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Ono S, Nishino T, Takahashi K, Mimaki M. A Case of Shear Wave Velocity Reflecting the Disease Activity in Glomerulonephritis. J Med Ultrasound 2023; 31:235-237. [PMID: 38025002 PMCID: PMC10668900 DOI: 10.4103/jmu.jmu_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2023] Open
Abstract
Ultrasound elastography can measure tissue elasticity using the shear wave velocity (SWV). Evaluating disease activity with elastography instead of renal biopsy may be less invasive. However, to the best of our knowledge, although there are studies comparing different glomerular diseases using SWV, there are no reports that have measured glomerulonephritis longitudinally from the acute phase of the disease. This study aimed to assess whether SWV reflects disease activity in glomerulonephritis, and we continued to observe children with post-streptococcal acute glomerulonephritis (PSAGN) from the acute phase to over a year later. In this case, a 6-year-old boy diagnosed with PSAGN had impaired renal function, and was admitted and tested. He was placed in a prone resting position and measurements were taken from the back. SWV was measured ≥50 times at each examination, and the mean was calculated when the net amount of effective SWV was ≥50%. The tests were performed once in the acute phase and thrice during the recovery phase for 13 months. SWV was found to be significantly lower in the recovery period than during the disease onset, and continued to stay lower at each test during the recovery period (P < 0.02). In conclusion, this indicated that SWV fluctuated similarly to the disease activity of glomerulonephritis; therefore, we suggest using SWV measurement to estimate the disease activity in glomerulonephritis in children. Although more clinical cases are needed, SWV measurement is a noninvasive and reproducible imaging modality to estimate the disease activity in glomerulonephritis.
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Affiliation(s)
- Sayaka Ono
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomohiko Nishino
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
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Cho H, Lee YB, Ha Y, Chon YE, Kim MN, Lee JH, Park H, Rim KS, Hwang SG. Changes in liver stiffness values assessed using transient elastography in chronic hepatitis B patients treated with tenofovir disoproxil fumarate: a prospective observational study. BMC Gastroenterol 2023; 23:210. [PMID: 37322445 DOI: 10.1186/s12876-023-02846-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND/AIMS Regression of liver fibrosis during antiviral therapy in chronic hepatitis B (CHB) patients has been demonstrated, but data on the influence of long-term treatment with tenofovir disoproxil fumarate (TDF) on liver stiffness (LS) measured by transient elastography are scarce. We aimed to investigate the changes in LS values during the 144-week TDF therapy in treatment-naïve CHB patients. METHODS This prospective observational study was conducted from April 2015 to July 2020 at CHA Bundang Medical Center. Laboratory tests and LS measurements were performed at baseline and repeated at weeks 12, 24, 48, 96, and 144. A significant decline in LS was defined as ≥ 30% decrease in LS value at week 96 from baseline. RESULTS A total of 48 treatment-naïve CHB patients initiating TDF therapy were screened, and 36 patients were included in the final analysis (median age, 46 [interquartile range, 34.5-55.8] years; 19 men [52.8%]). During TDF therapy, the median LS values decreased from 13.8 kPa at baseline to 8.7 kPa, 6.5 kPa, and 6.4 kPa at weeks 48, 96, and 144, respectively (all P < 0.001). At week 96, virological and biochemical responses were achieved in 34 (94.4%) patients and 20 (76.9%) patients, respectively. Moreover, 21 of 36 (58.3%) patients showed a significant decline in LS value. A higher baseline LS value was a single independent predictor for the reduction in LS value at week 96 from baseline (P < 0.001). CONCLUSIONS During the 144-week TDF therapy, LS values declined significantly in treatment-naïve CHB patients.
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Affiliation(s)
- Heejin Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
| | - Yeonjung Ha
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Mi Na Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Ho Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hana Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyu Sung Rim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seong Gyu Hwang
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Hepatic steatosis leads to overestimation of liver stiffness measurement in both chronic hepatitis B and metabolic-associated fatty liver disease patients. Clin Res Hepatol Gastroenterol 2022; 46:101957. [PMID: 35609821 DOI: 10.1016/j.clinre.2022.101957] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/12/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The impact of hepatic steatosis on liver stiffness measurement (LSM) in both chronic hepatitis B(CHB) and metabolic-associated fatty liver disease (MAFLD) remains controversial. AIMS To determine whether LSM is affected by hepatic steatosis in CHB-MAFLD. METHODS Hepatic steatosis and liver fibrosis were assessed by histological and noninvasively methods. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic performance of LSM. RESULTS The prevalence of MAFLD in CHB patients (n = 436)was 47.5% (n = 207). For patients with low amounts of fibrosis (F0-1 and F0-2), the median LSM was 8.8 kPa and 9.2 kPa in patients with moderate- severe steatosis,which was significantly higher than that in patients with none-mild steatosis (P < 0.05) . The positive predictive value(PPV) was lower for LSM identifying significant fibrosis (F ≥ 2) as well as severe fibrosis (F ≥ 3) in group which controlled attenuation parameter(CAP) ≥ 268 dB/m than its counterpart(68.2% vs 84.6% and 24.3% vs 45.0%). The AUROC of LSM detected F ≥ 2 was 0.833 at a cutoff of 8.8 kPa and 0.873 at a cutoff of 7.0 kPa in patients with CAP ≥ 268 and CAP < 268, respectively. CONCLUSIONS The presence of moderate-severe steatosis, detected by histology or CAP, should be taken into account to avoid overestimation of LSM.
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Bao M, Zhu Q, Aji T, Wei S, Tuergan T, Ha X, Tulahong A, Hu X, Hu Y. Development of Models to Predict Postoperative Complications for Hepatitis B Virus-Related Hepatocellular Carcinoma. Front Oncol 2021; 11:717826. [PMID: 34676160 PMCID: PMC8523990 DOI: 10.3389/fonc.2021.717826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 01/27/2023] Open
Abstract
Background Surgical treatment remains the best option for patients with hepatocellular carcinoma (HCC) caused by chronic hepatitis B virus (HBV) infection. However, there is no optimal tool based on readily accessible clinical parameters to predict postoperative complications. Herein, our study aimed to develop models that permitted risk of severe complications to be assessed before and after liver resection based on conventional variables. Methods A total of 1,047 patients treated by hepatectomy for HCC with HBV infection at three different centers were recruited retrospectively between July 1, 2014, and July 1, 2018. All surgical complications were recorded and scored by the Comprehensive Complication Index (CCI). A CCI ≥26.2 was used as a threshold to define patients with severe complications. We built two models for the CCI, one using preoperative and one using preoperative and postoperative data. Besides, CCI and other potentially relevant factors were evaluated for their ability to predict early recurrence and metastasis. All the findings were internally validated in the Hangzhou cohort and then externally validated in the Lanzhou and Urumqi cohorts. Results Multivariable analysis identified National Nosocomial Infections Surveillance (NNIS) index, tumor number, gamma-glutamyltransferase (GGT), total cholesterol (TC), potassium, and thrombin time as the key preoperative parameters related to perioperative complications. The nomogram based on the preoperative model [preoperative CCI After Surgery for Liver tumor (CCIASL-pre)] showed good discriminatory performance internally and externally. A more accurate model [postoperative CCI After Surgery for Liver tumor (CCIASL-post)] was established, combined with the other four postoperative predictors including leukocyte count, basophil count, erythrocyte count, and total bilirubin level. No significant association was observed between CCI and long-term complications. Conclusion Based on the widely available clinical data, statistical models were established to predict the complications after hepatectomy in patients with HBV infection. All the findings were extensively validated and shown to be applicable nationwide. Such models could be used as guidelines for surveillance follow-up and the design of post-resection adjuvant therapy.
