Establishing Reliability Criteria for Liver ElastPQ Shear Wave Elastography (ElastPQ-SWE): Comparison Between 10, 5 and 3 Measurements

2019 ◽  
Author(s):  
Davide Roccarina ◽  
Laura Iogna Prat ◽  
Elena Buzzetti ◽  
Marta Guerrero Misas ◽  
Francesco Marcello Aricó ◽  
...  
Keyword(s):  
Liver Disease ◽  
Diagnostic Performance ◽  
Liver Stiffness ◽  
Quality Criterion ◽  
Quality Criteria ◽  
Shear Wave Elastography ◽  
Primary Biliary Cholangitis ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
The Difference

Abstract Purpose ElastPQ is a new elastography technique for non-invasive liver fibrosis staging. However, it does not have validated reliability criteria. We tested the reliability of a different number of measurements in patients with chronic liver disease and explored whether the application of quality criteria improves the diagnostic performance. Materials and Methods All patients underwent liver stiffness assessment (LSM) with ElastPQ and Fibroscan (F-TE). The mean, median, standard deviation (SD) and interquartile range (IQR) of 10, 5 and 3 measurements were retrospectively collected for each patient and compared to each other. Liver histology was available in a subset of patients. Results Overall, 400 patients met the inclusion criteria. Non-alcoholic fatty liver disease (NAFLD) was the most represented etiology (75 %), followed by primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH). The correlation of medians was significantly better between 10 and 5 measurements than between 10 and 3. The difference of medians was significant only in the comparison between 10 and 3 measurements. The correlation between ElastPQ and F-TE was equally good for 10 and 5 measurements and significantly improved after an IQR/median ≤ 30 % was applied. The diagnostic performance of ElastPQ was better with the median value of 10 and 5 measurements and improved if LSM values were obtained with IQR/M ≤ 30 %. Conclusion The median value of 5 valid LSMs suffices for the reliable estimation of liver stiffness using ElastPQ. The quality criterion of IQR/M ≤ 30 % should also be followed when using this technique.

scholarly journals Advances in non-invasive assessment of hepatic fibrosis

Gut ◽  
2020 ◽  
Vol 69 (7) ◽  
pp. 1343-1352 ◽  
Author(s):  
Rohit Loomba ◽  
Leon A Adams
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Response To Treatment ◽  
Fibrosis Score ◽  
Alcoholic Fatty Liver ◽  
Need For Treatment ◽  
Non Invasive ◽  
Confirmatory Tests

Liver fibrosis should be assessed in all individuals with chronic liver disease as it predicts the risk of future liver-related morbidity and thus need for treatment, monitoring and surveillance. Non-invasive fibrosis tests (NITs) overcome many limitations of liver biopsy and are now routinely incorporated into specialist clinical practice. Simple serum-based tests (eg, Fibrosis Score 4, non-alcoholic fatty liver disease Fibrosis Score) consist of readily available biochemical surrogates and clinical risk factors for liver fibrosis (eg, age and sex). These have been extensively validated across a spectrum of chronic liver diseases, however, tend to be less accurate than more ‘complex’ serum tests, which incorporate direct measures of fibrogenesis or fibrolysis (eg, hyaluronic acid, N-terminal propeptide of type three collagen). Elastography methods quantify liver stiffness as a marker of fibrosis and are more accurate than simple serum NITs, however, suffer increasing rates of unreliability with increasing obesity. MR elastography appears more accurate than sonographic elastography and is not significantly impacted by obesity but is costly with limited availability. NITs are valuable for excluding advanced fibrosis or cirrhosis, however, are not sufficiently predictive when used in isolation. Combining serum and elastography techniques increases diagnostic accuracy and can be used as screening and confirmatory tests, respectively. Unfortunately, NITs have not yet been demonstrated to accurately reflect fibrosis change in response to treatment, limiting their role in disease monitoring. However, recent studies have demonstrated lipidomic, proteomic and gut microbiome profiles as well as microRNA signatures to be promising techniques for fibrosis assessment in the future.

scholarly journals The Usefulness of Noninvasive Liver Stiffness Assessment Using Shear-Wave Elastography for Predicting Liver Fibrosis in Children

2020 ◽  
Author(s):  
Seunghyun Lee ◽  
Young Hun Choi ◽  
Yeon Jin Cho ◽  
Seul Bi Lee ◽  
Jung-Eun Cheon ◽  
...  
Keyword(s):  
Liver Disease ◽  
Shear Wave ◽  
Diagnostic Performance ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Fibrosis Stage ◽  
Receiver Operating Curve ◽  
Affecting Factors ◽  
Cutoff Value ◽  
Factors Affecting

