Ultrasound evaluation of the fibrosis stage in chronic liver disease by the simultaneous use of low and high frequency probes

Abstract Purpose To assess the performance of two-dimensional shear wave elastography (2D-SWE) on the GE LOGIQ E9 ultrasound system in a cohort of healthy subjects and to investigate its accuracy in the staging of liver fibrosis in patients with chronic liver disease (CLD) using liver biopsy as a reference standard. Materials and Methods From October 2014 to June 2016, 54 healthy subjects and 174 patients with CLD were consecutively enrolled. Liver fibrosis stage was assessed by the METAVIR scoring system. 18 (10.3 %) and 17 (9.8 %) patients had advanced fibrosis and cirrhosis, respectively. The correlation of liver stiffness measurement (LSM) and continuous variable was assessed using the Spearman rank correlation. The accuracy of 2D-SWE was evaluated with areas under the receiver operating characteristics curves (AUROC). Results Reliable LSMs were obtained in all subjects. The interobserver agreement ICC was excellent: 0.847. In healthy subjects, gender, but not anthropometric and biochemical data, were correlated with LSM. In patients with CLD, LSM had a strong positive correlation with fibrosis stage (rho = 0.628; p > 0.001). The AUROC was 0.724 for mild fibrosis (F≥ 1), 0.857 for moderate fibrosis (F≥ 2), 0.946 for severe fibrosis (F≥ 3), and 0.935 for cirrhosis (F4). Likewise, good accuracy was observed in the HCV subgroup. The optimal cut-off value in differentiating healthy subjects from CLD patients with any fibrosis was 5.47 kPa with an AUROC of 0.875. Conclusion 2D-SWE is a reliable and reproducible method to assess LSM with good diagnostic accuracy to assess liver fibrosis in patients with CLD.

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Therapeutic effects of Silybum marianum in the treatment of liver fibrosis and cirrhosis

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i2.21799 ◽

2019 ◽

Vol 10 (2) ◽

pp. 20-25

Author(s):

Asim Awan ◽

Aftab Saeed ◽

Khan Usmanghani ◽

Muhammad Rafiq

Keyword(s):

Liver Disease ◽

Hepatitis C ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Liver Stiffness ◽

Post Treatment ◽

Chronic Liver ◽

Fibrosis Stage ◽

Therapeutic Effects ◽

Silybum Marianum

Background: Cirrhosis is the late, symptomatic stage of chronic liver disease which occurs when scar tissue (fibrosis) largely replaces healthy liver tissue, compromising the function of the organ and predisposing to liver failure and hepatocellular carcinoma. It is mainly caused by hepatitis B and C virus infections or prolonged excessive consumption of alcohol. Aims and Objective: To study the therapeutic effects of Silybum marianum on liver fibrosis and cirrhosis in patients with chronic hepatitis C virus infection with Child Pugh Stage A& B. Materials and Methods: In this study 119 patients were treated for 6 months with Silybum marianum, their Liver stiffness measurements were carried out through Fibroscan, which is a non-invasive technique to assess liver fibrosis. Liver Fibrosis Scores viz; Aspartate aminotransferase/platelet ratio index(APRI) and fibrosis index based on four factors(FIB-4) were also employed at baseline and end of treatment. Results: Pre-treatment Liver Stiffness Measurement (LSM) score was 22.54 kilopascals(kPa) and post treatment was 17.30 kPa, a statistically significant change of 5.24 kPa (P ˂ 0.01) was observed, the mean percent change was 23.24%, its impact was observed in all METAVIR stages. Of the 72 (60.5%) patients with LSM ≥ 12.5 kPa (cirrhosis) at baseline 23 (32%) proved to have no cirrhosis (≥ 1 decrease in fibrosis stage) at post treatment. Similarly, 19 patients moved to stage F0-F1, 28 patients in F2 and 23 in F3. Overall fibrosis stage was improved (≥ 1 decrease in fibrosis stage) in 46 (38.7%) of 119 patients after 6 months of treatment. Serum fibrosis scores APRI and FIB-4 significantly decreased in comparison to baseline values. APRI values drooped from 1.24 to 0.83. FIB-4 score changed from 3.90 to 2.10. Conclusion: Our result suggests significant improvement with Silybum marianum in the patients status of liver fibrosis and cirrhosis associated with hepatitis C related chronic liver disease. Silybum marianum shows therapeutic effect in real life setting on the entire aspect of disease, as evaluated with the fibroscan and serum fibrosis score.

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Frequency and Characteristics of Overestimated Renal Function in Japanese Patients with Chronic Liver Disease and Its Relation to Sarcopenia

Nutrients ◽

10.3390/nu13072415 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2415

Author(s):

Sonoe Yoshida ◽

Goki Suda ◽

Masatsugu Ohara ◽

Qingjie Fu ◽

Zijian Yang ◽

...