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Affiliation(s)
- Mingyang Bao
- State Key Laboratory of Genetic Engineering, Institute of Biostatistics, School of Life Sciences, Fudan University, Shanghai, China
| | - Qiuyu Zhu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Surgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tuerganaili Aji
- Department of Hepatobiliary and Hydatid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shuyao Wei
- Clinical Laboratory Diagnostics, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Hydatid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoqin Ha
- Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Alimu Tulahong
- Department of Hepatobiliary and Hydatid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoyi Hu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yueqing Hu
- State Key Laboratory of Genetic Engineering, Institute of Biostatistics, School of Life Sciences, Fudan University, Shanghai, China.,Shanghai Center for Mathematical Sciences, Fudan University, Shanghai, China
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Neves YCS, de Castro-Lima VAC, Solla DJF, Ogata VSDM, Pereira FL, Araujo JM, Nastri ACS, Ho YL, Chammas MC. Staging liver fibrosis after severe yellow fever with ultrasound elastography in Brazil: A six-month follow-up study. PLoS Negl Trop Dis 2021; 15:e0009594. [PMID: 34283826 PMCID: PMC8323872 DOI: 10.1371/journal.pntd.0009594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/30/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Yellow fever (YF) is a hemorrhagic disease caused by an arbovirus endemic in South America, with recent outbreaks in the last years. Severe cases exhibit fulminant hepatitis, but there are no studies regarding its late-term effects on liver parenchyma. Thus, the aim of this study was to determine the frequency and grade of liver fibrosis in patients who recovered from severe YF and to point out potential predictors of this outcome. METHODOLOGY/PRINCIPAL FINDINGS We followed-up 18 patients who survived severe YF during a recent outbreak (January-April 2018) in Brazil using ultrasound (US) with shear-wave elastography (SWE) at 6 months after symptoms onset. No patient had previous history of liver disease. Median liver stiffness (LS) was 5.3 (4.6-6.4) kPa. 2 (11.1%) patients were classified as Metavir F2, 1 (8.3%) as F3 and 1 (8.3%) as F4; these two last patients had features of cardiogenic liver congestion on Doppler analysis. Age and cardiac failure were associated with increased LS (p = 0.036 and p = 0.024, respectively). SAPS-3 at ICU admission showed a tendency of association with significant fibrosis (≥ F2; p = 0.053). 7 patients used sofosbuvir in a research protocol, of which none showed liver fibrosis (p = 0.119). CONCLUSIONS/SIGNIFICANCE We found a low frequency of liver fibrosis in severe YF survivors. US with SWE may have a role in the follow up of patients of age and / or with comorbidities after hospital discharge in severe YF, a rare but reemergent disease.
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Affiliation(s)
- Yuri Costa Sarno Neves
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | | | - Davi Jorge Fontoura Solla
- Department of Neurology, Division of Neurosurgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Vivian Simone de Medeiros Ogata
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Fernando Linhares Pereira
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Jordana Machado Araujo
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Ana Catharina Seixas Nastri
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Maria Cristina Chammas
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
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Dietrich CF, Shi L, Wei Q, Dong Y, Cui XW, Löwe A, Worni M, Ferraioli G. What does liver elastography measure? Technical aspects and methodology. Minerva Gastroenterol (Torino) 2021; 67:129-140. [PMID: 33267564 DOI: 10.23736/s2724-5985.20.02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Elastography can be thought as an extension of the ancient technique of palpation. After giving a short introduction to the history of elastography, the different technologies that are nowadays available and the physics behind them, the article focuses on the assessment of liver stiffness in patients with diffuse liver disease using shear wave elastography (SWE). Practical advices on how to perform the SWE techniques and on the factors that should be considered for a correct interpretation of the results are given. This paper aimed to provide a practical guide for beginners and advanced clinical users to better understand technical aspects, methodologies and terminology.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland -
| | - Long Shi
- Department of Ultrasound, Jingmen N. 2 People's Hospital, Jingmen, China
| | - Qi Wei
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Axel Löwe
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland
| | - Mathias Worni
- Department of Visceral Surgery, Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara University Hospital, Basel, Switzerland
- Swiss Institute for Translational and Entrepreneurial Medicine, Stiftung Lindenhof, Campus SLB, Bern, Switzerland
- Department of Surgery, Clinic Beau Site, Bern, Switzerland
| | - Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Abstract
The prognosis of chronic liver diseases, which represent a major public health problem, is mainly linked to the extent and progression of liver fibrosis and the subsequent risk of developing cirrhosis and related complications, mainly hepatocellular carcinoma. During the past decade many noninvasive methods and in particular electrographic techniques, have been developed to reduce the need for liver biopsy in staging fibrosis and to overcome whenever possible its limitations, mainly: invasiveness, costs, low reproducibility and poor acceptance by patients. The aim of this review was to provide a comprehensive review of the role of elastography techniques in viral chronic liver diseases and autoimmune hepatitis, with the focus on the possible advantages and limitations of these techniques and on their diagnostic accuracy in predicting the stage of liver fibrosis.
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Affiliation(s)
- Nicoletta Nandi
- Unit of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mirella Fraquelli
- Unit of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy -
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Fraquelli M, Fanetti I, Costantino A. Elastography After Treatment and During Follow-Up. ELASTOGRAPHY OF THE LIVER AND BEYOND 2021:119-141. [DOI: 10.1007/978-3-030-74132-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Suzuki H, Kawashima H, Ohno E, Ishikawa T, Hashimoto S, Nakamura M, Miyahara R, Ishigami M, Hirooka Y, Fujishiro M. What is the role of measuring shear wave dispersion using shear wave elastography in pancreatic parenchyma? J Med Ultrason (2001) 2020; 47:575-581. [PMID: 32602019 DOI: 10.1007/s10396-020-01033-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/23/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Shear wave elastography (SWE) using transabdominal ultrasonography (US) is widely used for diagnosis of tissue stiffness. Ultrasound shear wave dispersion (SWD) enables evaluation of tissue viscosity using SWE. The objective of this study was to investigate the reliability and clinical significance of SWD in pancreatic screening. METHODS SWE and SWD were measured in 76 patients examined by US in pancreatic screenings performed between November 2017 and November 2018. The median pancreatic elastic modulus (PEM) and dispersion slope were obtained from at least five measurements. The reproducibility of these values and their correlations with patient characteristics, pancreatic echogenicity, and the pancreas-to-spleen attenuation ratio (P/S) on plain CT, which is associated with fatty change in pancreatic parenchyma, were investigated retrospectively. RESULTS The median PEM and dispersion slope were 7.4 kPa and 15.7 (m/sec)/kHz, respectively, and both values had high intraclass correlation coefficients, showing high reproducibility (ρ = 0.869 and ρ = 0.867, respectively). The interquartile range/median value of PEM and dispersion slope were 0.36 and 0.28, respectively. PEM had a positive correlation with age (rs = 0.348, p = 0.002), and dispersion slope was positively correlated with age (rs = 0.278, p = 0.016) and BMI (rs = 0.397, p < 0.001). The hyperechoic pancreas had significantly higher PEM (6.6 vs. 7.8 kPa, p = 0.037) and dispersion slope (13.2 vs. 16.3 (m/sec)/kHz, p < 0.001). On plain CT performed in 50 patients, the P/S was not correlated with PEM (rs = - 0.180, p = 0.221), but was inversely correlated with dispersion slope (rs = - 0.338, p = 0.019). CONCLUSION Measurement of SWD in pancreatic screening was highly reproducible and may permit objective evaluation of fatty change of the pancreas.
