Real time ultrasound tissue Elastography in post-hepatitis chronic liver disease; role, limitations and pitfalls

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Noha M Diaa ◽  
Merhan A Nasr ◽  
Mohamed M Mohamed ◽  
Shimaa M Radwan
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Real Time ◽  
Transient Elastography ◽  
Chronic Liver ◽  
P Value ◽  
Hcv Rna ◽  
Significant Fibrosis ◽  
Non Invasive

Abstract Assessment of liver fibrosis stage is important in determining the prognosis and treatment strategy in chronic liver diseases. To overcome the limitations of liver biopsy, great efforts have been made to develop and validate non-invasive methods for detecting liver fibrosis, including serological indicators and imaging methods. Among these noninvasive methods, ultrasound-based elastography techniques are increasingly employed to assess parenchymal stiffness. Real-time transient elastography is most accurate one of them and rapidly evolving technique that can reveal the elastic properties of tissues, and display it as real time images. This technique can avoid unnecessary invasive liver biopsy. Patients and methods This descriptive study was done on 20 chronic HCV patients as diagnosed by seropositivity for HCV antibodies and HCV RNA by PCR, Patients were recruited from police hospitals outpatient clinics to find an alternative method to assess liver fibrosis. Results showed highly significant agreement between fibroscan scores and biopsy results (p value was < 0.001), the identification of patients with significant fibrosis (F ≥ 2) “F2, 3, 4” We reported that the cut off level of significant fibrosis (F ≥ 2) assessed by the METAVIR scoring system was 10.2 kpa, with sensitivity 86.7 % and specificity 80 %. However, cut-off level of 13.8 kpa for the detection of cirrhosis (F4) with an area under the ROC of 0.913, and a very high sensitivity and specificity (sensitivity 90.1% and specificity 85.7%). Conclusion Transient Elastography is an easy and quick clinical non-invasive method to perform. Results are available immediately, and this technique is accurate in predicting significant fibrosis ≥f2. Hence, Transient Elastography could be useful not only to evaluate liver fibrosis as to monitor liver disease progression, but also to monitor anti-viral or antifibrotic therapy effects and to help taking decisions in daily clinical practice.

scholarly journals Transient elastography correlated to four different histological fibrosis scores in children with liver disease

2021 ◽  
Author(s):  
Ulrike Teufel-Schäfer ◽  
Christa Flechtenmacher ◽  
Alexander Fichtner ◽  
Georg Friedrich Hoffmann ◽  
Jens Peter Schenk ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Aspartate Aminotransferase ◽  
Gold Standard ◽  
Scoring System ◽  
Transient Elastography ◽  
Non Invasive ◽  
Apri Score ◽  
Severe Fibrosis

AbstractCurrently, liver histology is the gold standard for the detection of liver fibrosis. In recent years, new methods such as transient elastography (TE) have been introduced into clinical practice, which allow a non-invasive assessment of liver fibrosis. The aim of the present study was to investigate the predictive value of TE for higher grade fibrosis and whether there is any relevance which histologic score is used for matching. For this purpose, we compared TE with 4 different histologic scores in pediatric patients with hepatopathies. Furthermore, we also determined the aspartate aminotransferase-to-platelet ratio (APRI) score, another non-invasive method, to investigate whether it is equally informative. Therefore, liver fibrosis in 75 children was evaluated by liver biopsy, TE and laboratory values. Liver biopsies were evaluated using four common histological scoring systems (Desmet, Metavir, Ishak and Chevalier’s semi-quantitative scoring system). The median age of the patients was 12.3 years. TE showed a good correlation to the degree of fibrosis severity independent of the histological scoring system used. The accuracy of the TE to distinguish between no/minimal fibrosis and severe fibrosis/cirrhosis was good (p = 0.001, AUC-ROCs > 0.81). The optimal cut-off value for the prediction of severe fibrosis was 10.6 kPa. In contrast, the APRI score in our collective showed no correlation to fibrosis.Conclusion: TE shows a good correlation to the histological findings in children with hepatopathy, independent of the used histological scoring system. What is Known:• The current gold standard for detecting liver fibrosis is liver biopsy. Novel non-invasive ultrasound-based methods are introduced to clinical diagnostics.• Most histological scores have been developed and evaluated in adult populations and for only one specific liver disease.What is New:• Transient elastography (TE) in children showed a good correlation to fibrosis severity irrespective of the utilized histological scoring system.• The aspartate aminotransferase-to-platelet ratio (APRI) showed no correlation with different stages of liver fibrosis in children.

