scholarly journals The potential role of Transient Elastography in assessing patients with Primary Budd Chiari Syndrome

2020 ◽  
Author(s):  
Muriel Webb ◽  
Oren Shibolet ◽  
Yoav Lurie ◽  
Yakov Maor ◽  
Helena Katchman ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Potential Role ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
P Value ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Cirrhotic Patients

Abstract Background: Budd-Chiari syndrome (BCS) is a rare disease defined as hepatic venous outflow obstruction at any level from the hepatic venules up to the cavo-atrial junction. Transjugular Intrahepatic Portosystemic Shunt (TIPS) is performed as a decompressive treatment in some patients.Aim: To evaluate the potential role of Transient Elastography (TE) in assessing liver stiffness in patients with primary BCS.Methods: Twenty one BCS patients and 10 patients with liver cirrhosis with different underlying etiologies underwent abdominal ultrasound and TE.Results: Ninety-five percent of BCS patients had liver stiffness compatible with F4 with a median of 21 kPa, values which are usually obtained in patients with liver cirrhosis. Ten BCS and 10 cirrhotic patients underwent repeated TE with a median of 320 days between exams for BCS and 4.5 years for cirrhotic patients. The change of liver stiffness in BCS patients was 5.75 kPa (range − 0.4 to 26.6), compared with − 4.85 kPa (range − 15.6 to 15.0) in cirrhotic patients (p-value = 0.0029). Change in liver stiffness from baseline to follow-up in BCS patients who underwent TIPS (n = 4) was 0.2 kPa (range − 0.4 to 15.3), whereas in patients without intervention (n = 6) it was 6.75 kPa (range 1.3 to 26.6). The difference was not statistically significant.Conclusion: Liver stiffness in BCS patients is a dynamic progressive process with parameters of TE resembling liver cirrhosis. Even if TIPS seem to slow down the increment of liver stiffness, because of decreased liver congestion, it kept most patients with high score. The TE in BCS patients may be considered for monitoring for stable or upfront disease deterioration.

scholarly journals Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis

2015 ◽  
Vol 17 (1) ◽  
pp. 5 ◽  
Author(s):  
Adriana Bintintan ◽  
Romeo Ioan Chira ◽  
Vasile Virgil Bintintan ◽  
Georgiana Nagy ◽  
Roberta Maria Manzat-Saplacan ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Statistical Power ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
Non Invasive ◽  
Cirrhotic Patients ◽  
Ultrasound Parameters

Aims: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with he- patic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. Material and methods: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogas- troduodenoscopy. Results: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical signifi- cance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) ≥ 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. Conclusions: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.

Reliability of Transient Elastography as a non-Invasive Technique for Detection of Fibrosis in Budd Chiari Syndrome Patients after Endovascular Intervention

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed F Montasser ◽  
Eman M Barakat ◽  
Mohamed S Ghazy ◽  
Sara M Abdelhakam ◽  
Hend E Ebada ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Endovascular Intervention ◽  
Invasive Technique ◽  
Budd Chiari Syndrome ◽  
Metavir Score ◽  
Before And After ◽  
Chiari Syndrome

Abstract Aim of the work To test the reliability of fibroscan in detection of fibrosis in patients with Budd Chiari syndrome before and after endovascular intervention (after elimination of hepatic congestion). Background transient elastography (TE) is a noninvasive methodology that has been used to monitor liver stiffness in patients with chronic viral hepatitis. One of the limitations for accurate assessment of liver fibrosis by TE is the liver congestion. Liver congestion can result from Budd Chiari syndrome (BCS).The treatment of BCS is through restoring the flow of the blood between the portal vein to the inferior vena cava, which will lead to decongestion of the liver.TE, will be tested after liver decongestion for proper detection of liver fibrosis. Patients and methods This was a prospective cohort study conducted on 25 Egyptian patients with confirmed diagnosis of primary Budd-Chiari Syndrome (BCS) in the period from June 2017 to September 2019. TE was performed three days before endovascular intervention and three months after it. Liver biopsy was taken during the intervention for assessment of METAVIR score. Comparison was done between TE assessments before and after intervention in detection of the degree of liver fibrosis in comparison to METAVIR score measured in liver biopsy. Results FVLM was the most common hypercoagulable cause in the involved patients. There was significant drop in Liver Stiffness Measurements (LSM) measured three months post-intervention indicating improvement of liver fibrosis after relieving liver congestion but still not correlated to the METAVIR scores measured in the liver biopsy. Conclusion Liver congestion has high impact on Liver stiffness measurement giving overestimation which improves significantly after decongestion of the liver by the endovascular intervention.