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Affiliation(s)
- Hirotaka Suzuki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Senju Hashimoto
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshiki Hirooka
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-ku, Nagoya, 466-8550, Japan
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Effenberger M, Grander C, Fritsche G, Bellmann-Weiler R, Hartig F, Wildner S, Seiwald S, Adolph TE, Zoller H, Weiss G, Tilg H. Liver stiffness by transient elastography accompanies illness severity in COVID-19. BMJ Open Gastroenterol 2020; 7:e000445. [PMID: 32665398 PMCID: PMC10577726 DOI: 10.1136/bmjgast-2020-000445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Severe liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with COVID-19. DESIGN We investigated 32 patients with COVID-19 admitted to the University Hospital of Innsbruck in a prospective cross-sectional study. We performed laboratory testing, liver and spleen sonography and elastography to measure organ stiffness. RESULTS 12 patients (38%) showed elevated aminotransferases and gamma-glutamyltransferase levels. LS was positively correlated with elevated aminotransferase levels in patients with COVID-19 compared with those without elevated enzymes. Even mild liver damage raised LS significantly in COVID-19 as it was in patients with gastrointestinal symptoms. Furthermore, higher LS measurements were significantly associated with illness severity like pneumonia, need for mechanical ventilation, and even death. CONCLUSION Transient elastography is a useful and non-invasive tool to assess onset and severity of acute liver injury in patients with COVID-19 patients. Increased LS seems to be predictive for a more severe and complicated course of disease.
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Affiliation(s)
- Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Grander
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Fritsche
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Frank Hartig
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophie Wildner
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefanie Seiwald
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Timon Erik Adolph
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinz Zoller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Gunter Weiss
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
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Han XZ, Zhang SF, Yi JY, Wang B, Sun HQ. Effect of FibroScan test in antiviral therapy for HBV-infected patients with ALT <2 upper limit of normal. Open Life Sci 2020; 15:418-422. [PMID: 33817230 PMCID: PMC7874573 DOI: 10.1515/biol-2020-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/17/2019] [Accepted: 07/03/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this study is to detect the liver stiffness of hepatitis B virus (HBV)-infected patients with an alanine aminotransferase (ALT) level of <2 upper limit of normal (2ULN) by FibroScan and compare histological changes to assess the progression of liver lesions and its test results. METHODS There were 36 patients who had a liver FibroScan degree of >7.3 KD (F1), and a liver biopsy was conducted. Along with serology of liver fibrosis, indexes and hierarchical processing were used for evaluation. The correlation between these factors was analyzed. RESULTS The histopathological results of the liver were closely correlated with liver hardness. In the pathological diagnosis of chronic hepatitis, G represents the grade of inflammation and S represents the stage of hepatic fibrosis. Pathological examination results of H&E staining of liver tissue sections revealed that the area under the work characteristic curve of the subjects in G2S1, G2S2, G3S2, and G3S3 stages was 0.923, 0.916, 0.955, and 0.971, respectively, with diagnostic cut-off values of 9.03, 9.85, 15.14, and 30.67, respectively. Furthermore, hydroxyapatite, type III procollagen, laminin, and type IV collagen of serum fibrosis indexes are associated with liver stiffness values (P < 0.05). CONCLUSION FibroScan can be used as an alternative to liver biopsy. It is meaningful in determining whether HBV infected patients with an ALT level of <2 ULN should receive antiviral therapy.
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Affiliation(s)
- Xian-Zhi Han
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Shu-Feng Zhang
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jia-Yin Yi
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Bin Wang
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hui-Qing Sun
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Shen F, Mi YQ, Xu L, Liu YG, Wang XY, Pan Q, Zhang RN, Hu XQ, Xu LM, Fan JG. Moderate to severe hepatic steatosis leads to overestimation of liver stiffness measurement in chronic hepatitis B patients without significant fibrosis. Aliment Pharmacol Ther 2019; 50:93-102. [PMID: 31094016 DOI: 10.1111/apt.15298] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/29/2018] [Accepted: 04/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver stiffness measurement (LSM) by transient elastography is a noninvasive method for the diagnosis of hepatic fibrosis. The impact of hepatic steatosis on LSM remains to be explored. AIM To determine whether LSM is affected by hepatic steatosis in patients with chronic hepatitis B (CHB). METHODS Consecutive patients with biopsy-proven CHB were prospectively enrolled. Hepatic steatosis was classified by pathology as none (S0, <5%), mild (S1, 5%-33%), and moderate-severe (S2-3, >33%), and quantitatively by controlled attenuation parameter (CAP) as CAP S0 (≤247 dB/m), CAP S1 (248-267 dB/m) and CAP S2-3 (≥268 dB/m). Liver fibrosis was assessed by METAVIR classification and noninvasively by LSM. RESULTS The prevalence of non-alcoholic fatty liver disease (n = 223) in CHB patients (n = 593) was 37.6%. Forty-eight belonged to S2-3 and 127 belonged to CAP S2-3. In patients without significant fibrosis (F0-1), the median LSM (kPa) was 7.4 in S2-3 and 7.1 in CAP S2-3, which was significantly higher than that in S0/S1 (P = 0.005) and CAP S0/S1 (P = 0.003). No significant difference was found in significant fibrosis (F2-4). For LSM identifying significant fibrosis (F2-4), the negative predictive value was higher in CHB patients with CAP ≥ 268 compared to those with CAP < 268 (0.81 vs 0.73); the positive predictive value was lower in CAP ≥ 268 than its counterpart (0.65 vs 0.76). CONCLUSIONS Moderate-severe steatosis increased the LSM value in CHB patients without significant fibrosis. A CAP ≥ 268 did not affect LSM for ruling out, but it slightly affected LSM for ruling in significant fibrosis. TRIAL REGISTRATION ChiCTR-DDT-13003983.