scholarly journals A review of the clinical utility of the Enhanced Liver Fibrosis test in multiple aetiologies of chronic liver disease

2019 ◽  
Vol 57 (1) ◽  
pp. 36-43
Author(s):  
Preya Janubhai Patel ◽  
Declan Connoley ◽  
Freya Rhodes ◽  
Ankur Srivastava ◽  
William Rosenberg
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Chronic Liver Disease ◽  
Clinical Utility ◽  
Chronic Liver ◽  
Biliary Cirrhosis ◽  
Alcoholic Fatty Liver ◽  
Functional Changes ◽  
Non Invasive

The rising incidence of chronic liver disease continues to be an increasing health burden. The morbidity and mortality associated with chronic liver disease typically occur in patients with advanced fibrosis. Hence, early identification of those at-risk is of vital importance to ensure appropriate ongoing management. Currently, tools for appropriate risk stratification remain limited. Increasing awareness of the limitations of liver biopsy has driven research into alternative non-invasive methods of fibrosis assessment including serological markers assessing functional changes. One such biomarker, the Enhanced Liver Fibrosis test, was initially validated in a cohort of 1021 patients with mixed aetiology chronic liver disease and shown to perform well. Since this pathfinder study, it has been independently validated in cohorts of hepatitis C, non-alcoholic fatty liver disease, alcoholic liver disease, primary biliary cirrhosis and primary sclerosing cholangitis. In addition to performing well as a diagnostic tool, the Enhanced Liver Fibrosis test has been shown to outperform liver biopsy in prognostic studies and is the only non-invasive marker to do so. However, questions remain regarding the use of this test, particularly regarding the possible effect age and alcohol may have on test scores. This review examines the current literature published in relation to the Enhanced Liver Fibrosis test and its clinical utility and highlights areas requiring further study.

scholarly journals Non-Invasive Indirect Markers of Liver Fibrosis after Interferon-Free Treatment for Hepatitis C

2021 ◽  
Vol 10 (17) ◽  
pp. 3951
Author(s):  
Dagmara Przekop ◽  
Jakub Klapaczynski ◽  
Agnieszka Grytczuk ◽  
Ewa Gruszewska ◽  
Andrzej Gietka ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Transient Elastography ◽  
Histopathological Examination ◽  
Hcv Rna ◽  
Significant Fibrosis ◽  
Non Invasive ◽  
Free Treatment ◽  
Ap Index

The effectiveness of interferon-free therapy during the course of HCV infection has already been confirmed. Liver fibrosis can be assessed in several ways, from biopsies to imaging tests. The present study evaluates the usefulness of non-invasive indirect biomarkers of liver fibrosis (APRI, GAPRI, FORNS, FIB-4, the AP index and HUI score) as markers of the effective treatment of HCV with the 3D regimen. Blood samples were collected from 70 patients suffering from chronic hepatitis C. Patients received the 3D AbbVie regimen for hepatitis C. All patients had HCV genotype 1b. The APRI, GAPRI, FIB-4, FORNS, HUI and AP index (age–platelet score) values were calculated with their respective algorithms. The stage of fibrosis was evaluated on the basis of a liver biopsy and confirmed by FibroScan-based transient elastography. An undetectable level of HCV RNA after 12 weeks of treatment with the 3D regimen indicates 100% eradication of hepatitis C virus. After the treatment, non-invasive indirect markers of liver fibrosis achieved levels below the limit for significant fibrosis, Thus, non-invasive indirect biomarkers of hepatic fibrosis failed to detect the presence of significant fibrosis, which was proved in histopathological examination. However, the eradication of hepatitis C virus by means of the 3D regimen treatment does not mean that patients were completely cured.

scholarly journals The Diagnostic Accuracy of LOGIQ S8 and E9 Shear Wave Elastography for Staging Hepatic Fibrosis, in Comparison with Transient Elastography

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1817
Author(s):  
Jeong-Ju Yoo ◽  
Sang Gyune Kim ◽  
Young Seok Kim
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Chronic Liver Disease ◽  
Shear Wave ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Chronic Liver ◽  
Significant Fibrosis