Abstract Background: Pediatric patients with liver disease require noninvasive monitoring for the likelihood of fibrosis progression. The purpose of this study is to evaluate the significant factors affecting liver stiffness values from two-dimensional-shear wave elastography (2D-SWE), and whether liver stiffness can predict the fibrosis stage of various childhood liver diseases.Methods: This study comprised 30 children (22 boys and 8 girls; mean age, 5.1 ± 6.1 years; range, 7 days–17.9 years) who had undergone biochemical evaluation, 2D-SWE examination, and histopathologic analysis with fibrosis grade (F0 to F3), necroinflammatory activity, and steatosis grade between August 2016 and March 2020. The liver stiffness from 2D-SWE were compared between fibrosis stages using the Kruskal-Wallis analysis. The significant affecting factors to liver stiffness were evaluated using univariate and multivariate linear regression analyses. The diagnostic performance was determined from the area under the receiver operating curve (AUC) values of the 2D-SWE liver stiffness.Results: Liver stiffness at the F0-1, F2, and F3 stages were 7.9, 13.2, and 21.7 kPa (P < 0.001). Both of fibrosis stage and necroinflammatory grade were factors significantly associated with liver stiffness (P < 0.001 and P = 0.021). Liver stiffness value could distinguish significant fibrosis (≥F2) with an AUC of 0.950 (cutoff value, 11.3 kPa) and the severe fibrosis (F3 stage) with an AUC of 0.924 (cutoff value, 18.1 kPa). Conclusion: The liver stiffness values from 2D-SWE can be effected through both fibrosis and necroinflammatory grade and can provide excellent diagnostic performance in evaluating the fibrosis stage, even in various liver disease.

scholarly journals Quantification of Liver Fibrosis, Steatosis, and Viscosity Using Multiparametric Ultrasound in Patients with Non-Alcoholic Liver Disease: A “Real-Life” Cohort Study

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 783
Author(s):  
Alexandru Popa ◽  
Felix Bende ◽  
Roxana Șirli ◽  
Alina Popescu ◽  
Victor Bâldea ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Plane Wave ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Real Life ◽  
Final Analysis ◽  
Multivariate Regression Analysis ◽  
Alcoholic Fatty Liver ◽  
Non Invasive

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. This study aimed to evaluate the performance of four ultrasound-based techniques for the non-invasive multiparametric (MPUS) assessment of liver fibrosis (LF), steatosis (HS), and inflammation in patients with NAFLD. We included 215 consecutive adult patients with NAFLD (mean age: 54.9 ± 11.7; 54.5% were male), in whom LF, HS, and viscosity were evaluated in the same session using four new ultrasound-based techniques embedded on the Aixplorer MACH 30 system: ShearWave Elastography (2D-SWE.PLUS), Sound Speed Plane-wave UltraSound (SSp.PLUS), Attenuation Plane-wave UltraSound (Att.PLUS), and Viscosity Plane-wave UltraSound (Vi.PLUS). Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) (FibroScan) were considered as control. All elastographic measurements were performed according to guidelines. Valid liver stiffness measurements (LSM) were obtained in 98.6% of patients by TE, in 95.8% of patients by 2D-SWE.PLUS/Vi.PLUS, and in 98.1% of patients by Att.PLUS/SSp.PLUS, respectively. Therefore, 204 subjects were included in the final analysis. A strong correlation between LSMs by 2D-SWE.PLUS and TE (r = 0.89) was found. The best 2D-SWE.PLUS cut-off value for the presence of significant fibrosis (F ≥ 2) was 7 kPa. Regarding steatosis, SSp.PLUS correlated better than Att.PLUS with CAP values: (r = −0.74) vs. (r = 0.45). The best SSp.PLUS cut-off value for predicting the presence of significant steatosis was 1524 m/s. The multivariate regression analysis showed that Vi.PLUS values were associated with BMI and LSM by 2D-SWE.PLUS. In conclusion, MPUS was useful for assessing fibrosis, steatosis, and inflammation in a single examination in patients with NAFLD.

scholarly journals Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease: A Step Forward for Better Evaluation Using Ultrasound Elastography

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2778
Author(s):  
Monica Lupsor-Platon ◽  
Teodora Serban ◽  
Alexandra-Iulia Silion ◽  
Alexandru Tirpe ◽  
Mira Florea
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Shear Wave Elastography ◽  
Ultrasound Elastography ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Alcoholic Fatty Liver Disease

