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Wang TJ, Jirapinyo P, Shah R, Schuster K, Thompson CC, Lautz DB, Doyon L, Chang K, Ryou M. EUS-guided liver palpation as a screening tool for advanced fibrosis and cirrhosis in patients with suspected metabolic dysfunction-associated steatotic liver disease: a pilot study. Gastrointest Endosc 2024; 100:317.e1-317.e9. [PMID: 38431106 DOI: 10.1016/j.gie.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND AIMS Endoscopic liver "palpation" can be performed by indenting the liver surface under EUS. Indentation depth is measured with the use of sonographic calipers. We hypothesized that fibrotic livers are more difficult to indent, and that indentation can accurately predict liver fibrosis staging. We compared EUS-guided liver palpation and conventional screening modalities in patients with suspected metabolic dysfunction-associated steatotic liver disease. METHODS This was a cross-sectional pilot study. Consecutive patients at 3 hospitals from 2021 to 2023 underwent EUS-guided palpation with liver biopsy. Liver palpation was compared with fibrosis-4 index (FIB-4), aspartate transaminase to platelet ratio index (APRI), nonalcoholic fatty liver disease fibrosis score (NFS), and transient elastography in predicting fibrosis staging on histology. Area under the receiver operating characteristic curve analysis was performed. RESULTS Seventy-three patients were included. Mean age was 49.1 years, and 71.2% were female. Mean body mass index was 41.1 kg/m.2 Indentation depth was negatively correlated with fibrosis stage (Kruskal-Willis test, P < .0001). EUS palpation demonstrated c-statistics of 0.79 and 0.95 in discriminating advanced fibrosis and cirrhosis, respectively. EUS liver palpation was superior to NFS in predicting advanced fibrosis (P = .0057) and superior to APRI and NFS in predicting cirrhosis (P = .0099 and P = .045, respectively). EUS palpation was not significantly different from FIB-4. EUS palpation was superior to transient elastography in predicting cirrhosis (P = .045). When optimal cutoffs were used, indentation measurement ≤3.5 mm yielded 100% predictive value for ruling in advanced fibrosis, and ≥4.0 mm yielded 100% predictive value for ruling out cirrhosis. CONCLUSIONS EUS liver palpation is a novel, accurate, and easy-to-use screening tool for advanced fibrosis and cirrhosis in patients with metabolic dysfunction-associated steatotic liver disease.
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Affiliation(s)
- Thomas J Wang
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pichamol Jirapinyo
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raj Shah
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Christopher C Thompson
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David B Lautz
- Center for Weight Loss, Emerson Hospital, Concord, Massachusetts
| | - Laura Doyon
- Center for Weight Loss, Emerson Hospital, Concord, Massachusetts
| | - Kenneth Chang
- Division of Gastroenterology, University of California, Irvine, School of Medicine, Irvine, California
| | - Marvin Ryou
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts
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Ruan D, Shi Y, Jin L, Yang Q, Yu W, Ren H, Zheng W, Chen Y, Zheng N, Zheng M. An ultrasound image-based deep multi-scale texture network for liver fibrosis grading in patients with chronic HBV infection. Liver Int 2021; 41:2440-2454. [PMID: 34219353 PMCID: PMC9291892 DOI: 10.1111/liv.14999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The evaluation of the stage of liver fibrosis is essential in patients with chronic liver disease. However, due to the low quality of ultrasound images, the non-invasive diagnosis of liver fibrosis based on ultrasound images is still an outstanding question. This study aimed to investigate the diagnostic accuracy of a deep learning-based method in ultrasound images for liver fibrosis staging in multicentre patients. METHODS In this study, we proposed a novel deep learning-based approach, named multi-scale texture network (MSTNet), to assess liver fibrosis, which extracted multi-scale texture features from constructed image pyramid patches. Its diagnostic accuracy was investigated by comparing it with APRI, FIB-4, Forns and sonographers. Data of 508 patients who underwent liver biopsy were included from 4 hospitals. The area-under-the ROC curve (AUC) was determined by receiver operating characteristics (ROC) curves for significant fibrosis (≥F2) and cirrhosis (F4). RESULTS The AUCs (95% confidence interval) of MSTNet were 0.92 (0.87-0.96) for ≥F2 and 0.89 (0.83-0.95) for F4 on the validation group, which significantly outperformed APRI, FIB-4 and Forns. The sensitivity and specificity of MSTNet (85.1% (74.5%-92.0%) and 87.6% (78.0%-93.6%)) were better than those of three sonographers in assessing ≥F2. CONCLUSIONS The proposed MSTNet is a promising ultrasound image-based method for the non-invasive grading of liver fibrosis in patients with chronic HBV infection.
