
- Radiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Christian Görg
- Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | | | - Stefan Klein
- Department of Hematology and Oncology, University Clinic Mannheim, Mannheim, Germany
| | - Nathalie Lassau
- Gustave Roussy Imaging Department, CNRS Université Paris-Sud, Paris, France
| | - Rosa Miquel
- Liver Histopathology, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | | | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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13
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Jeong JY, Cho YS, Sohn JH. Role of two-dimensional shear wave elastography in chronic liver diseases: A narrative review. World J Gastroenterol 2018; 24:3849-3860. [PMID: 30228779 PMCID: PMC6141332 DOI: 10.3748/wjg.v24.i34.3849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
Liver biopsy is the gold standard for evaluating the degree of liver fibrosis in patients with chronic liver disease. However, due to the many limitations of liver biopsy, there has been much interest in the use of noninvasive techniques for this purpose. Among these techniques real-time two-dimensional shear wave elastography (2D-SWE) has the advantage of measuring tissue elasticity with the guidance of B-mode images. Recently, many studies have been conducted on the application of 2D-SWE in patients with various liver diseases, and their validity has been confirmed. Here, we briefly discuss the role of 2D-SWE in patients with chronic liver diseases, particularly aspects of the examination techniques and clinical applications.
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Affiliation(s)
- Jae Yoon Jeong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
| | - Young Seo Cho
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
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14
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Jin JY, Zheng YB, Zheng J, Liu J, Mao YJ, Chen SG, Gao ZL, Zheng RQ. 2D shear wave elastography combined with MELD improved prognostic accuracy in patients with acute-on-chronic hepatitis B liver failure. Eur Radiol 2018; 28:4465-4474. [PMID: 29696433 DOI: 10.1007/s00330-018-5336-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/01/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate accuracy of two-dimensional shear wave elastography (2D SWE) and develop and validate a new prognostic score in predicting prognosis of acute-on-chronic liver failure (ACLF) patients. METHODS From 1 October 2013 to 30 September 2015, we consecutively enrolled 290 patients, sequentially collected data (including 2D SWE, ultrasound parameters, laboratory data and prognostic scores) and recorded patients' outcome (recovering/steady or worsening) during a 90-day follow-up period. We evaluated ability of 2D SWE to predict outcomes of acute-on-chronic hepatitis B liver failure (ACLF-HBV) patients. We developed a new score (MELD-SWE, combining MELD and SWE values) for predicting mortality risk of ACLF-HBV in 179 patients in a derivation group, and validated in 111 patients. RESULTS 2D SWE values were higher in worsening patients than recovering/steady ones (p < 0.001). Accuracy of 2D SWE in predicting outcomes of ACLF-HBV was comparable to that of the MELD score (p = 0.441). MELD-SWE showed a significantly higher prognostic value than MELD in both derivation (AUROC, 0.80 vs. 0.76, p = 0.040) and validation (AUROC, 0.87 vs. 0.82, p = 0.018) group. CONCLUSIONS The MELD-SWE score, combining MELD and SWE values, was superior to MELD alone for outcoming prediction in patients with ACLF-HBV. KEY POINTS • 2D SWE is a simple prognostic evaluation tool in patients with ACLF-HBV. • MELD-SWE was created in this study: 1.3×MELD + 0.3×2D SWE (kPa). • MELD-SWE score was superior to MELD alone for outcoming prediction in ACLF-HBV. • In this study, 46.8 was the optimal cut-off value of MELD-SWE score.