The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population prompts for a quick response from physicians. As NAFLD can progress to liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), new non-invasive, rapid, cost-effective diagnostic methods are needed. In this review, we explore the diagnostic performance of ultrasound elastography for non-invasive assessment of NAFLD and NAFLD-related HCC. Elastography provides a new dimension to the conventional ultrasound examination, by adding the liver stiffness quantification in the diagnostic algorithm. Whilst the most efficient elastographic techniques in staging liver fibrosis in NAFLD are vibration controlled transient elastography (VCTE) and 2D-Shear wave elastography (2D-SWE), VCTE presents the upside of assessing steatosis through the controlled attenuation parameter (CAP). Hereby, we have also critically reviewed the most important elastographic techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography (pSWE) and 2D-SWE. As our paper shows, elastography should not be considered as a substitute for FLL biopsy because of the stiffness values overlap. Furthermore, by using non-invasive, disease-specific surveillance tools, such as US elastography, a subset of the non-cirrhotic NAFLD patients at risk for developing HCC can be detected early, leading to a better outcome. A recent ultrasomics study exemplified the wide potential of 2D-SWE to differentiate benign FLLs from malignant ones, guiding the clinician towards the next steps of diagnosis and contributing to better long-term disease surveillance.

scholarly journals Plasma sgp130 is an independent predictor of non-alcoholic fatty liver disease severity

2022 ◽  
Author(s):  
Aysim Gunes ◽  
Laurent Bilodeau ◽  
Catherine Huet ◽  
Assia Belblidia ◽  
Cindy Baldwin ◽  
...  
Keyword(s):  
Metabolic Disease ◽  
Liver Disease ◽  
Disease Severity ◽  
Liver Stiffness ◽  
Morbidly Obese ◽  
Resonance Spectroscopy ◽  
Liver Pathology ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Nafld Fibrosis Score

Background: Nonalcoholic steatohepatitis (NASH) is a metabolic disease associated with liver failure and cancer. Accurate monitoring of advancing NASH is challenging. There are few reliable, non-invasive biomarkers of early NASH. Since liver inflammation is a main driver of fibrosis, we investigated relationships between circulating components of the interleukin-6 signaling pathway (IL-6, sIL-6R and sgp130) and liver pathology in subjects with NAFLD and NASH. Methods: Predictive performance of plasma IL-6, sIL-6R and sgp130 were investigated in two independent cohorts: 1) patients with biopsy-confirmed NASH (n=49), where magnetic resonance spectroscopy (MRS), imaging (MRI) and elastography (MRE) assessed liver fat, volume and stiffness; and 2) patients with morbid obesity (n=245) undergoing bariatric surgery where Bedossa algorithm and steatosis, activity, and fibrosis scores assessed NASH severity. Correlations were evaluated between circulating IL-6, sIL-6R and sgp130 and anthropomorphic characteristics, plasma markers of metabolic disease or liver pathology, adjusting for covariates of liver disease such as age, sex, BMI and diabetes. Results: In patients with NASH, plasma IL-6 and sgp130 strongly correlated with liver stiffness, which for sgp130, was independent of age, sex, BMI, and chronic disease (diabetes, hyperlipidemia, hypertension or history of HCC). Plasma sgp130 was the strongest predictor of liver stiffness compared to commonly used biomarkers and predictive algorithms. Plasma sIL-6R correlated with liver volume independent of age, sex, and BMI. In stepwise forward regression analysis, plasma sgp130 followed by NAFLD fibrosis score and plasma globulin, predicted up to 74% of liver stiffness with/without adjustment for sex. In morbidly obese subjects, circulating IL-6 correlated with hepatocellular ballooning and sgp130 correlated with advanced liver fibrosis. Conclusions: Circulating sgp130 could represent a robust biomarker of active NASH and may be used alone or in combination with other biomarkers as a non-invasive measure of liver disease severity.

scholarly journals Non-invasive diagnosis of non-alcoholic fatty liver disease in children: role of shear-wave elastography and steatometry

2020 ◽  
Vol 15 (6) ◽  
pp. 409-419
Author(s):  
Yu.M. Stepanov ◽  
N.Yu. Zavhorodnia ◽  
O.Yu. Zavhorodnia ◽  
I.S. Konenko ◽  
V.B. Yagmur ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Shear Wave ◽  
Fatty Liver Disease ◽  
Shear Wave Elastography ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Alcoholic Fatty Liver Disease

Liver Fibrosis Assessment in a Cohort of Greek HIV Mono-Infected Patients by Non-Invasive Biomarkers