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Affiliation(s)
- Dongsheng Ruan
- Qiushi Academy for Advanced StudiesZhejiang UniversityHangzhouZhejiangP. R. China,State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesNational Clinical Research Center for Infectious DiseasesCollaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP. R. China
| | - Yu Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesNational Clinical Research Center for Infectious DiseasesCollaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP. R. China
| | - Linfeng Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesNational Clinical Research Center for Infectious DiseasesCollaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP. R. China
| | - Qiao Yang
- Department of Infectious DiseasesSir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhouZhejiangP. R. China
| | - Wenwen Yu
- Department of Infectious DiseasesBeilun People’s HospitalNingboP. R. China
| | - Haotang Ren
- State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesNational Clinical Research Center for Infectious DiseasesCollaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP. R. China
| | - Weiyang Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesNational Clinical Research Center for Infectious DiseasesCollaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP. R. China
| | - Yongping Chen
- Wenzhou Key Laboratory of HepatologyDepartment of Infectious DiseasesHepatology Institute of Wenzhou Medical UniversityThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangP. R. China
| | - Nenggan Zheng
- Qiushi Academy for Advanced StudiesZhejiang UniversityHangzhouZhejiangP. R. China
| | - Min Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesNational Clinical Research Center for Infectious DiseasesCollaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP. R. China
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Chen J, Huang H, Hao W, Xu J. A machine learning method correlating pulse pressure wave data with pregnancy. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3272. [PMID: 31709770 DOI: 10.1002/cnm.3272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
Pulse feeling , representing the tactile arterial palpation of the heartbeat, has been widely used in traditional Chinese medicine (TCM) to diagnose various diseases. The quantitative relationship between the pulse wave and health conditions however has not been investigated in modern medicine. In this paper, we explored the correlation between pulse pressure wave (PPW), rather than the pulse key features in TCM, and pregnancy by using deep learning technology. This computational approach shows that the accuracy of pregnancy detection by the PPW is 84% with an area under the curve (AUC) of 91%. Our study is a proof of concept of pulse diagnosis and will also motivate further sophisticated investigations on pulse waves.
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Affiliation(s)
- Jianhong Chen
- Department of Mathematics, Pennsylvania State University, State College, Pennsylvania
| | - Huang Huang
- School of Mathematical Sciences, Peking University, Beijing, China
| | - Wenrui Hao
- Department of Mathematics, Pennsylvania State University, State College, Pennsylvania
| | - Jinchao Xu
- Department of Mathematics, Pennsylvania State University, State College, Pennsylvania
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Brand JF, Furenlid LR, Altbach MI, Galons JP, Bhattacharyya A, Sharma P, Bhattacharyya T, Bilgin A, Martin DR. Task-based optimization of flip angle for fibrosis detection in T1-weighted MRI of liver. J Med Imaging (Bellingham) 2016; 3:035502. [PMID: 27446971 DOI: 10.1117/1.jmi.3.3.035502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/28/2016] [Indexed: 11/14/2022] Open
Abstract
Chronic liver disease is a worldwide health problem, and hepatic fibrosis (HF) is one of the hallmarks of the disease. The current reference standard for diagnosing HF is biopsy followed by pathologist examination; however, this is limited by sampling error and carries a risk of complications. Pathology diagnosis of HF is based on textural change in the liver as a lobular collagen network that develops within portal triads. The scale of collagen lobules is characteristically in the order of 1 to 5 mm, which approximates the resolution limit of in vivo gadolinium-enhanced magnetic resonance imaging in the delayed phase. We use MRI of formalin-fixed human ex vivo liver samples as phantoms that mimic the textural contrast of in vivo Gd-MRI. We have developed a local texture analysis that is applied to phantom images, and the results are used to train model observers to detect HF. The performance of the observer is assessed with the area-under-the-receiver-operator-characteristic curve (AUROC) as the figure-of-merit. To optimize the MRI pulse sequence, phantoms were scanned with multiple times at a range of flip angles. The flip angle that was associated with the highest AUROC was chosen as optimal for the task of detecting HF.