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Affiliation(s)
- Jie-Yang Jin
- Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.,GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China
| | - Yu-Bao Zheng
- GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.,Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China
| | - Jian Zheng
- Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.,GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China
| | - Jing Liu
- GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.,Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China
| | - Yong-Jiang Mao
- Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.,GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China
| | - Shi-Gao Chen
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Zhi-Liang Gao
- GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China. .,Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
| | - Rong-Qin Zheng
- Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China. .,GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
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15
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Tsukano N, Miyase S, Saeki T, Mizobe K, Iwashita H, Arima N, Fujiyama S. Usefulness of virtual touch quantification for staging liver fibrosis in patients with hepatitis C, and factors affecting liver stiffness measurement failure compared with liver biopsy. Hepatol Res 2018; 48:373-382. [PMID: 29226524 DOI: 10.1111/hepr.13041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/10/2017] [Accepted: 12/02/2017] [Indexed: 02/08/2023]
Abstract
AIM The assessment of liver fibrosis in patients with hepatitis C is important to predict carcinogenesis. In this study, we evaluated the usefulness of virtual touch quantification (VTQ) for staging liver fibrosis, and investigated factors causing discrepancies between the estimated fibrosis stage using VTQ and the pathological fibrosis stage. METHODS Patients with hepatitis C (n = 302) were assessed using VTQ and underwent pathological liver investigation within 1 week before and after VTQ. A receiver operator characteristic (ROC) curve was obtained for VTQ, fibrosis-4 (FIB-4) index, and aspartate aminotransferase-to-platelet ratio index (APRI), and each area under the ROC curve (AUROC) was compared to predict fibrosis stage. We used univariate and multivariate analyses to investigate the factors related to the discrepancy between the estimated fibrosis stage using VTQ and the pathological fibrosis stage. RESULTS At any stage, VTQ was the most accurate for staging liver fibrosis. The VTQ cut-off values were 1.33 m/s (AUROC = 0.822) for ≥F2, 1.51 m/s (AUROC = 0.836) for ≥F3, and 1.92 m/s (AUROC = 0.890) for F4. Skin liver capsule distance (SCD) was the most relevant factor for the discrepancy between the estimated fibrosis stage using VTQ and the pathological fibrosis stage. The SCD cut-off value was 17.5 mm. CONCLUSIONS Virtual touch quantification is a non-invasive, simple method that is more accurate for staging liver fibrosis than the FIB-4 index and APRI. However, when the SCD is longer than 17.5 mm, there may be measurement failures.
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Affiliation(s)
- Natsumi Tsukano
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Shiho Miyase
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Tatsuhiko Saeki
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Keiko Mizobe
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Hirofumi Iwashita
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Nobuyuki Arima
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Shigetoshi Fujiyama
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
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Eriksson S, Borsiin H, Öberg CF, Brange H, Mijovic Z, Sturesson C. Perioperative liver and spleen elastography in patients without chronic liver disease. World J Gastrointest Surg 2018; 10:21-27. [PMID: 29492187 PMCID: PMC5827034 DOI: 10.4240/wjgs.v10.i2.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/14/2018] [Accepted: 02/06/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate changes in hepatic and splenic stiffness in patients without chronic liver disease during liver resection for hepatic tumors.
METHODS Patients scheduled for liver resection for hepatic tumors were considered for enrollment. Tissue stiffness measurements on liver and spleen were conducted before and two days after liver resection using point shear-wave elastography. Histological analysis of the resected liver specimen was conducted in all patients and patients with marked liver fibrosis were excluded from further study analysis. Patients were divided into groups depending on size of resection and whether they had received preoperative chemotherapy or not. The relation between tissue stiffness and postoperative biochemistry was investigated.
RESULTS Results are presented as median (interquartile range). 35 patients were included. The liver stiffness increased in patients undergoing a major resection from 1.41 (1.24-1.63) m/s to 2.20 (1.72-2.44) m/s (P = 0.001). No change in liver stiffness in patients undergoing a minor resection was found [1.31 (1.15-1.52) m/s vs 1.37 (1.12-1.77) m/s, P = 0.438]. A major resection resulted in a 16% (7%-33%) increase in spleen stiffness, more (P = 0.047) than after a minor resection [2 (-1-13) %]. Patients who underwent preoperative chemotherapy (n = 20) did not differ from others in preoperative right liver lobe [1.31 (1.16-1.50) vs 1.38 (1.12-1.56) m/s, P = 0.569] or spleen [2.79 (2.33-3.11) vs 2.71 (2.37-2.86) m/s, P = 0.515] stiffness. Remnant liver stiffness on the second postoperative day did not show strong correlations with maximum postoperative increase in bilirubin (R2 = 0.154, Pearson’s r = 0.392, P = 0.032) and international normalized ratio (R2 = 0.285, Pearson’s r = 0.534, P = 0.003).
CONCLUSION Liver and spleen stiffness increase after a major liver resection for hepatic tumors in patients without chronic liver disease.