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Affiliation(s)
- Feng Shen
- Department of Gastroenterology, Center for Fatty Liver, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu-Qiang Mi
- Research Institute of Liver Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Liang Xu
- Research Institute of Liver Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Yong-Gang Liu
- Research Institute of Liver Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Xiao-Ying Wang
- Department of Pathology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qin Pan
- Department of Gastroenterology, Center for Fatty Liver, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Rui-Nan Zhang
- Department of Gastroenterology, Center for Fatty Liver, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xi-Qi Hu
- Department of Pathology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Lei-Ming Xu
- Department of Gastroenterology, Center for Fatty Liver, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Gao Fan
- Department of Gastroenterology, Center for Fatty Liver, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China
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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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Rinaldi L, Ascione A, Messina V, Rosato V, Valente G, Sangiovanni V, Zampino R, Marrone A, Fontanella L, de Rosa N, Orabona P, Buonomo C, Chirianni A, Adinolfi LE, Piai G. Influence of antiviral therapy on the liver stiffness in chronic HBV hepatitis. Infection 2018; 46:231-238. [PMID: 29335905 DOI: 10.1007/s15010-017-1113-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of antiviral therapy on liver stiffness measurement (LSM). METHODS Two hundred HBV patients were enrolled from four hospital centers in southern Italy; median age was 50.7 (25-75) males were 68%; 171 patients underwent to liver biopsy and 200 patients had LSM at baseline and 189 at the end of follow-up. One hundred and forty-nine patients were treated with nucleos(t)ide analogs, while 51 patients were untreated. The cutoffs of the LSM, related to the fibrosis stages, were as follows: non-advanced fibrosis ≤ 8.1 kPa and advanced fibrosis ≥ 8.2 Kpa. RESULTS At baseline, the median value of LSM was 14.1 kPa for advanced fibrosis/cirrhosis and 6.9 kPa for non-advanced fibrosis. LSM was performed at 24 months from the start of therapy. The treated patients (68% received Entecavir and 32% Tenofovir) showed a decrease in liver stiffness measurement of 1.5 kPa (p < 0.001) in non-advanced fibrosis and of 6 kPa (p < 0.001) in advanced fibrosis/cirrhosis. In the patients not undergoing antiviral treatment, no statistically significant change of the LSM was observed (p = 0.26). A logistic binary regression model showed that the only independent factor associated with a significant change in the LSM was the liver stiffness value at baseline (odd ratio 2.855; 95% CI 1.456-5.788; (p = 0.007). CONCLUSION Long-term antiviral therapy induced a significant reduction of liver stiffness measurement and this result may be related to the reduction of liver fibrosis.
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Affiliation(s)
- Luca Rinaldi
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy.
| | - Antonio Ascione
- Department of Internal Medicine, Centre for Liver Diseases, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Vincenzo Messina
- Infectious Diseases C.O. Unit, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Valerio Rosato
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Giovanna Valente
- Department of Medical Sciences, AORN S.Anna e S. Sebastiano, Caserta, Italy
| | - Vincenzo Sangiovanni
- Department of Infectious Emergencies and Infectious Diseases, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Rosa Zampino
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Aldo Marrone
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Luca Fontanella
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Nicolina de Rosa
- Department of Diagnostic Service, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Pasquale Orabona
- Department of Service, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Carmela Buonomo
- Department of Service, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Antonio Chirianni
- Department of Infectious Emergencies and Infectious Diseases, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Guido Piai
- Department of Medical Sciences, AORN S.Anna e S. Sebastiano, Caserta, Italy
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Tapper EB, Afdhal NH. Noninvasive Assessment of Disease Progression. ZAKIM AND BOYER'S HEPATOLOGY 2018:117-126.e3. [DOI: 10.1016/b978-0-323-37591-7.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Lee CH, Wan YL, Hsu TH, Huang SF, Yu MC, Lee WC, Tsui PH, Chen YC, Lin CY, Tai DI. Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy. APPLIED SCIENCES 2017; 7:1164. [DOI: 10.3390/app7111164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammation has significant impacts on liver fibrosis measurement by ultrasound elastography. The interpretation requires further optimization in patients with or without anti-viral therapy. We prospectively enrolled a consecutive series of patients with chronic hepatitis B who received liver histology analysis and acoustic radiation force impulse (ARFI). 146 patients who underwent liver biopsy (50.9%) or tumor resection (49.1%) were enrolled. 34 patients (23.3%) had been receiving anti-hepatitis B therapy of various duration. The areas under the receiver-operating characteristic (AUROC) for the diagnosis of Metavir F4 by mean ARFI was 0.820 in the non-treatment group and 0.796 in the treatment group. The ARFI tended to be not lower (100%) than the corresponding Metavir grading in patients with treatment within 12 months, equal (75%) from 13 to 31 months, and lower (71.4%) after 32 months. We conclude that ARFI is a reliable tool for measurement of liver fibrosis in chronic hepatitis B patients with ALT (alanine aminotransferase) <5x the upper limit of normal. For those patients under anti-HBV therapy, the optimal timing for ARFI analysis will be over 1–2.5 years of nucleos(t)ide analogue therapy. The ARFI measurement after 2.5 years tends to be lower than the corresponding histology grading.
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Affiliation(s)
- Cheng-Han Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Yung-Liang Wan
- Department of Medical imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medical imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Taoyuan 333, Taiwan
| | - Tse-Hwa Hsu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Shiu-Feng Huang
- Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei 115, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Wei-Chen Lee
- Department of Liver and Transplantation Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Taoyuan 333, Taiwan
| | - Yi-Cheng Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan
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Liu X, Li N, Xu T, Sun F, Li R, Gao Q, Chen L, Wen C. Effect of renal perfusion and structural heterogeneity on shear wave elastography of the kidney: an in vivo and ex vivo study. BMC Nephrol 2017; 18:265. [PMID: 28789641 PMCID: PMC5547675 DOI: 10.1186/s12882-017-0679-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background To evaluate the effect of perfusion status on elasticity measurements of different compartments in the kidney using shear wave elastography (SWE) both in vivo and ex vivo. Methods Thirty-two rabbit kidneys were used to observe the elasticity variation caused by renal artery stenosis and vein ligation in vivo, and six beagle kidneys were studied ex vivo to explore the effect of renal perfusion on elasticity. Supersonic SWE was applied to quantify the elasticity values of different renal compartments (cortex, medulla and sinus). Additionally, histopathological examination was performed to explore the possible mechanisms. Results The elasticity of the cortex was higher than that of the medulla, and the elasticity of the sinus was lowest among the compartments in native kidneys. The Young’s modulus (YM) of the cortex, medulla and sinus increased gradually as the duration of renal vein ligation increased, from 16.34 ± 1.01 kPa to 55.06 ± 5.61 kPa, 13.71 ± 1.16 kPa to 39.63 ± 2.91 kPa, and 12.61 ± 0.84 kPa to 29.30 ± 2.04 kPa, respectively. In contrast, the YM of the three compartments respectively decreased with progressive artery stenosis, from 16.34 ± 1.83 kPa to 11.21 ± 1.79 kPa, 13.31 ± 1.67 kPa to 8.07 ± 1.37 kPa, and 12.78 ± 2.66 kPa to 6.72 ± 0.95 kPa. Artery perfusion was the main factor influencing elasticity in ex vivo. The cortical elasticity was more prone to change with renal perfusion both in vivo and ex vivo. Histopathological examination showed progressive changes in the structure and content of the three compartments, consistent with the elasticity variation. Conclusions Both the complex structure/anisotropy and the perfusion of the kidney obviously influence the evaluation of renal elasticity. The measurement of SWE should be performed at a specific location along a certain angle or direction, and renal perfusion status should also be taken into account to ensure reproducible detection.