scholarly journals “SPLEEN STIFFNESS MEASUREMENT IN LIVER CIRRHOSIS PATIENTS FOR NONINVASIVE ASSESSMENT OF ESOPHAGEAL VARICES USING FIBROSCAN”

2020 ◽  
pp. 1-2
Author(s):  
Revathy Marimuthu Shanmugam ◽  
Vinay C ◽  
Sathya Gopalasamy ◽  
Chitra Shanmugam
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Esophageal Varix ◽  
Esophageal Varices ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Surrogate Marker ◽  
Stiffness Measurement ◽  
Spleen Stiffness ◽  
Cirrhotic Patients

BACKGROUND: Many noninvasive surrogate marker for Portal hypertension or for the presence or grade of esophageal varices were studied..Splenomegaly along with splenic congestion secondary to splenic hyperdynamic circulation is seen secondary to Portal hypertension in cirrhotic patients that can be quantified by elastography. AIM:The aim of this study was to investigate whether spleen stiffness, assessed by TE, useful tool for grading chronic liver diseases and to compare its performance in predicting the presence and size of esophageal varices in liver cirrhosis patients. METHODOLOGY:86 patients with cirrhosis and 80 controls underwent transient elastography of liver and spleen for the assessment of liver stiffness (LSM) and spleen stiffness (SSM) . Upper GI endoscopy done in all Cirrhotic patients. RESULTS: Spleen stiffness showed higher values in liver cirrhosis patients as compared with controls: 58.2 kpa vs14.8 kpa (P < 0.0001) and also found to be significantly higher in cirrhotic patients compared with varices and those without varices (69.01 vs 42.05 kpa, P < 0.0001). Liver stiffness was also found to be higher in cirrhotic patients with varices when compared to patients without varices (38.5vs 21.2 kpa). Using both liver and spleen stiffness measurement we can predicted the presence of esophageal varices correctly. CONCLUSION: Spleen stiffness can be assessed using transient elastography, higher value correlated well with liver cirrhosis and presence of esophageal varices although it couldn’t correlate with grade of Esophageal Varix. Combined assessment of spleen and liver stiffness had better prediction of presence of Esophageal Varix.

scholarly journals Assessment of Spleen Stiffness for Prediction of Varices in Patients with Hepatitis C Related Cirrhosis Using Transient Elastography

2020 ◽  
pp. 9-18
Author(s):  
Naglaa El-Toukhy Ramadan El-Toukhy ◽  
Sharaf Elsayed Ali Hassanien ◽  
Ramy A. Metwaly ◽  
Medhat A. Khalil ◽  
Badawy A. Abdulaziz
Keyword(s):  
Liver Cirrhosis ◽  
Hepatitis C ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Diagnostic Value ◽  
Group I ◽  
Spleen Stiffness ◽  
Cirrhotic Patients

Background and Study Aims: Portal hypertension is one of the most important complications of liver cirrhosis. The prevalence of varices among cirrhotic patients is variable. Therefore, endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burdens to endoscopic units. Our aim was to assess the diagnostic accuracy of spleen stiffness measured by transient elastography (Fibroscan) for prediction of the presence of varices in patients with hepatitis C related cirrhosis. Patients and Methods: The study was carried out on 100 patients with HCV-induced cirrhosis and were divided into 2 groups according to presence or absence of varices by Esophago-gastro-duodenoscopy: Group I: patients with HCV-induced cirrhosis with varices; Group II: patients with HCV-induced cirrhosis without varices. Clinical and laboratory parameters, andominal ultrasonography, Upper gastrointestinal endoscopy and transient elastography to assess the liver and spleen stiffness were carried out to all studied persons. Results: Spleen stiffness had significant diagnostic value to differentiate between cirrhotic patients with varices and cirrhotic patients without varices , it had significant diagnostic value in presence of esophageal varices at cut-off (≥46.4 K Pascal) the sensitivity for detection of esophageal varices was 93%, specificity 100%, positive predictive value (PPV) was 80%, negative predictive value (NPV) was 100%; accuracy was 95% and area under the curve was 0.98 denoting that spleen stiffness is a good predictor of esophageal varices. Conclusion: Spleen stiffness was considered as an excellent predictor of esophageal varices and better than liver stiffness in prediction of esophageal varices presence and had significant diagnostic value to differentiate between the patients with varices and patients without varices at cut off (≥46.4 K Pascal) and it may have a role in variceal grading.