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17
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Özkan MB, Bilgici MC, Eren E, Caltepe G, Yilmaz G, Kara C, Gun S. Role of Point Shear Wave Elastography in the Determination of the Severity of Fibrosis in Pediatric Liver Diseases With Pathologic Correlations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2337-2344. [PMID: 28586157 DOI: 10.1002/jum.14277] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Our aims in this study were as follows: (1) to determine the cutoff value that can distinguish between advanced liver fibrosis and normal liver tissue for two different elastographic techniques; (2) to determine the cutoff value that can distinguish mild liver fibrosis from normal liver tissue for the techniques; and (3) to assess tissue stiffness in nonalcoholic fatty liver disease (NAFLD). METHODS Seventy-five patients assessed for liver biopsy on the same day were evaluated by point shear wave elastography. Thirty-one healthy children and 11 children with NAFLD were also evaluated. A 9L4 transducer with Virtual Touch quantification (VTQ) and Virtual Touch imaging and quantification (VTIQ) modes (Siemens Medical Solutions, Mountain View, CA) was used for quantification. RESULTS The shear wave speed of the patients with NAFLD was higher than that of the control group. The only predictive factor for VTQ and VTIQ was the histologic fibrosis score (model-adjusted R2 = 0.56 for VTQ and 0.75 for VTIQ). Shear wave speed cutoffs were 1.67 m/s for VTQ and 1.56 m/s for VTIQ in detecting fibrosis or inflammation and 2.09 m/s for VTQ and 2.17 m/s for VTIQ in discriminating children with low and high histologic liver fibrosis scores. CONCLUSIONS The VTQ and VTIQ values reveal high-grade histopathologic fibrosis and have high success rates when distinguishing high- from low-grade fibrosis. However, they have limited success rates when differentiating low-grade fibrosis from normal liver tissue.
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Affiliation(s)
- Mehmet Burak Özkan
- Department of Pediatric Radiology, Dr Sami Ulus Research and Training Hospital, Ankara, Turkey
| | | | - Esra Eren
- Department of Pediatric Gastroenterology, Omu, Samsun, Turkey
| | - Gonul Caltepe
- Department of Pediatric Gastroenterology, Omu, Samsun, Turkey
| | - Gulay Yilmaz
- Department of Pediatric Endocrinology, Omu, Samsun, Turkey
| | - Cengiz Kara
- Department of Pediatric Endocrinology, Omu, Samsun, Turkey
| | - Seda Gun
- Department of Pathology, Omu, Samsun, Turkey
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18
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Li J, Yu J, Peng XY, Du TT, Wang JJ, Tong J, Lu GL, Wu XW. Acoustic Radiation Force Impulse (ARFI) Elastography and Serological Markers in Assessment of Liver Fibrosis and Free Portal Pressure in Patients with Hepatitis B. Med Sci Monit 2017; 23:3585-3592. [PMID: 28735336 PMCID: PMC5540073 DOI: 10.12659/msm.905896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) elastography, AST-to-platelet ratio index (APRI), and FIB-4 in assessing liver fibrosis and free portal pressure in patients with hepatitis B. Material/Methods We enrolled 126 patients with hepatitis B who underwent liver surgery at the General Surgery Department of the First Affiliated Hospital of Shihezi University Medical School from February 2013 to August 2015. Preoperatively, shear wave velocity (SWV) of the liver was measured with the Siemens S2000 ultrasound system to reflect liver stiffness. Serological markers were collected and fibrosis indices APRI and FIB-4 were calculated. Intraoperatively, liver tissues were harvested and free portal pressure (FPP) was measured. Postoperatively, fibrosis of liver tissues was pathologically staged. Results The results of SWV, APRI, FIB-4, and FPP were all correlated with the degree of liver fibrosis (Spearman correlation coefficients: r=0.777, P<0.001; r=0.526, P<0.001; r=0.471, P<0.001; p<0.000; r=0.675, p<0.000). Receiver operating characteristic curve (ROC) analysis showed that the areas under the curve (AUC) of ARFI, APRI, and FIB-4 in diagnosing liver fibrosis were 0.830, 0.768, and 0.717, respectively, for stage F≥1; 0.861, 0.773, and 0.754, respectively, for stage F≥2; 0.941, 0.793, and 0.779, respectively, for stage F≥3; and 0.945, 0.783, and 0.754, respectively, for stage F=4. SWV, APRI, and FIB-4 were all correlated with FPP (Pearson correlation coefficients: 0.387, P<0.001; 0.446, P<0.001; 0.419, P<0.001). Conclusions ARFI, APRI, and FIB-4 can assess liver fibrosis in patients with hepatitis B when assessing the portal venous pressure. The difference in diagnostic efficacy between the 3 was not significant.