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Affiliation(s)
- Xiaona Liu
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China.,Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Na Li
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China.,Department of Auxiliary Diagnosis, The 463rd Hospital of Shenyang Military Region, Shenyang, Liaoning, 110042, People's Republic of China
| | - Tao Xu
- Department of Ultrasound, Chinese PLA Navy General Hospital, Beijing, 100048, People's Republic of China
| | - Fang Sun
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Rui Li
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Qimin Gao
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Lianxiang Chen
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Chaoyang Wen
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China. .,Department of Ultrasound, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, 572013, People's Republic of China.
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ARFI elastography: Changes after direct-acting antiviral treatment in transplanted livers with relapse of hepatitis C virus infection. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Alfageme Zubillaga M, Fontanilla Echeveste T, Pérez González I, Royuela Vicente A, Duca A, Ruiz Peralbo R, González Hernando C. Elastografía tipo ARFI: modificación tras tratamiento antiviral en el trasplante hepático con recidiva por VHC. RADIOLOGIA 2017; 59:139-146. [PMID: 28214021 DOI: 10.1016/j.rx.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/29/2016] [Accepted: 12/30/2016] [Indexed: 02/07/2023]
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Wu T, Wang P, Zhang T, Zheng J, Li S, Zeng J, Kudo M, Zheng R. Comparison of Two-Dimensional Shear Wave Elastography and Real-Time Tissue Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Dig Dis 2016; 34:640-649. [PMID: 27750231 DOI: 10.1159/000448825] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Noninvasive assessment of liver fibrosis has important clinical significance. Different techniques including two-dimensional shear-wave elastography (2D SWE) and real-time tissue elastography (RTE) are reported to be useful for the noninvasive diagnosis of hepatic fibrosis. All these techniques are affected by many factors. How to choose a reasonable method needs further studies. PURPOSE This study was conducted to comparatively assess the diagnostic performance of 2D SWE and RTE in patients with Chronic Hepatitis B (CHB) and influence of inflammation on the stiffness values obtained by both techniques, so as to objectively assess the reasonable choice between these 2 elastography techniques for noninvasive assessment of hepatic fibrosis in clinical practice. MATERIALS AND METHODS Four-hundred and thirty-seven patients with CHB meeting the inclusion criteria were enrolled in the study. All patients underwent liver stiffness measurements by using 2D SWE and RTE on the same day. Histologic fibrosis was staged and inflammation activity was graded based on the METAVIR scoring system on liver biopsy specimens. RESULTS The liver stiffness values by using 2D SWE and RTE both increased in parallel with the degree of liver fibrosis and the grade of inflammation. However, the diagnostic efficacy of significant fibrosis and cirrhosis using 2D SWE was significantly higher than that of RTE. The 2D SWE measurement values were statistically different in different alanine aminotransferase (ALT) levels and METAVIR activity grades; however, no statistically significant differences were observed by using RTE. The diagnostic efficacy of 2D SWE significantly varied with elevated ALT levels compared with RTE. CONCLUSION 2D SWE was more accurate than RTE in the assessment of significant fibrosis and cirrhosis in patients with CHB. Compared with RTE, the measurement values and diagnostic performance obtained by 2D SWE were prone to be more easily affected by the inflammation fluctuations.
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Giunta M, Conte D, Fraquelli M. Role of spleen elastography in patients with chronic liver diseases. World J Gastroenterol 2016; 22:7857-7867. [PMID: 27672283 PMCID: PMC5028802 DOI: 10.3748/wjg.v22.i35.7857] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 02/06/2023] Open
Abstract
The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations.
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Shen F, Zheng R, Shi J, Mi Y, Chen G, Hu X, Liu Y, Wang X, Pan Q, Chen G, Chen J, Xu L, Zhang R, Xu L, Fan J. Impact of skin capsular distance on the performance of controlled attenuation parameter in patients with chronic liver disease. Liver Int 2015; 35:2392-2400. [PMID: 25689614 PMCID: PMC5023997 DOI: 10.1111/liv.12809] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/11/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Controlled attenuation parameter (CAP) is a non-invasive method for evaluating hepatic steatosis. However, larger skin capsular distance (SCD) can affect the accuracy. The aim of this study was to investigate the impact of SCD on the diagnostic performance of CAP and liver stiffness measurement (LSM). METHODS Of 101 patients with non-alcoholic fatty liver disease (NAFLD) and 280 patients with chronic hepatitis B (CHB) who underwent liver biopsy were prospectively recruited. CAP, LSM and SCD were performed using FibroScan with M probe. The areas under receiver operating characteristics curves (AUROCs) were calculated to determine the diagnostic efficacy. The optimal thresholds were defined by the maximum Youden index. RESULTS SCD (B 30.34, P < 0.001) and hepatic steatosis (B 23.04, P < 0.001) were independently associated with CAP by multivariate analysis. The AUROCs were slightly higher for SCD <25 mm compared to those for SCD ≥25 mm for steatosis ≥5% (0.88 vs. 0.81), >33% (0.90 vs. 0.85) and >66% (0.84 vs. 0.72). For SCD <25 mm, the optimal CAP cut-offs for differentiating steatosis ≥5%, >33% and >66% were 255.0 dB/m, 283.5 dB/m and 293.5 dB/m. However, cut-offs were elevated by approximately 60-70 dB/m for SCD ≥25 mm. When stratified by fibrosis grade, LSM was significantly affected by SCD ≥25 mm for advanced fibrosis (≥F3) in NAFLD, but not in CHB. CONCLUSION CAP is a promising tool for detecting and quantifying hepatic steatosis. SCD ≥25 mm may cause overestimation of steatosis. Similarly, SCD ≥25 mm affects the detection of advanced fibrosis by LSM in NAFLD patients.