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Affiliation(s)
- Jonathan F Brand
- University of Arizona , College of Optical Sciences, 1630 East University Boulevard, Tucson, Arizona 85719, United States
| | - Lars R Furenlid
- University of Arizona, College of Optical Sciences, 1630 East University Boulevard, Tucson, Arizona 85719, United States; University of Arizona, College of Medicine, Department of Medical Imaging, P.O. Box 245067 Tucson, Arizona 85724-5067, United States
| | - Maria I Altbach
- University of Arizona , College of Medicine, Department of Medical Imaging, P.O. Box 245067 Tucson, Arizona 85724-5067, United States
| | - Jean-Philippe Galons
- University of Arizona , College of Medicine, Department of Medical Imaging, P.O. Box 245067 Tucson, Arizona 85724-5067, United States
| | - Achyut Bhattacharyya
- University of Arizona , College of Medicine, Department of Pathology, 1501 North Campbell Avenue, Tucson, Arizona 85724, United States
| | - Puneet Sharma
- University of Arizona , College of Medicine, Department of Medical Imaging, P.O. Box 245067 Tucson, Arizona 85724-5067, United States
| | - Tulshi Bhattacharyya
- University of Arizona , College of Medicine, Department of Pathology, 1501 North Campbell Avenue, Tucson, Arizona 85724, United States
| | - Ali Bilgin
- University of Arizona , College of Medicine, Department of Medical Imaging, P.O. Box 245067 Tucson, Arizona 85724-5067, United States
| | - Diego R Martin
- University of Arizona , College of Medicine, Department of Medical Imaging, P.O. Box 245067 Tucson, Arizona 85724-5067, United States
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Tuomi H, Kultti J, Danielsson J, Kangastupa P, Akerman K, Niemelä O. Serum soluble urokinase plasminogen activator receptor in alcoholics: relation to liver disease severity, fibrogenesis, and alcohol use. J Gastroenterol Hepatol 2014; 29:1991-5. [PMID: 24909734 DOI: 10.1111/jgh.12639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Heavy alcohol consumption may lead to development of liver disease and the need for non-invasive parameters for detecting those at risk is widely acknowledged. METHODS We measured serum soluble urokinase-type plasminogen activator receptor (suPAR) levels from 63 patients with alcoholic liver disease (ALD), 57 heavy drinkers without apparent liver disease, and 39 controls who were either moderate drinkers or abstainers. RESULTS The highest serum suPAR concentrations were detected in patients with ALD (P < 0.001) showing high diagnostic accuracy in differentiating ALD patients from heavy drinkers without liver disease (area under curve 0.921, P < 0.001). Levels of suPAR correlated positively with serum markers of fibrogenesis (aminoterminal propeptide of type III procollagen and hyaluronic acid) (P < 0.001), with clinical (combined clinical and laboratory index P < 0.01) and morphological (combined morphological index P < 0.05) indices of liver disease severity and with the stage of fibrosis (P < 0.01). The suPAR concentrations were also elevated in heavy drinkers when compared with healthy controls (P < 0.001). CONCLUSION The data indicate that serum suPAR concentrations are increased as a result of heavy alcohol consumption and further with development of ALD, showing a good diagnostic performance in detecting those with liver disease. The association with the histological severity of ALD and correlation with fibrosis indicates potential of serum suPAR also as a prognostic marker in ALD.