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Affiliation(s)
- Jun Li
- Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Department of Ultrasound, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China (mainland)
| | - Jie Yu
- Department of Pathology, High-tech District People's Hospital, Suzhou, Jiangsu, China (mainland)
| | - Xin-Yu Peng
- Department of Gastroenterology-Hepatology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China (mainland)
| | - Ting-Ting Du
- Department of Ultrasound, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China (mainland)
| | - Jia-Jia Wang
- Department of Ultrasound, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China (mainland)
| | - Jin Tong
- Department of Ultrasound, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China (mainland)
| | - Gui-Lin Lu
- Department of Ultrasound, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China (mainland)
| | - Xiang-Wei Wu
- Department of Gastroenterology-Hepatology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China (mainland)
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19
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Abstract
Noninvasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine practice. Using hepatic shear wave elastography, cut-off levels can help to detect the degree of relevant fibrosis (F ≥ 2) with a diagnostic accuracy using the area under the reader operating characteristic (AUROC) of 87 % and cirrhosis (F = 4, AUROC 93 %). Normal values virtually exclude liver cirrhosis (negative predictive value up to 97 %) and high shear wave velocities predict complications in the course of primary sclerosing cholangitis, liver cirrhosis and chronic hepatitis B or C. Elastography is of no relevant help in the differentiation of the dignity of hepatic lesions. Concerning thyroid or breast lesions, low shear wave velocities are indicative of benign lesions and in contrast, high velocities of malignant lesions. A differentiation between benign and malignant thyroid nodules is performed by elastography with a sensitivity of 89 % and a specificity of 82 %. In breast lesions a differentiation of nodes can be improved with elastography compared to B-mode ultrasound alone with a sensitivity of 97 % and a specificity of 83 %. Invasive biopsy punctures can therefore be specifically performed or can be omitted. Due to several influencing factors, in particular during liver elastography, the measurements need to be interpreted in the clinical context. In summary, ultrasound-based elastography provides helpful information for the detection of hepatic fibrosis and for further characterization of thyroid or breast lesions in addition to classical techniques, such as B-mode imaging and color Doppler.
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20
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Abbas Z, Shazi L. Pattern and profile of chronic liver disease in acute on chronic liver failure. Hepatol Int 2015; 9:366-372. [PMID: 26016461 DOI: 10.1007/s12072-015-9627-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/30/2015] [Indexed: 12/19/2022]
Abstract
The etiology of the chronic liver disease (CLD) in patients with acute on chronic liver failure (ACLF) may vary from region to region. The major cause of underlying CLD is viral (hepatitis B and C) in the East, while it is alcohol related in the West and in some parts of the Indian subcontinent. Autoimmune liver disease and Wilson's disease are the major underlying etiologies in the pediatric age group. The patients with CLD without cirrhosis should be included when defining ACLF. Non-alcoholic fatty liver disease related chronic liver insult in patients with known risk factors for progressive disease should be taken as a chronic liver disease in the setting of ACLF, whereas fatty liver with normal aminotransferases in low risk patients should not. The patients with CLD and previous decompensation should be excluded. Diagnosis of chronic liver disease in the setting of ACLF is made by history, physical examination and previously available or recent laboratory, endoscopic or radiological investigations. A liver biopsy through the transjugular route may help in cases where the presence of underlying CLD or its cause is not clear. The need of liver biopsy in ACLF should, however, be individualized. Standardization of liver biopsy assessment is essential for a uniform approach to the diagnosis and treatment of CLD and acute insult. Tools to measure liver stiffness may aid in identifying patients with advanced fibrosis. Studies are needed to validate the performance of these tests in the setting of ACLF.
