The Frequency and Determinants of Liver Stiffness Measurement Failure: A Retrospective Study of “Real-Life” 38,464 Examinations

Background & Aims: Noninvasive assessment of liver stiffness has been increasingly used to evaluate fibrosis instead of liver biopsy, especially in patients with chronic viral hepatitis. The aim of this study was to assess the performance in staging liver fibrosis of the updated ElastPQ® technique (EPIQ7 ultrasound system, Philips Healthcare, Bothell, WA, USA) in the “real life” setting by using the FibroScan as the reference standard and to understand whether the use of the quality criteria improves the performance of the technique. Methods: This was a cross-sectional study: 278 patients affected by chronic hepatitis C referred for liver stiffness measurement with the FibroScan® 502 Touch device (Echosens, Paris, France) underwent measurements also with the ElastPQ® technique. For the assessment of significant fibrosis (F≥2), advanced fibrosis (F≥3) and cirrhosis (F=4), respectively, we used the cutoffs of 7.0, 9.5 and 12.0 kPa. The diagnostic performance of ElastPQ® was assessed using the area under the ROC (AUROC) curve analysis and was evaluated overall and for cases with (a) 10 measurements and IQR/M≤30%, (b) 5 measurements and IQR/M ≤30%, (c) 10 measurements and IQR/M>30%, (d) 5 measurements and IQR/M>30%. Results: The optimal cutoffs of ElastPQ® for significant fibrosis, advanced fibrosis and cirrhosis were 6.43, 9.54 and 11.34 kPa, respectively. For measurements with an IQR/M≤30%, there was no statistically significant decrease in sensitivity between 10 and 5 measurements (p=0.26, p=0.09, p=0.71, for F≥2, F≥3, and F=4, respectively). Conclusion: The ElastPQ® technique is reliable and accurate for staging liver fibrosis. The number of measurements does not affect the performance. Abbreviations: ALP: alkaline phosphatase; ALT: alanine aminotransferase; AST: aspartate aminotransferase; AUROC: area under the ROC curve; BMI: body mass index; GGT: gamma-glutamyl transferase; LR: likelihood ratio; LSM: liver stiffness measurement; pSWE: point shear wave elastography; ROC: receiver operating characteristic; VCTE: vibration controlled transient elastography; VTQ®: virtual touch quantification.

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Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Scientific Reports ◽

10.1038/s41598-020-80136-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Youwen Hu ◽

Zhili Wen

Keyword(s):

Platelet Count ◽

Retrospective Study ◽

Prediction Models ◽

Liver Stiffness ◽

International Normalized Ratio ◽

Ratio Score ◽

Liver Stiffness Measurement ◽

Stiffness Measurement ◽

Non Invasive ◽

Rule Out

AbstractSeveral non‐invasive tests (NITs) based on liver stiffness measurement (LSM) have been developed to rule out varices needing treatment (VNT), including the Baveno VI criteria (B6C), the expanded Baveno VI criteria (EB6C), the LSM-spleen diameter to platelet ratio score (LSPS), and the VariScreen algorithm. We aimed to validate and compare those NITs in patients with compensated advanced chronic liver disease (cACLD). This retrospective study enrolled 354 patients with cACLD; LSM, platelet count (PLT), international normalized ratio (INR), gastroscopy and spleen diameter (SD) were collected. VNT prevalence was 28.5%. In comparison, patients with VNT included higher LSM, INR, and SD and lower PLT. Gastroscopies were spared for 27.7% of patients using the B6C with 1.0% VNT missed rate, 47.2% of patients using the EB6C with 5.9% VNT missed rate, 57.6% of patients using the LSPS with 9.9% VNT missed rate, and 45.5% of patients using the VariScreen algorithm with 3.0% VNT missed rate. Only the B6C and the VariScreen algorithm could safely avoid gastroscopies, and the VariScreen algorithm spared more gastroscopies than the B6C. The results were consistent with the previous when performed subgroup analysis. In conclusion, the VariScreen algorithm performed the best and can be used in clinical.

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Role of Liver Stiffness Measurement in Predicting HCC Occurrence in Direct-Acting Antivirals Setting: A Real-Life Experience

Digestive Diseases and Sciences ◽

10.1007/s10620-019-05604-8 ◽

2019 ◽

Vol 64 (10) ◽

pp. 3013-3019 ◽

Cited By ~ 7

Author(s):

Luca Rinaldi ◽

Maria Guarino ◽

Alessandro Perrella ◽

Pia Clara Pafundi ◽

Giovanna Valente ◽

...

Keyword(s):

Life Experience ◽

Liver Stiffness ◽

Real Life ◽

Direct Acting Antivirals ◽

Liver Stiffness Measurement ◽

Stiffness Measurement ◽

Direct Acting

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Feasibility of Transient Elastography with M and XL probes in real life

Medical Ultrasonography ◽

10.11152/mu.2013.2066.181.xsi ◽

2016 ◽

Vol 18 (1) ◽

pp. 7 ◽

Cited By ~ 12

Author(s):

Ioan Sporea ◽

Roxana Șirli ◽

Ruxandra Mare ◽

Alina Popescu ◽

Siegfried Cristian Ivașcu

Keyword(s):

Liver Disease ◽

Transient Elastography ◽

Liver Stiffness ◽

Real Life ◽

Daily Practice ◽

Obese Patients ◽

Liver Stiffness Measurement ◽

Stiffness Measurement ◽

Probe Transducer ◽

Transducer Frequency

Aim: Reliable liver stiffness measurement (RLSM) using Transient Elastography (TE) with the standard M probe are difficult to obtain in overweight (BMI≥25kg/m2) and obese (BMI>30kg/m2) patients. The aim of our paper was to assess the feasibility of TE in daily practice using both M and XL probes. Material and method: We studied retrospectively 3235 patients with chronic liver disease assessed by TE first by the M probe (standard probe – transducer frequency 3.5 MHz), and if the measurements were unreliable, with the XL probe (transducer frequency 2.5 MHz). Reliable measurements were defined as the median of 10 valid measurements with a success rate ≥ 60% and an interquartile range < 30%. Results of liver elasticity were expressed in kiloPascals (kPa). Results: RLSM by M probe were obtained in 62.2% (2015/3235) patients, and by XL probe in 1011/1220 (80%) of patients with unreliable measurements by M probe; thus we obtained RLSM in 93.5% of 3235 cases.In overweight patients we obtained RLSM in 89.9% (1039/1156) cases: in 63.1% (729) by M probe and in 26.8% (310) by XL probe. In obese patients we obtained RLSM in 83.8% (746/890): in 18.4% (164) by M probe and in 65.4% (582) by XL probe. Thus, by using both probes, RLSM were obtained in 1785 (87.2%) of overweight and obese patients. Conclusion: The feasibility of the M probe was 62.2% in our Department. Reliable measurements using M or XL probe allowed the evaluation of liver stiffness in 93.5% of cases. By using both M and XL probes, reliable LSM by TE can be obtained in the majority of obese and overweight patients (87.2%).

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