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Affiliation(s)
- Heidi Tuomi
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and University of Tampere, Seinäjoki, Finland
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Ding H, Wu T, Ma K, Wang X, Wu Z, Guo W, Qi J, Ning Q. Noninvasive measurement of liver fibrosis by transient elastography and influencing factors in patients with chronic hepatitis B-A single center retrospective study of 466 patients. ACTA ACUST UNITED AC 2012; 32:69-74. [PMID: 22282248 DOI: 10.1007/s11596-012-0012-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Indexed: 12/11/2022]
Abstract
The noninvasive measurement of liver stiffness (LS) was evaluated by transient elastography (FibroScan) and the possible influencing factors from the patients' clinical situations including age, gender, liver inflammation represented by alanine transaminase (ALT) and total billirubin (TBIL) level, HBV replication (HBV DNA loads), portal vein pressure (portal vessel diameter, PVD), splenic thickness (SPT) and body mass index (BMI) were analyzed in patients with chronic hepatitis B (CHB). A total of 466 patients including 31 patients with acute-on-chronic liver failure (ACLF), and 435 patients with chronic hepatitis B (CHB) among which 82 patients were diagnosed with liver cirrhosis (LC) by clinical manifestations and liver B-type ultrasonic inspection were enrolled at Tongji Hospital from April to December 2009. LS was measured by a FibroScan device (EchoSens, France). Simultaneously, ALT and TBIL levels, HBV DNA loads, PVD, SPT and BMI in all patients were also tested. Forty-one healthy volunteers served as controls. The values of LS were correlated positively with ages of CHB patients and significantly higher in males than in females. In patients with BMI>28 kg/m(2) (obesity) and abnormal levels of ALT and TBIL, LS values were significantly increased as compared with those having normal levels of ALT and TBIL. The patients with ACLF had the highest LS value. Furthermore, LS values in the patients with LC were significantly higher than those in patients without LC. It is concluded that noninvasive measurement of liver fibrosis by FibroScan provides an alternative method to evaluate liver fibrosis of patients with CHB. In order to properly illustrate the stiffness value taken by transient elastography, patients' gender should be taken into consideration and it is also suggested to avoid possible influencing factors including liver inflammation (high levels of ALT and TBIL) and obesity (high BMI).
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Affiliation(s)
- Hongfang Ding
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Ting Wu
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ke Ma
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaojing Wang
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zeguang Wu
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Guo
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junying Qi
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qin Ning
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Noninvasive diagnosis and prognosis of liver cirrhosis: a comparison of biological scores, elastometry, and metabolic liver function tests. Eur J Gastroenterol Hepatol 2010; 22:532-40. [PMID: 20164779 DOI: 10.1097/meg.0b013e3283343f58] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Recently, noninvasive methods for the diagnosis of liver cirrhosis have been extensively developed. We assessed the accuracy of liver stiffness measurement, aspartate aminotransferase-to-platelet ratio index (APRI) score, 13C-aminopyrine breath test, and indocyanine green plasma clearance for the diagnosis of cirrhosis in patients with chronic liver disease and for the prediction of severe complications in cirrhotic patients. METHODS A total of 296 consecutive patients with chronic liver diseases of various causes were studied. Diagnostic accuracy was assessed by receiver operating characteristic curve analysis. RESULTS Areas under the receiver operating characteristic curve for the diagnosis of cirrhosis were (95% confidence interval) 0.93 (0.90-0.96) for liver stiffness measurement, 0.82 (0.77-0.87) for 13C-aminopyrine breath test, and 0.81 (0.76-0.86) for APRI score. Using cutoff values of 14.1 kPa for liver stiffness, 4.15% dose/h for 13C-aminopyrine breath test, and 1 for APRI score, the positive predictive value was approximately 90% for the diagnosis of cirrhosis. Using cutoff values of 65.2 kPa for liver stiffness, 1.17% dose/h for 13C-aminopyrine breath test, 2.82 for APRI score, and 51.1% for indocyanine green plasma clearance, the positive predictive value was approximately 80% for the occurrence of severe complications among cirrhotic patients. CONCLUSION Liver stiffness measurement, 13C-aminopyrine breath test, indocyanine green plasma clearance, and APRI score are reliable noninvasive methods for the diagnosis of cirrhosis in patients with chronic liver diseases of various causes, and are also prognostic indicators for the occurrence of severe complications in cirrhotic patients.