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Affiliation(s)
- Zaigham Abbas
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan,
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21
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Value of liver elastography and abdominal ultrasound for detection of complications of allogeneic hemopoietic SCT. Bone Marrow Transplant 2014; 49:806-11. [PMID: 24710567 DOI: 10.1038/bmt.2014.61] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/10/2014] [Accepted: 02/15/2014] [Indexed: 12/19/2022]
Abstract
Hepatic complications contribute to morbidity and mortality after allogeneic hemopoietic SCT. Liver Doppler ultrasound and elastography represent promising methods for pretransplant risk assessment and early detection of complications. Ultrasound (liver and spleen size, liver perfusion) and elastography (transient elastography (TE); right liver lobe acoustic radiation force impulse imaging (r-ARFI); left liver lobe ARFI (l-ARFI)) were prospectively evaluated in patients with indications for allo-SCT. Measurements were performed before and repeatedly after SCT. Results were compared with the incidence of life-threatening complications and death during the first 150 days after SCT. Of 59 included patients, 16 suffered from major complications and 9 of them died within the follow-up period. At baseline, liver and spleen size, liver perfusion, TE and r-ARFI did not differ significantly between patients with and without severe complications. In contrast, l-ARFI was significantly elevated in patients who later developed severe complications (1.58±0.30 m/s vs 1.37±0.27 m/s, P=0.030). After SCT, l-ARFI values remained elevated and TE showed increasing liver stiffness in patients with complications. The value of conventional liver ultrasound for prediction of severe SCT complications is limited. Increased values for TE and l-ARFI are associated with severe SCT complications and demand further evaluation.
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22
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Czaja AJ. Review article: The prevention and reversal of hepatic fibrosis in autoimmune hepatitis. Aliment Pharmacol Ther 2014; 39:385-406. [PMID: 24387318 DOI: 10.1111/apt.12592] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/29/2013] [Accepted: 12/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti-fibrotic effects are inconsistent secondary gains. AIM To describe the anti-fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti-fibrotic interventions, indicate the non-invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities. METHODS Studies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti-fibrotic therapy and non-invasive tests of hepatic fibrosis were selected. RESULTS Hepatic fibrosis improves in 53-57% of corticosteroid-treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non-invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non-invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti-fibrotic therapies are poised for study in this disease. CONCLUSIONS The prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti-fibrotic interventions, must be evaluated.
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Affiliation(s)
- A J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
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23
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Tomita H, Hoshino K, Fuchimoto Y, Ebinuma H, Ohkuma K, Tanami Y, Du W, Masugi Y, Shimojima N, Fujino A, Kano M, Fujimura T, Ishihama H, Shimizu T, Tanabe M, Saito H, Sakamoto M, Hibi T, Kitagawa Y, Kuroda T. Acoustic radiation force impulse imaging for assessing graft fibrosis after pediatric living donor liver transplantation: a pilot study. Liver Transpl 2013; 19:1202-13. [PMID: 23894066 DOI: 10.1002/lt.23708] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/19/2013] [Indexed: 12/19/2022]
Abstract
Graft fibrosis is a common finding during protocol biopsy examinations after pediatric liver transplantation. We evaluated the clinical utility of liver stiffness measurements by acoustic radiation force impulse (ARFI) imaging, a novel ultrasound-based elastography method, for assessing graft fibrosis after pediatric living donor liver transplantation (LDLT). We performed 73 liver stiffness measurements by ARFI imaging in 65 pediatric LDLT recipients through the upper midline of the abdomen (midline value) and the right intercostal space (intercostal value) around the time of protocol biopsy examinations. Fifty-nine of these liver stiffness measurements could be compared with histopathological findings. Graft fibrosis was assessed according to the degrees of portal and pericellular fibrosis. Significant fibrosis, which was defined as F2 or worse portal fibrosis and/or moderate or worse pericellular fibrosis, was observed in 14 examinations, which had significantly higher midline (P = 0.005) and intercostal values (P < 0.001) than the others. Liver stiffness measurements by ARFI imaging significantly increased with increases in the portal and pericellular fibrosis grades. For the diagnosis of significant fibrosis, the areas under the receiver operating characteristic curve (AUROCs) were 0.760 (P = 0.005) and 0.849 (P < 0.001) for the midline and intercostal values, respectively. The optimal cutoff values were 1.30 and 1.39 m/second for midline and intercostal values, respectively. Slight but significant elevations were noted in the results of biochemical liver tests: serum levels of γ-glutamyltransferase showed the highest AUROC (0.809, P = 0.001) with an optimal cutoff value of 20 IU/L. In conclusion, liver stiffness measurements by ARFI imaging had good accuracy for diagnosing graft fibrosis after pediatric LDLT. The pericellular pattern of fibrosis was frequently observed after pediatric LDLT, and moderate pericellular fibrosis was detectable by ARFI imaging.