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Affiliation(s)
- Feng Shen
- Department of GastroenterologyXinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Rui‐Dan Zheng
- Research and Therapy Centre for Liver DiseaseZhengxing HospitalZhangzhouChina
| | - Jun‐Ping Shi
- Department of Liver DiseasesThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouChina
| | - Yu‐Qiang Mi
- Research Institute of Liver DiseasesTianjin Second People's HospitalTianjinChina
| | - Guo‐Feng Chen
- Centre for Liver Fibrosis Treatment Unit302 Military HospitalBeijingChina
| | - Xiqi Hu
- Department of PathologyShanghai Medical College of Fudan UniversityShanghaiChina
| | - Yong‐Gang Liu
- Research Institute of Liver DiseasesTianjin Second People's HospitalTianjinChina
| | - Xiao‐Ying Wang
- Department of PathologyXinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Qin Pan
- Department of GastroenterologyXinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Guang‐Yu Chen
- Department of GastroenterologyXinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Jian‐Neng Chen
- Research and Therapy Centre for Liver DiseaseZhengxing HospitalZhangzhouChina
| | - Liang Xu
- Research Institute of Liver DiseasesTianjin Second People's HospitalTianjinChina
| | - Rui‐Nan Zhang
- Department of GastroenterologyXinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Lei‐Ming Xu
- Department of GastroenterologyXinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Jian‐Gao Fan
- Department of GastroenterologyXinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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Moon SK, Kim SY, Cho JY, Kim SH. Quantification of kidney fibrosis using ultrasonic shear wave elastography: experimental study with a rabbit model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:869-77. [PMID: 25911705 DOI: 10.7863/ultra.34.5.869] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the feasibility of ultrasonic shear wave elastography for quantification of renal fibrosis in an experimental rabbit model. METHODS Thirty-eight kidneys of 19 rabbits were studied and categorized into 3 groups: group I, ureter obstruction (n = 9); group II, renal vein occlusion (n = 10); and group III, normal control (n = 19). Before surgery, we measured stiffness at the renal cortex using shear wave elastography and evaluated the sonographic findings, including size, echogenicity, and resistive index. We repeated the same sonographic examinations weekly until the fourth week. The degree of histologically quantified fibrosis and the measured stiffness values were statistically compared. RESULTS There was no significant difference in the mean stiffness values for the renal cortex in the 3 groups before surgery (8.95 kPa in group I, 9.06 kPa in group II, and 9.74 kPa in group III; P > .05). However, the mean stiffness in each group on the last sonographic examination was significantly different (10.91 kPa in group I, 13.92 kPa in group II, and 9.77 kPa in group III; P = .003). Pathologically, the degree of fibrosis was also significantly different (3.62% in group I, 11.70% in group II, and 0.70% in group III; P< .001). The fibrosis degree and stiffness were positively correlated (ρ = 0.568; P = 0.01). CONCLUSIONS Tissue stiffness measured by ultrasonic shear wave elastography was positively correlated with histopathologic renal fibrosis. Ultrasonic shear wave elastography may be used as a noninvasive tool for predicting renal fibrosis.
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Affiliation(s)
- Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.K.M.); and Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.Y.K., J.Y.C., S.H.K.)
| | - Sang Yoon Kim
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.K.M.); and Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.Y.K., J.Y.C., S.H.K.)
| | - Jeong Yeon Cho
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.K.M.); and Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.Y.K., J.Y.C., S.H.K.)
| | - Seung Hyup Kim
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.K.M.); and Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.Y.K., J.Y.C., S.H.K.)
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Abstract
Newer noninvasive tests have begun to replace liver biopsy for staging purposes. The clinician must evaluate these tools and apply them to individual patients. None of these modalities give the exact same staging of fibrosis as a liver biopsy, but they are excellent tools for risk stratification. Still, it should be recognized that there are disease-specific issues with different utilizations and cutoffs for different clinical diseases. This article provides a framework for incorporating the use of serum biomarkers and elastography-based approaches to stage fibrosis into clinical practice. This review also covers recent developments in this rapidly advancing area.
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Affiliation(s)
- Alan Bonder
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elliot B Tapper
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nezam H Afdhal
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Tapper EB, Castera L, Afdhal NH. FibroScan (vibration-controlled transient elastography): where does it stand in the United States practice. Clin Gastroenterol Hepatol 2015; 13:27-36. [PMID: 24909907 DOI: 10.1016/j.cgh.2014.04.039] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 02/07/2023]
Abstract
With widespread screening and increasingly effective treatments for patients with viral hepatitis as well as the increasing prevalence of nonalcoholic fatty liver disease, the population presenting to the care of gastroenterologists and hepatologists is certain to increase. Assessment of advanced liver disease is traditionally invasive and expensive. Vibration-controlled transient elastography, commonly delivered by the FibroScan device, is an option recently approved by the Food and Drug Administration for the noninvasive assessment of liver disease at the point of care. Herein, we review the promise and pitfalls of vibration-controlled transient elastography with the aim of providing clinicians with a framework to interpret its results and apply this technology to the changing needs of our patients.
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Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Laurent Castera
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U773, University of Paris-VII, Clichy, France
| | - Nezam H Afdhal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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26
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Fraquelli M, Giunta M, Pozzi R, Rigamonti C, Della Valle S, Massironi S, Conti CB, Aghemo A, Ronchi G, Iurlo A, Primignani M, Conte D, Colombo M. Feasibility and reproducibility of spleen transient elastography and its role in combination with liver transient elastography for predicting the severity of chronic viral hepatitis. J Viral Hepat 2014; 21:90-98. [PMID: 24383922 DOI: 10.1111/jvh.12119] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 04/06/2013] [Indexed: 02/05/2023]
Abstract
Liver transient elastography (L-TE) is a reliable, noninvasive predictor of disease severity in chronic liver disease of viral aetiology (CLD). Owing to the relationships among severity of CLD, portal hypertension and spleen involvement, the assessment of splenic stiffness (S-TE) may have an added value in staging CLD. Of 132 CLD patients of viral aetiology, 48 with myeloproliferative disorders (MD) and 64 healthy volunteers (HV), were concurrently investigated by both L-TE and S-TE. Liver disease severity was staged by liver biopsy (LB; Metavir) taken concurrently with TE examination and upper gastrointestinal tract endoscopy for gastro-oesophageal varices. The S-TE inter-observer agreement was analysed by an intra-class correlation coefficient (ICC); L-TE and S-TE accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis assessed the independent effect of L-TE and S-TE as predictors of hepatic fibrosis stage. S-TE failed in 22 CLD (16.6%), 12 (25%) MD and 12 (18%) HV. In the three groups, the ICC was 0.89 (0.84-0.92), 0.90 (0.85-0.94) and 0.86(0.80-0.91), respectively. In the CLD group, L-TE and S-TE independently predicted significant fibrosis (OR 5.2 and 4.6) and cirrhosis (OR 7.8 and 9.1), but at variance from L-TE, S-TE was independent from liver necroinflammation and steatosis. The NPV of S-TE for gastro-oesophageal varices was 100% using a 48 kPa cut-off. In CLD, spleen stiffness alone or in combination with hepatic stiffness can be reliably and reproducibly assessed by TE with the added value of improving the noninvasive diagnosis of severe liver disease and excluding the presence of oesophageal varices.