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Abstract
Fibroscan (FS) is a novel non-invasive method to assess hepatic fibrosis in patients with chronic liver disease by measuring liver stiffness. It is a rapid and user-friendly technique that can be easily performed with immediate results and good reproducibility. So far, FS has been used not only in patients with chronic hepatitis C but also in those with chronic liver diseases of other etiologies, such as chronic hepatitis B, alcoholic liver disease, and non-alcoholic liver disease. Moreover, FS appears to be an excellent tool for early detection of cirrhosis and complications of cirrhosis. As FS has excellent patient acceptance, it is useful for monitoring fibrosis progression and regression in the individual case. However, some influencing factors and certain limitations exist in the clinical application of FS. The aim of this article is to review the application value of FS in the diagnosis of hepatic fibrosis.
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Abstract
Elasticity imaging indirectly reflects tissue pathological changes by measuring tissue elastic modulus and therefore offers a new method for noninvasive diagnosis of hepatic diseases. Particularly, tissue elasticity measurement using Fibroscan is of outstanding value for staging and diagnosing hepatic fibrosis in patients with chronic hepatitis C and monitoring the development of hepatic cirrhosis and portal hypertension. In addition, magnetic resonance elastography and acoustic radiation force impulse have shown great promise in the diagnosis of hepatic diseases. This article reviews the basic knowledge of elasticity imaging and the recent advances in elasticity imaging of hepatic diseases.
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Barnes SL, Young PP, Miga MI. A novel model-gel-tissue assay analysis for comparing tumor elastic properties to collagen content. Biomech Model Mechanobiol 2009; 8:337-43. [DOI: 10.1007/s10237-009-0150-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 02/23/2009] [Indexed: 10/21/2022]
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Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008; 134:960-74. [PMID: 18395077 DOI: 10.1053/j.gastro.2008.01.034] [Citation(s) in RCA: 1031] [Impact Index Per Article: 64.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 01/10/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Transient elastography has been studied in a multitude of liver diseases for the staging of liver fibrosis with variable results. A meta-analysis was performed to assess the overall performance of transient elastography for the diagnosis of liver fibrosis and to analyze factors influencing the diagnostic accuracy. METHODS Literature databases and international conference abstracts were searched. Inclusion criteria were as follows: evaluation of transient elastography, liver biopsy as reference, and assessment of the area under the receiver operating characteristic curve (AUROC). The meta-analysis was performed using the random-effects model for the AUROC, summary receiver operating curve techniques, as well as meta-regression approaches. RESULTS Fifty studies were included in the analysis. The mean AUROC for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis were 0.84 (95% confidence interval [CI], 0.82-0.86), 0.89 (95% CI, 0.88-0.91), and 0.94 (95% CI, 0.93-0.95), respectively. For the diagnosis of significant fibrosis a significant reduction of heterogeneity of the AUROC was found when differentiating between the underlying liver diseases (P < .001). Other factors influencing the AUROC were the scoring system used and the country in which the study was performed. Age, body mass index, and biopsy quality did not have a significant effect on the AUROC. CONCLUSIONS Transient elastography can be performed with excellent diagnostic accuracy and independent of the underlying liver disease for the diagnosis of cirrhosis. However, for the diagnosis of significant fibrosis, a high variation of the AUROC was found that is dependent on the underlying liver disease.
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Affiliation(s)
- Mireen Friedrich-Rust
- Department of Internal Medicine I, J. W. Goethe-University Hospital, Frankfurt, Germany
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12
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Lefkowitch JH. Liver biopsy assessment in chronic hepatitis. Arch Med Res 2007; 38:634-43. [PMID: 17613355 DOI: 10.1016/j.arcmed.2006.08.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 08/23/2006] [Indexed: 02/06/2023]
Abstract
Liver biopsy has been a major diagnostic tool in the evaluation of individuals with chronic hepatitis for many decades and remains the most direct way of visualizing hepatic necroinflammation and fibrosis. In chronic viral hepatitis B and C, immune attack on hepatocytes bearing viral antigens results in the entry of lymphocytes and other effector cells through the portal tracts from which other lesions may evolve, including interface and lobular hepatitis as well as fibrosis or cirrhosis. Classification systems have been developed in order to provide semiquantitative grading of necroinflammation and staging of fibrosis and include the Scheuer, Batts and Ludwig, Ishak, and METAVIR systems. This review provides an historical perspective on histopathological methods of analyzing chronic hepatitis, describes the essential criteria of each of the major scoring systems and discusses problems related to sampling error, observer variation, and specimen size.