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Affiliation(s)
- Hirofumi Tomita
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Bota S, Sporea I, Peck-Radosavljevic M, Sirli R, Tanaka H, Iijima H, Saito H, Ebinuma H, Lupsor M, Badea R, Fierbinteanu-Braticevici C, Petrisor A, Friedrich-Rust M, Sarrazin C, Takahashi H, Ono N, Piscaglia F, Marinelli S, D'Onofrio M, Gallotti A, Salzl P, Popescu A, Danila M. The influence of aminotransferase levels on liver stiffness assessed by Acoustic Radiation Force Impulse Elastography: a retrospective multicentre study. Dig Liver Dis 2013; 45:762-768. [PMID: 23510533 DOI: 10.1016/j.dld.2013.02.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/18/2013] [Accepted: 02/12/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acoustic Radiation Force Impulse Elastography is a new method for non-invasive evaluation of liver fibrosis. AIM To evaluate the impact of elevated alanine aminotransferase levels on liver stiffness assessment by Acoustic Radiation Force Impulse Elastography. METHODS A multicentre retrospective study including 1242 patients with chronic liver disease, who underwent liver biopsy and Acoustic Radiation Force Impulse. Transient Elastography was also performed in 512 patients. RESULTS The best Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis was 1.29 m/s in cases with normal alanine aminotransferase levels and 1.44 m/s in patients with alanine aminotransferase levels>5 × the upper limit of normal. The best cut-off for predicting liver cirrhosis were 1.59 and 1.75 m/s, respectively. Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis and cirrhosis were relatively similar in patients with normal alanine aminotransferase and in those with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal: 1.29 m/s vs. 1.36 m/s and 1.59 m/s vs. 1.57 m/s, respectively. For predicting cirrhosis, the Transient Elastography cut-offs were significantly higher in patients with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal compared to those with normal alanine aminotransferase: 12.3 kPa vs. 9.1 kPa. CONCLUSION Liver stiffness values assessed by Acoustic Radiation Force Impulse and Transient Elastography are influenced by high aminotransferase levels. Transient Elastography was also influenced by moderately elevated aminotransferase levels.
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Affiliation(s)
- Simona Bota
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.
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Bota S, Herkner H, Sporea I, Salzl P, Sirli R, Neghina AM, Peck-Radosavljevic M. Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int 2013; 33:1138-1147. [PMID: 23859217 DOI: 10.1111/liv.12240] [Citation(s) in RCA: 327] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 05/27/2013] [Indexed: 12/11/2022]
Abstract
AIMS This meta-analysis aims to compare the diagnostic performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis using liver biopsy (LB) as 'gold-standard'. METHODS PubMed, Medline, Lilacs, Scopus, Ovid, EMBASE, Cochrane and Medscape databases were searched for all studies published until 31 May 2012 that evaluated the liver stiffness by means of ARFI, TE and LB. Information abstracted from each study according to a fixed protocol included study design and methodological characteristics, patient characteristics, interventions, outcomes and missing outcome data. RESULTS Thirteen studies (11 full-length articles and 2 abstracts) including 1163 patients with chronic hepatopathies were included in the analysis. Inability to obtain reliable measurements was more than thrice as high for TE as that of ARFI (6.6% vs. 2.1%, P < 0.001). For detection of significant fibrosis, (F ≥ 2) the summary sensitivity (Se) was 0.74 (95% CI: 0.66-0.80) and specificity (Sp) was 0.83 (95% CI: 0.75-0.89) for ARFI, while for TE the Se was 0.78 (95% CI: 0.72-0.83) and Sp was 0.84 (95% CI: 0.75-0.90). For the diagnosis of cirrhosis, the summary Se was 0.87 (95% CI: 0.79-0.92) and Sp was 0.87 (95% CI: 0.81-0.91) for ARFI elastography, and, respectively, 0.89 (95% CI: 0.80-0.94) and 0.87 (95% CI: 0.82-0.91) for TE. The diagnostic odds ratio of ARFI and TE did not differ significantly in the detection of significant fibrosis [mean difference in rDOR = 0.27 (95% CI: 0.69-0.14)] and cirrhosis [mean difference in rDOR = 0.12 (95% CI: 0.29-0.52)]. CONCLUSION Acoustic radiation force impulse elastography seems to be a good method for assessing liver fibrosis, and shows higher rate of reliable measurements and similar predictive value to TE for significant fibrosis and cirrhosis.