Keyword(s):

Renal Function ◽

Liver Disease ◽

Chronic Liver Disease ◽

Muscle Mass ◽

High Frequency ◽

Psoas Muscle ◽

Japanese Patients ◽

Multivariate Regression Analysis ◽

Chronic Liver ◽

Function Loss

Renal dysfunction and sarcopenia are important prognostic factors in patients with chronic liver disease (CLD). Muscle atrophy can cause the overestimation of renal function based on serum creatinine. However, the frequency of overestimated renal function in Japanese patients with CLD and its relationship with sarcopenia are unclear. In present study, we evaluated the frequency of overestimated renal function, defined as a >20% higher eGFR using creatinine than using cystatin C, in 307 patients with CLD as well as its relationship with indicators of sarcopenia. In total, 24.8% of patients had overestimated renal function. In a multivariate regression analysis, liver cirrhosis (p = 0.004) and psoas muscle mass index (p = 0.049) were significantly associated with overestimated renal function. Loss of skeletal muscle mass was significantly more frequent in both male and female patients with overestimated renal function than without. In males, the loss of muscle strength and rate of sarcopenia, defined as loss of muscle mass and strength, were significantly higher in patients with than without overestimated renal function. The high frequency of overestimated renal function in Japanese patients suggests that indicators of renal function should be carefully considered; furthermore, monitoring and interventions for both renal function and sarcopenia are needed in patients with CLD.

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The assessment of liver fibrosis stage by two-dimensional shear wave ultrasound and transient elastography in patients with chronic liver disease

Journal of Hepatology ◽

10.1016/s0168-8278(17)31814-7 ◽

2017 ◽

Vol 66 (1) ◽

pp. S672

Author(s):

S.G. Kim ◽

B. Lee ◽

J.J. Yoo ◽

Y.S. Kim ◽

S.W. Jeong ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Shear Wave ◽

Transient Elastography ◽

Chronic Liver ◽

Fibrosis Stage ◽

Two Dimensional

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Temporal stability assessment in shear wave elasticity images validated by deep learning neural network for chronic liver disease fibrosis stage assessment

Medical Physics ◽

10.1002/mp.13521 ◽

2019 ◽

Vol 46 (5) ◽

pp. 2298-2309 ◽

Cited By ~ 9

Author(s):

Ilias Gatos ◽

Stavros Tsantis ◽

Stavros Spiliopoulos ◽

Dimitris Karnabatidis ◽

Ioannis Theotokas ◽

...

Keyword(s):

Neural Network ◽

Deep Learning ◽

Liver Disease ◽

Chronic Liver Disease ◽

Shear Wave ◽

Temporal Stability ◽

Chronic Liver ◽

Fibrosis Stage ◽

Stability Assessment ◽

Deep Learning Neural Network

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Protein C Deficiency in Chronic Hepatitis C

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029615587356 ◽

2016 ◽

Vol 23 (1) ◽

pp. 72-77 ◽

Cited By ~ 4

Author(s):

Aida Saray ◽

Rusmir Mesihovic ◽

Nenad Vanis ◽

Mehmedović Amila

Keyword(s):

Chronic Hepatitis ◽

Liver Disease ◽

Hepatitis C ◽

Chronic Liver Disease ◽

Chronic Hepatitis C ◽

Protein C ◽

Chronic Liver ◽

Fibrosis Stage ◽

Coagulation System ◽

Control Group

There is accumulating evidence that the coagulation system is involved in the process of fibrogenesis in chronic liver disease. Recent studies postulated a possible connection between plasmatic hypercoagulability and progression of fibrosis. The aim of the study was to investigate disorders of the coagulation system in patients with chronic hepatitis C having different extent of hepatic fibrosis well defined by liver histology. A total of 62 patients with chronic hepatitis C were recruited and categorized into 2 groups according to their histological fibrosis stage : mild/moderate fibrosis group (F0-F3 group, n = 30) and extensive fibrosis/cirrhosis group (F4-F6 group, n = 32). The control group consisted of 31 healthy individuals. The following hemostatic assays were evaluated: antithrombin III (AT), protein C (PC) activity, activated partial thromboplastin time, prothrombin time, plasma fibrinogen as well as conventional liver function test. The PC level exhibited a significant reduction in both patient groups when compared to the normal control group (89.25% ± 10.05% and 48.33% ± 15.86% vs 111.86 ± 10.90; P < .001 and P < .001). The PC was found to be the strongest associated factor to histological fibrosis stage ( r = –.834; P < .0001). Univariate and multivariate analysis showed that AT ( P = .003) and PC ( P = .0001) were the most important factors associated with advanced fibrosis. The PC ( P = .001) was found to be the only predictor of mild fibrosis. In conclusion, PC deficiency occurs in an early stage of liver fibrosis. The severity of deficiency is proportional to extent of fibrosis. The PC may have a key role in linking hypercoagulability with hepatic fibrogenesis in chronic liver disease.

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