Background: The aim of this study was to evaluate the usefulness of two different types of 2-dimensional shear wave elastography (2D-SWE) for predicting liver fibrosis stages in comparison to transient elastography (TE), using a histologic METAVIR scoring system as the reference method. Methods: A total of 203 patients with chronic liver disease were prospectively enrolled in the study. Two different 2D-SWEs (LOGIQ S8 and E9 systems, GE Healthcare, Chalfont St Giles, UK) were assessed for liver stiffness in patients with chronic liver diseases. Patients received 2D-SWE examinations with the S8 and E9 systems, and also underwent TE (FibroScan®, Echosens, France) tests and liver biopsies on the same day. Results: The most common etiology of chronic liver disease was non-alcoholic fatty liver disease (28.7%), followed by chronic hepatitis B (25.1%). Liver fibrosis stages consisted of F0 (22.6%), F1 (29.7%), F2 (16.9%), F3 (12.8%) and F4 (17.9%). Overall, S8 and E9 were well correlated with the histologic fibrosis stages. The optimal cut-off values for S8 and E9 to differentiate significant fibrosis (≥F2) were 6.70 kPa and 6.42 kPa, respectively, while the cut-off values for S8 and E9 in distinguishing liver cirrhosis were 9.15 kPa and 8.88 kPa, respectively. Among the 195 patients who had successful measurements in both S8 and E9, liver stiffness showed good inter-equipment correlation (ICC: 0.900, p < 0.001). Regarding diagnostic ability, upon comparison (FibroScan®), there were no significant differences between 2D-SWEs and TE for detecting every stage of liver fibrosis. Conclusion: In comparison to TE, 2D-SWE with LOGIQ S8 and E9 (GE Healthcare) are useful non-invasive tools for predicting significant fibrosis and liver cirrhosis.

Liver Fibrosis Assessed by Transient Elastography in Adult Thalassemia Intermedia Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5406-5406
Author(s):  
Maria Rosaria Fasulo ◽  
Mirella Fraquelli ◽  
Claudia Cesaretti ◽  
Cristina Rigamonti ◽  
Elena Cassinerio ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Liver Damage ◽  
Transient Elastography ◽  
Hcv Rna ◽  
Thalassemia Intermedia ◽  
Non Invasive ◽  
Iron Load ◽  
Increased Risk ◽  
Invasive Method