scholarly journals Prediction of esophageal varices in liver cirrhosis by transient elastography and aspartate aminotransferase - to - platelet ratio index (APRI)

2018 ◽  
Vol 6 (1) ◽  
pp. 16-21
Author(s):  
Debashis Kumar Sarkar ◽  
Golam Azam ◽  
Majharul Haque ◽  
Anisur Rahman
Keyword(s):  
Liver Cirrhosis ◽  
Complete Blood Count ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Variceal Hemorrhage ◽  
Cutoff Value ◽  
Liver Injuries ◽  
Cirrhotic Patients ◽  
Cirrhosis Of Liver ◽  
Almost All

Background: Cirrhosis is a chronic liver disease that can be caused by almost all progressive liver injuries, such as viral, autoimmune, hereditary, metabolic and toxin mediated liver diseases. Esophageal varix (EV) is a frequent complication of cirrhosis. Although the survival rate of patients with bleeding cirrhosis has improved because of the progress in variceal hemorrhage management, the hospital mortality rate is still around 14.5% cases. Early detection of EV in all patients with liver cirrhosis is required in order to reduce the mortality.Method: This observational study was done at department of Gastrointestinal, Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, during the period of August 2015 to October 2016. A total of 65 patients with cirrhosis of liver were included. Complete blood count, liver function test, endoscopy of upper GIT, ultrasonography, transient elastogram were done for all patients. Statistical analysis was done with SPSS version 22.Result: The study included 65 cirrhotic patients, among them 66.2 % were male. The mean age was 53.8 years. For predicting EVs, transient elastography at a cutoff value of 18 kpa demonstrated a sensitivity was 88.7% (95% CI=82.3-92.7), specificity 75.0% (95% CI=46.9-92.6), PPV 94.0% (95% CI=87.2-98.2), NPV 60.0% (95% CI= 37.5 -74.0), AUC was 0.769. In APRI for prediction of EVs at cutoff value 1.00, sensitivity was 63.3% (95% CI=55.6-65.4), specificity 83.3.0% (95% CI=53.7-97.0), PPV 94.3% (95% CI=84.1-99.0), NPV 33.3% (95%CI=21.5-38.8) and AUC was 0.779.Conclusion: A significant positive correlation found between transient elastography with EVs in cirrhotic patients. Liver stiffness value at 18 Kpa can predict EVs in cirrhotic patients. On contrary, APRI had a less(negative predictive value) NPV that showed there is no satisfactory cutoff value for APRI to be used as a predictor of EVs.Bangladesh Crit Care J March 2018; 6(1): 16-21

scholarly journals Systemic Mastocytosis: A Rare Case of Increased Liver Stiffness

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Stefanie Adolf ◽  
Gunda Millonig ◽  
Helmut Karl Seitz ◽  
Andreas Reiter ◽  
Peter Schirmacher ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Histological Analysis ◽  
Transient Elastography ◽  
Systemic Mastocytosis ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
Bone Lesions ◽  
Non Invasive ◽  
Liver Specimen ◽  
Clinical Algorithms