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Affiliation(s)
- M Fraquelli
- Second Division of Gastro-enterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano - Università degli Studi di Milano, Milano, Italy
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27
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Sporea I, Bota S, Jurchis A, Sirli R, Grădinaru-Tascău O, Popescu A, Ratiu I, Szilaski M. Acoustic radiation force impulse and supersonic shear imaging versus transient elastography for liver fibrosis assessment. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1933-1941. [PMID: 23932281 DOI: 10.1016/j.ultrasmedbio.2013.05.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 06/02/2023]
Abstract
Our study compared three elastographic methods--transient elastography (TE), acoustic radiation force impulse (ARFI) imaging and supersonic shear imaging (SSI)--with respect to the feasibility of their use in liver fibrosis evaluation. We also compared the performance of ARFI imaging and SSI, with TE as the reference method. The study included 332 patients, with or without hepatopathies, in which liver stiffness was evaluated using TE, ARFI and SSI. Reliable measurements were defined as a median value of 10 (TE, ARFI imaging) or 5 (SSI) liver stiffness measurements with a success rate ≥60% and an interquartile range interval <30%. A significantly higher percentage of reliable measurements were obtained using ARFI than by using TE and SSI: 92.1% versus 72.2% (p < 0.0001) and 92.1% versus 71.3% (p < 0.0001). Higher body mass index and older age were significantly associated with inability to obtain reliable measurements of liver stiffness using TE and SSI. In 55.4% of patients, reliable liver stiffness measurements were obtained using all three elastographic methods, and ARFI imaging and TE were similarly accurate in diagnosing significant fibrosis and cirrhosis, with TE as the reference method.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
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28
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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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29
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D'Ambrosio R, Aghemo A, Fraquelli M, Rumi MG, Donato MF, Paradis V, Bedossa P, Colombo M. The diagnostic accuracy of Fibroscan for cirrhosis is influenced by liver morphometry in HCV patients with a sustained virological response. J Hepatol 2013; 59:251-256. [PMID: 23528378 DOI: 10.1016/j.jhep.2013.03.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/05/2013] [Accepted: 03/08/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Transient elastography (TE) is a validated non-invasive tool to evaluate hepatic fibrosis in patients with hepatitis C virus (HCV) infection. Whether TE may sense changes of liver fibrosis following therapeutic HCV eradication has never been evaluated. METHODS 37 HCV cirrhotics with paired pre- and post-sustained virological response (SVR) liver biopsies (LB) underwent TE at the time of post-SVR LB. Liver fibrosis was staged with the METAVIR scoring system and the area of fibrosis (%) was assessed morphometrically. RESULTS Thirty-three patients had valid TE measurements after 61 (48-104) months from an SVR, and 20 (61%) of them had cirrhosis regression. On post-SVR LB, the median area of fibrosis was 2.3%, being significantly reduced from baseline (p<0.0001). Median TE value was 9.8 kPa being lower in regressed vs. not regressed patients (9.1 kPa vs. 12.9 kPa, p=0.01). TE was <12 kPa in 5 (38%) F4 patients and in 19 (95%) ≤F3 patients (p=0.0007). The diagnostic accuracy of TE for diagnosing F4 after treatment was 61% sensitivity, 95% specificity, 12.3 LR+, 0.4 LR-, and AUROC 0.77. A significant correlation was found between TE and both fibrosis stage (r=0.56; p=0.001) and morphometry (r=0.56, p=0.001) as well as between fibrosis stage and area of fibrosis (r=0.72, p=0001). CONCLUSIONS Following therapeutic eradication of HCV, the predictive power of the viremic cut-off of 12 kPa was low as a consequence of liver remodelling and fibrosis reabsorption. LB still remains the only reliable approach to stage liver fibrosis following an SVR.
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Affiliation(s)
- Roberta D'Ambrosio
- A.M. and A. Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
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30
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Kim BK, Fung J, Yuen MF, Kim SU. Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives. World J Gastroenterol 2013; 19:1890-1900. [PMID: 23569334 PMCID: PMC3613104 DOI: 10.3748/wjg.v19.i12.1890] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 08/29/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the "gold standard" for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE), as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.
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de Souza DAT, Parente DB, de Araújo ALE, Mortelé KJ. Modern imaging evaluation of the liver: emerging MR imaging techniques and indications. Magn Reson Imaging Clin N Am 2013; 21:337-63. [PMID: 23642557 DOI: 10.1016/j.mric.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Modern MR imaging evaluation of the liver allows for a comprehensive morphologic and functional assessment of the liver parenchyma, hepatic vessels, and biliary tree, thus aiding in the diagnosis of both focal and diffuse liver diseases.
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32
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Sommerer C, Scharf M, Seitz C, Millonig G, Seitz HK, Zeier M, Mueller S. Assessment of renal allograft fibrosis by transient elastography. Transpl Int 2013; 26:545-51. [PMID: 23383606 DOI: 10.1111/tri.12073] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/13/2012] [Accepted: 01/07/2013] [Indexed: 01/06/2023]
Affiliation(s)
- Claudia Sommerer
- Department of Nephrology; University Hospital Heidelberg; Heidelberg; Germany
| | - Michael Scharf
- Department of Nephrology; University Hospital Heidelberg; Heidelberg; Germany
| | - Christoph Seitz
- Department of Nephrology; University Hospital Heidelberg; Heidelberg; Germany
| | - Gunda Millonig
- Department of Medicine; Salem Medical Center and Alcohol Research Center; University of Heidelberg; Heidelberg; Germany
| | - Helmut K. Seitz
- Department of Medicine; Salem Medical Center and Alcohol Research Center; University of Heidelberg; Heidelberg; Germany
| | - Martin Zeier
- Department of Nephrology; University Hospital Heidelberg; Heidelberg; Germany
| | - Sebastian Mueller
- Department of Medicine; Salem Medical Center and Alcohol Research Center; University of Heidelberg; Heidelberg; Germany
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33
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Yoshioka K. How to adjust the inflammation-induced overestimation of liver fibrosis using transient elastography? Hepatol Res 2013; 43:182-184. [PMID: 23409851 DOI: 10.1111/j.1872-034x.2012.01096.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kentaro Yoshioka
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Toyoake, Japan
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34
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Sporea I, Sirli R, Bota S, Popescu A, Sendroiu M, Jurchis A. Comparative study concerning the value of acoustic radiation force impulse elastography (ARFI) in comparison with transient elastography (TE) for the assessment of liver fibrosis in patients with chronic hepatitis B and C. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1310-1316. [PMID: 22698510 DOI: 10.1016/j.ultrasmedbio.2012.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/19/2012] [Accepted: 03/13/2012] [Indexed: 05/13/2023]
Abstract
Our aim was to compare liver stiffness (LS) measurements by means of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in patients with chronic hepatitis B and C, according to the severity of fibrosis. We also compared the correlation strength of ARFI and TE measurements with liver fibrosis. We included 53 patients with hepatitis B and 107 with hepatitis C in which liver biopsy, ARFI and TE measurements were performed in the same session. The mean LS values measured with ARFI were similar in patients with chronic hepatitis B and C and depended on the stage of fibrosis. The correlation strength of LS measurements by ARFI and by TE with fibrosis was similar in chronic hepatitis B and C patients. In conclusion, for the same stage of fibrosis, the mean LS values by ARFI were similar in patients with chronic hepatitis B and C. ARFI had similar predictive value with TE in both chronic viral hepatitis.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania.