2019 ◽  
Vol 17 (3) ◽  
pp. 173-182
Author(s):  
Theodoros Androutsakos ◽  
Maria Schina ◽  
Abraham Pouliakis ◽  
Athanasios Kontos ◽  
Nikolaos Sipsas ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Sensitivity And Specificity ◽  
Transient Elastography ◽  
Standard Procedure ◽  
Liver Stiffness ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Metavir Score ◽  
Significant Liver Fibrosis

Background: Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives. Objectives: Our study’s aim was to validate commonly used NIBMs for the assessment of liver fibrosis in a cohort of Greek HIV-mono-infected patients. Methods: Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement with TE and thorough laboratory work up and medical history were acquired at study entry. FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient. Results: A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was achieved. Conclusions: Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing patients with significant from those with mild/no fibrosis.

scholarly journals Elastography—A Bona Fide Non-Invasive Method for Assessing Non-Alcoholic Fatty Liver Disease in Children

2021 ◽  
Vol 11 (7) ◽  
pp. 3240
Author(s):  
Cristina Oana Mărginean ◽  
Lorena Elena Meliț ◽  
Maria Oana Săsăran
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Liver Stiffness ◽  
Major Public Health Problem ◽  
Systemic Complications ◽  
Alcoholic Fatty Liver ◽  
Non Invasive

Pediatric obesity has become a major public health problem worldwide, resulting in a wide spectrum of systemic complications. Liver disease associated with obesity, also known as nonalcoholic fatty liver disease (NAFLD), is currently the most common chronic liver condition in children. Therefore, its timely and proper diagnosis is essential for preventing further development of cirrhosis. Multiple studies focused on identifying the most accurate non-invasive diagnostic method for liver fibrosis or cirrhosis. Although liver biopsy remains the gold-standard in terms of this hepatopathy, elastography methods emerged as a relatively reliable alternative to liver biopsy. Thus, recent studies revealed the great importance of these non-invasive methods not only in diagnosing pediatric NAFLD, but also in its staging. MRE is commonly considered to have a greater accuracy than ultrasound-based elastography methods, but with lower availability and higher costs. Ultrasound-based elastography methods (transient elastography (TE), p-SWE, and 2-dimensional shear wave elastography (2D-SWE)) were proved to have similar accuracy in NAFLD staging. Nevertheless, multiple confounding factors account for potential challenges when using elastography for liver stiffness measurement, such as age, obesity itself (i.e., BMI), transaminase levels, or portal flow. A potential solution for facing these challenges might be represented by a complex approach based on the combination between elastography, clinical and laboratory findings. Although the studies that assessed the role of elastography in pediatric NAFLD staging are scarce, the current knowledge underlines a crucial role of these techniques taking into account their ability to distinguish between fibrosis degrees, their non-invasive patterns, lower costs and side effects when compared to liver biopsy. Therefore, elastography might become a cornerstone in staging pediatric NAFLD.

scholarly journals The Use of Two-Dimensional Shear Wave Elastography in People with Obesity for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

2020 ◽  
Vol 10 (1) ◽  
pp. 95
Author(s):  
Ritesh Chimoriya ◽  
Milan K Piya ◽  
David Simmons ◽  
Golo Ahlenstiel ◽  
Vincent Ho
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Severe Obesity ◽  
Shear Wave Elastography ◽  
Two Dimensional ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Alcoholic Fatty Liver Disease

Obesity is associated with significant comorbidities, including non-alcoholic fatty liver disease (NAFLD). Given its potential to progress to advanced liver disease, monitoring the extent and progress of liver fibrosis and assessing its fibrosis stage are essential. Although liver biopsy is considered to be the gold standard for liver fibrosis staging, it is an invasive procedure with risk of complications. Considering the rising prevalence of obesity and NAFLD globally, developing non-invasive diagnostic methods is a priority. Transient elastography (TE) is increasingly being used to assess the severity of liver disease. However, in the presence of severe obesity, the increased thickness of subcutaneous adipose tissue and changes in anatomy may affect its diagnostic accuracy. Two-dimensional shear wave elastography (2D-SWE) assesses the liver stiffness in real time along with simultaneous anatomic B-mode ultrasound imaging and allows selection of the region of interest. This would suggest that 2D-SWE has several advantages over TE in patients with severe obesity. The purpose of this review is to examine the current literature addressing the use of 2D-SWE in the assessment of liver fibrosis in patients with NAFLD. This review also examines the evidence on the use of 2D-SWE in patients with obesity and NAFLD and compares it to TE as a novel and non-invasive method of assessing liver fibrosis.

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