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Affiliation(s)
- Jay H Lefkowitch
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
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Koivisto H, Hietala J, Niemelä O. An inverse relationship between markers of fibrogenesis and collagen degradation in patients with or without alcoholic liver disease. Am J Gastroenterol 2007; 102:773-9. [PMID: 17222322 DOI: 10.1111/j.1572-0241.2006.01036.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Excessive deposition of collagen leading to cirrhosis is a major complication of alcohol abuse. However, the mechanisms behind the accumulation of the extracellular matrix proteins are poorly understood. METHODS We measured serum markers of collagen degradation (beta-CTx), fibrogenesis (PINP, PIIINP), and pro- and anti-inflammatory cytokines from 84 male heavy drinkers, who were either with (N = 52) or without (N = 32) clinical or histological signs of alcoholic liver disease (ALD), and from 20 healthy nonalcoholic controls. RESULTS Serum beta-CTx levels in ALD patients were significantly lower than in healthy controls or in the alcoholics without liver disease, while PINP and PIIINP, reflecting type I and type III collagen synthesis, respectively, were significantly increased. The alcoholics without liver disease showed values, that were not significantly different from those of healthy controls. Serum beta-CTx correlated negatively with serum PIIINP and proinflammatory cytokines (IL-2, IL-6, IL-8, TNF-alpha), and positively with anti-inflammatory cytokines (IL-1, TGF-beta), whereas serum PIIINP correlated positively with these proinflammatory cytokines and negatively with the anti-inflammatory cytokines. Calculation of PIIINP/beta-CTx ratio was found to yield an excellent sensitivity (94%) and specificity (98%) in differentiating the alcoholics with liver disease. CONCLUSION The present findings indicate a positive relationship between markers of collagen biosynthesis and proinflammatory cytokines, and a negative relationship between these markers and a marker of collagen degradation and anti-inflammatory cytokines, suggesting that a disturbed balance in these cellular responses may facilitate fibrogenesis and play a pivotal role in the pathogenesis of ALD. These findings should also be implicated in the development of noninvasive tools for discriminating individuals at risk for fibrogenesis.
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Affiliation(s)
- Heidi Koivisto
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, and University of Tampere, FIN-60220 Seinäjoki, Finland
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Grizzi F, Russo C, Franceschini B, Di Rocco M, Torri V, Morenghi E, Fassati LR, Dioguardi N. Sampling variability of computer-aided fractal-corrected measures of liver fibrosis in needle biopsy specimens. World J Gastroenterol 2006; 12:7660-5. [PMID: 17171796 PMCID: PMC4088049 DOI: 10.3748/wjg.v12.i47.7660] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the sampling variability of computer-aided, fractal-corrected measures of fibrosis in liver biopsies.
METHODS: Samples were derived from six to eight different parts of livers removed from 12 patients with clinically and histologically proven cirrhosis undergoing orthotopic liver transplantation. Sirius red-stained sections with a thickness of 2 μm were digitized using a computer-aided image analysis system that automatically measures the surface of fibrosis, as well as its outline perimeter, fractal surface and outline dimensions, wrinkledness, and Hurst coefficient.
RESULTS: We found a high degree of inter-sample variability in the measurements of the surface [coefficient of variation (CV) = 43% ± 13%] and wrinkledness (CV = 28% ± 9%) of fibrosis, but the inter-sample variability of Hurst’s exponent was low (CV = 14% ± 2%).
CONCLUSION: This study suggests that Hurst’s exponent might be used in clinical practice as the best histological estimate of fibrosis in the whole organ, and evidences the fact that biopsy sections, which are fundamental for the qualitative diagnosis of chronic hepatitis, play a key role in the quantitative estimate of architectural changes in liver tissue.