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35
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Lindvig K, Mössner BK, Pedersen C, Lillevang ST, Christensen PB. Liver stiffness and 30-day mortality in a cohort of patients admitted to hospital. Eur J Clin Invest 2012; 42:146-52. [PMID: 21793821 DOI: 10.1111/j.1365-2362.2011.02571.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transient elastography (TE) is a new noninvasive method to assess the degree of liver fibrosis by measuring liver stiffness. The objective of this study was to determine whether increased liver stiffness in patients admitted to medical wards was associated with increased 30-day mortality. MATERIALS AND METHODS A prospective cohort study at the medical admissions ward at Odense University Hospital, Denmark, covering a population of 300 000 inhabitants. Consecutive patients ≥ 18 years of age were examined by TE (Fibroscan) at admission. Outcome measure was 30-day mortality. RESULTS Among 568 patients admitted during 24 days, 289 (50·8%) were included in the study, 212 (73·4%) with valid TE measurement. Increased liver stiffness (TE value > 8 kPa) was found in 22·6% (48/212). This was independently associated with cirrhosis of the liver (P < 0·001) and congestive heart failure (CHF) (P < 0·001). The estimated prevalence of cirrhosis was 7% (95% CI 4-11%). The 30-day mortality among patients with TE value > 8 kPa was 20·8% (10/48, 95%CI 10·5-35·0%) compared to patients with TE value ≤ 8 kPa 3·7% (6/164, 95%CI 1·3-7·8%) (P < 0·001), and TE value > 8 kPa was an independent predictor of death. CONCLUSIONS Elevated TE value at admission is associated with increased mortality, cirrhosis of the liver and CHF. This information may potentially be used to improve the outcome of high-risk patients admitted to hospital.
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Affiliation(s)
- Kristoffer Lindvig
- Departments of Infectious Diseases, Odense University Hospital, Odense, Denmark
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36
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Mendeni M, Foca E, Gotti D, Ladisa N, Angarano G, Albini L, Castelnuovo F, Carosi G, Quiros-Roldan E, Torti C. Reply to van der Pas et al. Clin Infect Dis 2011. [DOI: 10.1093/cid/cir481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Andersen ES, Weiland O, Leutscher P, Krarup H, Westin J, Moessner B, Konopski Z, Frigstad SO, Kjær M, Christensen PB, Weis N. Low liver stiffness among cirrhotic patients with hepatitis B after prolonged treatment with nucleoside analogs. Scand J Gastroenterol 2011; 46:760-6. [PMID: 21438780 DOI: 10.3109/00365521.2011.565068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Case reports and short-term clinical trials have suggested that treatment for chronic hepatitis B (CHB) may lead to improvement of cirrhosis. The aim of the present study was to measure liver stiffness in patients diagnosed with advanced fibrosis or cirrhosis prior to prolonged treatment with nucleoside or nucleotide analogs (NUCs) for CHB. MATERIALS AND METHODS Patients with CHB and advanced fibrosis or cirrhosis prior to treatment with NUCs for at least 1 year were offered inclusion in the study. We measured liver stiffness using transient elastography (TE) at follow-up. TE cut-off levels to Metavir classification for fibrosis stage F2, F3 and F4 were ≥7.2 kPa, ≥8.1, and ≥11.0 kPa, respectively. RESULTS Among 66 patients with a successful TE examination at follow-up, 53 patients (80%) had cirrhosis and 13 had (20%) advanced fibrosis (F3) prior to treatment. Median treatment duration was 50.5 months. Among patients with cirrhosis prior to treatment, 26 (49%) had liver stiffness below 11.0 kPa at follow-up, suggesting regression of cirrhosis. Among patients with advanced fibrosis (F3) prior to treatment, 10 (77%) had liver stiffness below 8.1 kPa after treatment, suggesting improvement of fibrosis. CONCLUSION Transient elastography examinations demonstrate that prolonged treatment with NUCs in patients with CHB results in low liver stiffness, suggesting regression of fibrosis in a majority of patients with advanced fibrosis or cirrhosis.
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Affiliation(s)
- Ellen Sloth Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
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38
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Harata M, Hashimoto S, Kawabe N, Nitta Y, Murao M, Nakano T, Arima Y, Shimazaki H, Ishikawa T, Okumura A, Ichino N, Osakabe K, Nishikawa T, Yoshioka K. Liver stiffness in extrahepatic cholestasis correlates positively with bilirubin and negatively with alanine aminotransferase. Hepatol Res 2011; 41:423-429. [PMID: 21435129 DOI: 10.1111/j.1872-034x.2011.00797.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM Transient elastography is a non-invasive tool to measure liver stiffness (LS), which has been reported to correlate with stage of liver fibrosis. Extrahepatic cholestasis was reported to cause elevated LS, which is considered to be attributed to the increased hydrostatic pressure in the liver. In the present study, the correlation of LS with laboratory data was investigated in extrahepatic cholestasis. The change of LS after biliary drainage was also assessed. METHODS LS was measured in 29 patients with extrahepatic cholestasis due to carcinomas in 12 and non-neoplastic diseases of biliary tract or pancreas in 17. RESULTS In 15 patients, LS was 11.4 kPa or higher which suggested liver cirrhosis in chronic infection of hepatitis C virus. LS significantly correlated positively with serum bilirubin levels (r = 0.726, P < 0.0001) and negatively with serum aspartate aminotransferase (AST) levels (r = -0.481, P = 0.0082) and alanine aminotransferase (ALT) levels (r = -0.631, P = 0.0002). Biliary drainage led to a reduction of bilirubin by 13.5 to 0.9 mg/dL which was significantly correlated with a reduction of LS by 14.3 to 0.5 kPa (r = 0.524, P = 0.0257). CONCLUSION In extrahepatic cholestasis, the elevation of LS which is probably attributed to the increased hydrostatic pressure in the liver, correlates positively with the accumulation of bilirubin but negatively with damage of hepatocytes indicated by ALT levels. Further studies on the mechanism underlying the elevation of LS should be helpful to elucidate the pathogenesis of extrahepatic cholestasis.
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Affiliation(s)
- Masao Harata
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University Faculty of Medical Technology, School of Health Sciences Department of Clinical Laboratory, Fujita Health University Hospital, Toyoake Department of Medical Technology, Nagoya University School of Health Sciences, Nagoya Department of Gastroenterology, Kainan Hospital, Yatomi, Aichi, Japan
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39
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Abstract
Continued elucidation of the mechanisms of hepatic fibrosis has yielded a comprehensive and nuanced portrait of fibrosis progression and regression. The paradigm of hepatic stellate cell (HSC) activation remains the foundation for defining events in hepatic fibrosis and has been complemented by progress in a number of new areas. Cellular sources of extracellular matrix beyond HSCs have been identified. In addition, the role of chemokine, adipokine, neuroendocrine, angiogenic and NAPDH oxidase signaling in the pathogenesis of hepatic fibrosis has been uncovered, as has the contribution of extracellular matrix stiffness to fibrogenesis. There is also increased awareness of the contribution of innate immunity and greater understanding of the complexity of gene regulation in HSCs and myofibroblasts. Finally, both apoptosis and senescence have been recognized as orchestrated programs that eliminate fibrogenic cells during resolution of liver fibrosis. Ironically, the progress that has been made has highlighted the growing disparity between advances in the experimental setting and their translation into new diagnostic tools and treatments. As a result, focus is shifting towards overcoming key translational challenges in order to accelerate the development of new therapies for patients with chronic liver disease.
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