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Affiliation(s)
- Simona Bota
- Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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Kudo M, Shiina T, Moriyasu F, Iijima H, Tateishi R, Yada N, Fujimoto K, Morikawa H, Hirooka M, Sumino Y, Kumada T. JSUM ultrasound elastography practice guidelines: liver. J Med Ultrason (2001) 2013; 40:325-57. [PMID: 27277450 DOI: 10.1007/s10396-013-0460-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 04/26/2013] [Indexed: 12/16/2022]
Abstract
In diffuse liver disease, it is extremely important to make an accurate diagnosis of liver fibrosis prior to determining indications for therapy or predicting treatment outcome and malignant potential. Although liver biopsy has long been the gold standard in the diagnosis of liver fibrosis, it is still an invasive method. In addition, the sampling error is an intrinsic problem of liver biopsy. Non-invasive serological methods for the diagnosis of liver fibrosis can be affected by factors unrelated to the liver. Recently, after the introduction of FibroScan, it became possible to measure liver fibrosis directly and non-invasively by elastography, which has attracted attention as a non-invasive imaging diagnostic tool for liver fibrosis. In addition, real-time tissue elastography is currently being used to conduct clinical trials at many institutions. Moreover, virtual touch quantification enables the observation of liver stiffness at any location by simply observing B-mode images. Furthermore, the recently developed ShearWave elastography visualizes liver stiffness on a color map. Elastography is thought to be useful for all types of diffuse liver diseases. Because of its association with portal hypertension and liver carcinogenesis, elastography is expected to function as a novel prognostic tool for liver disease. Although various elastographic devices have been developed by multiple companies, each device has its own measurement principle, method, and outcome, creating confusion in clinical settings. Therefore, it is extremely important to understand the characteristics of each device in advance. The objective of this guideline, which describes the characteristics of each device based on the latest knowledge, is for all users to be able to make the correct diagnosis of hepatic fibrosis by ultrasound elastography.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Tsuyoshi Shiina
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hiroko Iijima
- Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihisa Yada
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kenji Fujimoto
- Department of Internal Medicine, Nagayama Hospital, Kumatori, Osaka, Japan
- Division of Clinical Research, ONH Minamiwakayama Medical Center, Tanabe, Wakayama, Japan
| | - Hiroyasu Morikawa
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yasukiyo Sumino
- Division of Gastroenterology and Hepatology, Toho University Ohmori Medical Center, Tokyo, Japan
| | - Takashi Kumada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
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Popescu A, Bota S, Sporea I, Sirli R, Danila M, Racean S, Suseanu D, Gradinaru O, Ivascu Siegfried C. The influence of food intake on liver stiffness values assessed by acoustic radiation force impulse elastography-preliminary results. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:579-584. [PMID: 23415282 DOI: 10.1016/j.ultrasmedbio.2012.11.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/31/2012] [Accepted: 11/12/2012] [Indexed: 06/01/2023]
Abstract
The present study assessed the influence of food intake on acoustic radiation force impulse elastography (ARFI) measurements. Seventy-three healthy volunteers were included: 57 subjects in the study group (on whom ARFI measurements were performed first in fasting condition, followed by measurements made 1h and 3h after food intake); and 16 subjects in the control group (on whom ARFI measurements were performed 3 times during a 3-h interval without eating). All subjects included in the study group received the same standard solid meal. In the study group, the mean liver stiffness (LS) values by ARFI increased significantly 1 h after food intake (1.51 ± 0.40 m/s vs. 1.27 ± 0.23, p = 0.003), but 3 h after the meal the differences were no longer significant (1.46 ± 0.51 vs. 1.27 ± 0.23, p = 0.06). In the control group, the mean LS values were similar in all 3 measurements. In conclusion, food intake significantly increased the LS values, thus ARFI measurements should be performed in fasting conditions.