Abstract Concomitant HCV infection and iron overload are responsible for increased risk of chronic liver disease (CLD) in thalassemic patients. Liver biopsy remains so far the gold standard to assess histological activity and iron burden, although it is an invasive method poorly accepted by patients and it can not be repeated regularly. MRI ferriscan is a good tool recently introduced to estimate hepatic and cardiac iron load but it does not allow to evaluate the tissue liver damage. Transient Elastography (TE) is a new non-invasive device that measures liver stiffness (LSM) and assesses liver damage, namely fibrosis and cirrhosis. TE use in thalassemic patients is still limited, thus the aim of this study was to evaluate LSM by TE in a cohort of adults affected by Thalassemia Intermedia (TI) in order to assess the liver damage. Ninety consecutive TI patients followed at a single Italian tertiary Thalassemia Care Center in Milan were enrolled in this study. Eighteen patients (20%) were regularly transfused, 28 (31%) occasionally transfused, 44 (49%) never transfused. No one patient was on regular chelation treatment. Table 1 summarizes the demographic, clinical and laboratory features at time of TE evaluation. Males n° (%) 43 (47.8%) LDH U/l * 570±296 *Mean ± SD TE (FibroScan®) was performed according to Fraquelli et al. and was expressed in KPa. Only the examination with at least 10 validated measurements, a success rate greater than 60% and the interquartile range of all validated measurements lower than 30% of the mean value were considered reliable. TE cut-off to diagnose different stages of hepatic fibrosis was &gt;7.9 kPa for F&gt;2, &gt;10.3 for F&gt;3 and &gt;11.9 for F&gt;4 (cirrhosis). Forty-eight patients underwent T2* Magnetic Resonance Imaging (MRI) in order to estimate liver iron concentration (LIC). Forty-three patients (48%) had normal TE values (TE≤5.0 KPa), 35 (39%) had F&gt;1 (5.0&lt;TE≤7.9 KPa), 5 (6%) had F&gt;2, 2 (2%) had F&gt;3, 5 (6%) had F&gt;4. Mean ± SD TE value was 6.0±2.8 KPa. A significant correlation (p&lt;0.05) was observed between LSM and age (p&lt;0.001), transfusion regimen (p=0.017), serum ferritin (p=0.006), AST (p&lt;0.001), ALT (p&lt;0.001), GGT (p=0.003), bilirubin (p=0.003), albumin (p=0.017), IgG (p=0.006) and HCV positivity (HCV-Ab p&lt;0.001; HCV-RNA p=0.028). AGE yrs * 40.5±11.1 BILIRUBIN (tot) mg/dl * 2.8±1.8 BMI kg/m2 * 21.8±2.9 BILIRUBIN (conj) mg/dl * 0.5±0.3 Hb g/dl * 8.9±1.3 ALBUMIN g/dl * 4.6±0.3 FERRITIN LEVELS ng/ml* 730±690 IgG mg/dl * 1611±543 AST U/l * 32±17 SPLENECTOMY n° (%) 49 (54.4%) ALT U/l * 29±22 CHOLECYSTECTOMY n° (%) 38 (42.2%) ALP U/l * 72±25 HCV-Ab + n° (%) 18 (20.0%) GGT U/l * 24±23 HCV-RNA + n° (%) 8 (8.8%) CHE U/l * 5617±1664 LIC mg Fe/g dry weight * 7.37±5.03 Table 2 describes TE results based on transfusion regimen, ferritin levels and HCV-RNA positivity. TE (mean ± SD) Transfusion regimen Never 5.4±2.2 Occasionally 6.4±3.5 Regular 7.2±2.9 Ferritin levels ng/ml &lt;500 5.4±2.9 500–1000 5.5±2.8 &gt;1000 8.2±3.4 HCV-RNA Positive 7.7±2.9 Negative 5.9±2.8 Moreover, splenectomy (p=0.014) and cholecystectomy (p&lt;0.001) positively correlated with TE values. No significant correlations were found between TE values and sex, BMI, Hb, ALP, LDH, CHE and LIC by MRI. This study showed that fibrosis is common in TI patients and relates with iron load estimated by ferritin and with HCV positivity. Liver fibrosis can progress to cirrhosis and eventually to liver cancer, thus TE is a reliable non-invasive method for assessing liver fibrosis and for monitoring its progression in TI patients. It is advisable to introduce TE in the follow-up of thalassemic patients, although its role as a surrogate of liver biopsy remains to be established. The relationship between LSM and LIC measured by T2* MRI needs further investigations.

scholarly journals Su1288 Real-Time Tissue Elastography: Non-Invasive Evaluation for Liver Fibrosis in Chronic Liver Disease Due to HCV

2013 ◽  
Vol 144 (5) ◽  
pp. S-449
Author(s):  
Akiko Shiraishi ◽  
Atsushi Hiraoka ◽  
Ichiro Sogabe ◽  
Keizo Furuya ◽  
Haruka Tatsukawa ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Chronic Liver Disease ◽  
Real Time ◽  
Chronic Liver ◽  
Non Invasive ◽  
Invasive Evaluation ◽  
Tissue Elastography

Mac‐2 Binding Protein Glycan Isomer as non‐invasive tool to assess liver fibrosis in children with chronic liver disease

2021 ◽  
Author(s):  
Ola G Behairy ◽  
Soha A El‐Gendy ◽  
Dalia Y Ibrahim ◽  
Amira I Mansour ◽  
Ola S El‐Shimi
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Chronic Liver Disease ◽  
Binding Protein ◽  
Chronic Liver ◽  
Non Invasive

scholarly journals A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 37-38
Author(s):  
A Zoughlami ◽  
J Serero ◽  
G Sebastiani ◽  
M Deschenes ◽  
P Wong ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Chronic Liver ◽  
Non Invasive ◽  
Chronic Hepatitis B Virus

Abstract Background Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis. Aims We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD. Methods We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM &gt;9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM &lt;20 kPa and platelets &gt;150,000) and expanded Baveno VI criteria (LSM &lt;25 kPa and platelets &gt;110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was &gt;10 kPa. Results A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies. Conclusions These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD. Funding Agencies None

1196: Assessment of Liver Fibrosis by Real Time SonoElastography (Hitachi) as Compared to Liver Biopsy and Transient Elastography

2009 ◽  
Vol 35 (8) ◽  
pp. S152 ◽  
Author(s):  
Alina Popescu ◽  
Ioan Sporea ◽  
Mircea Focsa ◽  
Viviana Sandra ◽  
Veronica Ruta ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Real Time ◽  
Transient Elastography
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