Diagnosis of liver fibrosis: an emphasis on elastography

In the strategy of managing patients with chronic diffuse liver diseases, the priority areas are the determination of the diagnosis with the determination of the main risk factors, the activity of the process (steatosis, steatohepatitis), as well as the degree of fibrous transformation. The rate of progression of liver fibrosis is a decisive factor that will determine the prognosis, treatment tactics and the likelihood of severe complications. The “gold standard” for diagnosing chronic liver pathology is a puncture liver biopsy with morphological examination of the liver tissue. At the same time, potential complications, contraindications to the procedure, low patient compliance, as well as errors in the interpretation of the results obtained due to various reasons are significant limitations of this diagnostic method. These shortcomings were the reason for the search for reliable non-invasive methods for diagnosing liver fibrosis both during the initial examination and during subsequent monitoring in dynamics. Modern methods of liver elastography are widely used for non-invasive assessment of fibrosis, demonstrating good diagnostic capabilities and significantly reducing the need for liver biopsy. Various elastography methods, which have their own advantages and disadvantages, effectively complement each other, which is successfully used in clinical practice in the diagnosis of fibrous transformation. The combined use of elastographic methods and commercial predictive diagnostic panels will increase the diagnostic accuracy in the determination of liver fibrosis.

A Multidisciplinary Approach to Evaluate the Presence of Hepatic and Cardiac Abnormalities in Patients with Post-Acute COVID-19 Syndrome—A Pilot Study

(1) Background: Patients suffering from the novel coronavirus 2019 (COVID-19) disease could experience several extra-pulmonary involvements, including cardiovascular complications and liver injury. This study aims to evaluate the presence of cardiac and liver alterations in patients with post-acute COVID-19 syndrome using transthoracic echocardiography (TTE) and liver elastography (LE). (2) Methods: A total of 97 subjects recovering from COVID-19, attending the hospital’s specialized outpatient clinic for persisting symptoms at 3 to 11 weeks after the acute illness, were included in this study. They all had a basal COVID-19 assessment, and subsequently, a clinical evaluation, laboratory tests, TTE, and LE. (3) Results: considering the presence of pulmonary injury during COVID-19, patients were divided into two groups. Although none of them had altered systolic function, we evidenced pulmonary hypertension, diastolic dysfunction, increased liver stiffness, viscosity, and steatosis in around one-third of the patients, with significantly higher values in subjects with pulmonary injury compared to those without. (4) Conclusion: persisting symptoms characterizing the post-acute COVID-19 syndrome could be explained by residual cardiac and hepatic lesions, which were worse in more severe COVID-19 forms. These patients may be at risk of developing liver fibrosis and cardiac alterations and should be investigated in the first 12 weeks after the onset of the infection.

Liver Elastography in Healthy Children Using Three Different Systems – How Many Measurements Are Necessary?

Purpose Liver elastography is increasingly being applied in screening for and follow-up of pediatric liver disease, and has been shown to correlate well with fibrosis staging through liver biopsy. Because time is of the essence when examining children, we wanted to evaluate if a reliable result can be achieved with fewer acquisitions. Materials and Methods 243 healthy children aged 4–17 years were examined after three hours of fasting. Participants were divided into four age groups: 4–7 years; 8–11 years; 12–14 years and 15–17 years. Both two-dimensional shear wave elastography (2D-SWE; GE Logiq E9) and point shear wave elastography (pSWE; Samsung RS80A with Prestige) were performed in all participants, while transient elastography (TE, Fibroscan) was performed in a subset of 87 children aged 8–17 years. Median liver stiffness measurement (LSM) values of 3, 4, 5, 6, 7, and 8 acquisitions were compared with the median value of 10 acquisitions (reference standard). Comparison was performed for all participants together as well as within every specific age group. We investigated both the intraclass correlation coefficient (ICC) with absolute agreement and all outliers more than 10 %, 20 % or ≥ 0.5 or 1.0 kPa from the median of 10 acquisitions. Results For all three systems there was no significant difference between three and ten acquisitions, with ICCs ≥ 0.97. All systems needed 4 acquisitions to achieve no LSM deviating ≥ 1.0 kPa of a median of ten. To achieve no LSM deviating ≥ 20 % of a median of ten acquisitions, pSWE and TE needed 4 acquisitions, while 2D-SWE required 6 acquisitions. Conclusion Our results contradict recommendations of 10 acquisitions for pSWE and TE and only 3 for 2D-SWE.

External Validation and Clinical Utility of Non-Invasive Prediction Models for Non-Alcoholic Fatty Liver Disease in Malaysia

Background: Many prediction models have been developed to detect non-alcoholic fatty liver disease (NAFLD). The drawbacks of many of models are the use of parameters that are not routinely measured locally. This study aimed to evaluate the external validity of a series of prediction models for NAFLD, which were selected based on the routinely measured and tested clinical parameters in public healthcare centers in Malaysia. Methods: A literature search of articles that described the prediction models for NAFLD on adult subjects between 2000 and 2019 was conducted. The validation cohort comprised patients who underwent liver elastography using the Fibroscan® device in a public tertiary care center between January 2017 and December 2019. Both the discrimination and calibration of each model were assessed to determine their predictive performance. Results: Out of the 404 patients undergoing liver elastography, 280 were diagnosed with NAFLD (69.3%). Six prediction models were identified from the existing literature and evaluated. The calibration assessment demonstrated that although three of the models overestimated the NAFLD risk, updating the models generally improved their calibration performance. The discriminative performance of the selected models ranged from 0.717 to 0.783. With a specificity level of 90% and 80%, the sensitivity of all the models fell between 31.1%–48.9% and 46.4%–66.8%, respectively. The Framingham Steatosis Index (FSI) model demonstrated a better predictive performance compared to the other models. Conclusions: The FSI model demonstrates an acceptable predictive performance. Its application in clinical practice could promote the screening and early treatment of NAFLD in the Malaysian population.