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Affiliation(s)
- Alina Popescu
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timişoara, Romania.
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Jaffer OS, Lung PFC, Bosanac D, Shah A, Sidhu PS. Is ultrasound elastography of the liver ready to replace biopsy? A critical review of the current techniques. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2012. [DOI: 10.1258/ult.2011.011043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Accurate assessment of liver fibrosis in patients with chronic liver disease is necessary to determine prognosis, monitor disease progression and formulate treatment decisions. Currently, histological staging of liver biopsy is the most widely used reference standard for this purpose. Liver biopsy, however, has recognized risks, as well as sampling and observer error. These limitations have stimulated the search for new non-invasive approaches. Numerous methodologies, including serum markers, magnetic resonance elastography and ultrasound elastography, have evolved in the last decade to predict fibrosis in those with chronic liver disease. Ultrasound elastography methods assess liver fibrosis by determining liver stiffness and translate this into a quantifiable measurement for analysis. As these tests are non-invasive, without side-effect or discomfort, it is possible to conduct repeat examinations at much closer intervals than biopsy. The three most investigated ultrasound elastography methods are transient elastography, realtime elastography and acoustic radiation force impulse. Although significant strides have been made in the development of the technology, an unequivocal advocacy of elastography as a surrogate for biopsy is still not established. The aim of this review is to evaluate the advantages, limitations and clinical relevance of the three ultrasound-based modalities. Also, the review shall assess the current and possible future clinical application the modalities may serve both separate and in conjunction with liver biopsy.
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Affiliation(s)
- Ounali S Jaffer
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Phillip F C Lung
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Diana Bosanac
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Aarti Shah
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Paul S Sidhu
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
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Karlas T, Pfrepper C, Wiegand J, Wittekind C, Neuschulz M, Mössner J, Berg T, Tröltzsch M, Keim V. Acoustic radiation force impulse imaging (ARFI) for non-invasive detection of liver fibrosis: examination standards and evaluation of interlobe differences in healthy subjects and chronic liver disease. Scand J Gastroenterol 2011; 46:1458-67. [PMID: 21916815 DOI: 10.3109/00365521.2011.610004] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Acoustic radiation force impulse imaging (ARFI) is a non-invasive method for the quantification of liver stiffness. We aimed to develop standards for the measuring procedure and studied the impact of different measuring sites. MATERIALS AND METHODS ARFI was tested in a tissue phantom and in 50 healthy volunteers. In addition, 116 patients with chronic liver disease underwent ARFI. The results were compared with histological staging (non-viral liver disease) and transient elastography (hepatitis C). ARFI diagnostic performance was evaluated with receiver operating characteristic curves. RESULTS ARFI results were not normally distributed in >20% of cases. Deep inspiration significantly increased ARFI values by 13% (p < 0.05). The mean shear-wave velocity in healthy individuals was 1.28 ± 0.19 m/s in the left liver lobe and 1.15 ± 0.17 m/s in the right liver lobe (p < 0.001). Similarly, in 79/116 patients with chronic liver disease a significant difference of shear-wave velocity between both liver lobes was detected. The histological staging correlated with ARFI results of the biopsy site (r = 0.661, p < 0.001) in non-viral liver disease (n = 47). The mean shear-wave velocity in cases with F1 and F2 fibrosis was increased in the left compared with the right liver lobe (2.1 ± 0.73 m/s vs. 1.75 ± 0.89 m/s, p = 0.041). Similar results were obtained in patients with hepatitis C (n = 69). CONCLUSION Our study strengthens the necessity for definition of examination standards and demonstrates the usefulness of ARFI in non-viral liver disease. Interlobe variations of liver stiffness demand further investigation.
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Affiliation(s)
- Thomas Karlas
- Department of Internal Medicine, University Hospital Leipzig, Liebigstrasse 20, Leipzig, Germany
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