Assessment of liver stiffness (LS) by transient elastography (Fibroscan) has significantly improved the noninvasive diagnosis of liver fibrosis. We here report on a 55-year-old patient with drastically increased LS due to previously unknown systemic mastocytosis. The patient initially presented with increased weight loss, nocturnal pruritus, increased transaminases, bilirubinemia, and thrombocytopenia. Abdominal ultrasound showed ascites, hepatomegaly, and splenomegaly. In addition, LS was 75 kPa (IQR 0 kPa) clearly exceeding the cut-off value for F4 cirrhosis of 12.5 kPa. However, histological analysis of the liver specimen indicated liver involvement by systemic mastocytosis and excluded liver cirrhosis. An additional CT scan detected disseminated bone lesions. After three months of treatment with Midostaurin, LS slightly decreased down to 31.9 kPa (IQR 8.3 kPa). This case illustrates that diffused sinusoidal neoplastic infiltrates are a pitfall in the non-invasive diagnosis of liver cirrhosis. In conclusion, refined clinical algorithms for increased LS should also include mastocytosis in addition to inflammation, congestion, and biliary obstruction.

Evaluation of Transient Elastography in Prediction Of De novo Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nadia abdelaty Abdelkader ◽  
Moustafa Hamed Abdelaleem ◽  
Mohammed El-Gharib Abo El- maaty ◽  
Heba Ismail Aly ◽  
Sayed Ahmed Sayed
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Transient Elastography ◽  
P Value ◽  
Hepatic Decompensation ◽  
Non Invasive ◽  
Prediction Of Mortality ◽  
The Mean ◽  
One Year

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and it is also a common cause of death in patients with chronic liver disease. The curative treatment options for HCC that are currently available are surgical resection, liver transplantation and radiofrequency ablation .Despite progressive improvements in the efficacy of RFA, the survival of patients with HCC who undergo RFA remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after RFA. Aim of the work To evaluate the role of transient elastography (as an indirect indicator to degree of liver fibrosis) in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation in hepatitis C related hepatocellular carcinoma .And to compare between transient elastography and other non invasive fibrosis indices in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation hepatitis C related hepatocellular carcinoma Patients and methods This prospective cohrt study was conducted on hepatocellular carcinoma patient, who underwent radiofrequency ablation in Tropical Medicine Department in Eldemerdash and Ain Shams Specialized Hospital, HCC clinic Ain Shams University Hospitals, Cairo, Egypt between march, 2017 and May, 2019. Data of the patient, who underwent radiofrequency ablation during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria and underwent radiofrequency ablation were followed up for 12 months. Results TE revealed 28 patients with F4 and only 2 patients with F3, the mean measurement of liver stiffness was (22.45 ± 10.36) KPa. There was a significant negative correlation between LS and denovo recurrence of HCC (mean of LS in patients with complete response was 17.19 ± 3.32 and the mean of LS in patient with denovo recurrence was 36,94 ± 5.93,with the The best cut off value ≥24.65 (p value &lt; 0.001)). There was no significant correlation between CDC, FIB4, API scores and denovo recurrence of HCC. Also it was found that the LS was significantly associated with prediction of manifestation of hepatic decompensation after RFA (means of LS in patient without manifestation decompensation after RFA (p value &lt;0.001) .Regarding prediction of mortality, LS at cut off value &gt; 42 .75 (p value = 0,031) was significantly associated with prediction of mortality after one year of RFA. As regard serum non invasive fibrosis indices our results showed correlation between FIB4 score and hepatic decompensation after one year of intervention (the mean of FIB4 score in patients ascites and jaundice was 6.05 ± 4.71 (p value = 0.05) ).Therewas no statistically significant correlation between CDS and API with hepatic decompensation after RFA .As regard role of serum non invasive fibrosis indices in prediction of mortality after RFA, FIB4 score, CDS and API were statistically non significant. Conclusion Our data suggest that LS measurement is a useful predictor of HCC de novorecurrence overall survival and possibility of hepatic decompensation after RFA

scholarly journals Liver stiffness is a useful marker for assessing the therapeutic effect of angioplasty in Budd-Chiari syndrome: A case report

Kanzo ◽  
2018 ◽  
Vol 59 (10) ◽  
pp. 563-570
Author(s):  
Ran Nagahara ◽  
Tomomitsu Matono ◽  
Masahiko Koda ◽  
Yukako Matsuki ◽  
Masashi Yamane ◽  
...  
Keyword(s):  
Case Report ◽  
Therapeutic Effect ◽  
Liver Stiffness ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome
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