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Affiliation(s)
- Fabio Grizzi
- Laboratori di Medicina Quantitativa, Istituto Clinico Humanitas IRCCS, Rozzano MI, Italy
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Nguyen-Khac E, Capron D. Noninvasive diagnosis of liver fibrosis by ultrasonic transient elastography (Fibroscan). Eur J Gastroenterol Hepatol 2006; 18:1321-5. [PMID: 17099382 DOI: 10.1097/01.meg.0000243884.55562.37] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Methods for diagnosing hepatic fibrosis have progressed significantly over the last few years--notably with the appearance of minimally invasive biological tests (which avoid the need for liver needle biopsy but nevertheless require a blood sample). Hepatic ultrasonic transient elastography (Fibroscan) is a new diagnostic method for hepatic fibrosis: it is totally noninvasive and gives an immediate result. Here, we review the currently available data on the use of the Fibroscan. Today's main field of application is chronic, viral hepatitis C, with areas under the receiver operation characteristic curve of 0.79-0.83, 0.90-0.91 and 0.91-0.97 for the diagnosis of F2, F3 and F4 fibrosis (defined according to the Metavir classification system), respectively. Furthermore, the Fibroscan enables the noninvasive diagnosis of cirrhosis (regardless of the latter's aetiology), with positive and negative predictive values of 70-95% and 77-95%, respectively. Chronic viral hepatitis B, HIV-hepatitis C virus and HIV-hepatitis B virus coinfections, alcohol-related liver diseases and intrahepatic cholestatic diseases are the device's other main fields of application in hepatology. Today, the Fibroscan is a reliable alternative for the noninvasive diagnosis of hepatic fibrosis. Various diagnostic strategies and performing cost/benefit analyses are now necessary, to assess fully the value of hepatic elastography relative to biological tests for hepatic fibrosis.
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Affiliation(s)
- Eric Nguyen-Khac
- Hepatogastroenterology Service, Amiens University Hospital, Amiens, France.
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Abstract
PURPOSE OF REVIEW Publications concerning liver histopathology in fatty liver disease and chronic hepatitis C, iron and copper overload, and liver transplantation from the past year have been surveyed to highlight useful concepts and diagnostic information. RECENT FINDINGS Two microscopic forms of pediatric nonalcoholic steatohepatitis have been described: type 1 in which hepatocyte ballooning and/or pericellular fibrosis accompany the steatosis; and type 2 which has portal tract inflammation and/or fibrosis as the salient accompanying feature. In chronic hepatitis C, the ductular reaction appears to be a major factor associated with fibrosis. In patients transplanted for hepatitis C virus-related cirrhosis, immunostaining of post-transplant liver biopsies for alpha-smooth muscle actin (i.e. in activated hepatic stellate cells) may identify those individuals at risk for severe recurrence. Clinicopathological papers on several forms of non-HFE hemochromatosis were published and Wilson's disease was described in individuals of 60 years or more in age. Cholestasis in childhood was expertly reviewed and histopathologic precursor lesions of hepatocellular carcinoma were also examined in a comprehensive article. SUMMARY Recent publications with impact on liver biopsy interpretation include a morphologic classification of nonalcoholic steatohepatitis in childhood, the differential diagnosis of childhood cholestasis and pathogenetic factors involved in fibrogenesis in chronic hepatitis C.
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Affiliation(s)
- Jay H Lefkowitch
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Castera L, Foucher J, Bertet J, Couzigou P, de Ledinghen V. FibroScan and FibroTest to assess liver fibrosis in HCV with normal aminotransferases. Hepatology 2006; 43:373-4; author reply 375-6. [PMID: 16440359 DOI: 10.1002/hep.21019] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
The worldwide epidemic of obesity has raised the awareness of nonalcoholic fatty liver disease (NAFLD) from that of a curiosity to one of a potentially progressive liver disease with risk for cirrhosis and hepatocellular carcinoma. This overview is focused on the histopathology of the spectrum of fatty liver disease, and discusses the role of liver biopsy, differential diagnoses, and new techniques in development. When pertinent, pathophysiology of this metabolic liver disease and recent treatment considerations have been mentioned as well.
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Affiliation(s)
- Elizabeth M Brunt
- Saint Louis University School of Medicine, Saint Louis University Liver Center, Missouri, USA.
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