1
|
Atzori SM, Pasha Y, Maurice JB, Taylor-Robinson SD, Campbell L, Lim AKP. Prospective evaluation of liver shearwave elastography measurements with 3 different technologies and same day liver biopsy in patients with chronic liver disease. Dig Liver Dis 2024; 56:484-494. [PMID: 37968144 DOI: 10.1016/j.dld.2023.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/26/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Most ultrasound-based methods for assessing liver fibrosis still need further validation with liver biopsy used as gold standard to assess their accuracy. AIMS To assess accuracy of three shear wave elastography (SWE) methods: 1) Philips Elast Point Quantification (ElastPQTM), 2) Siemens Virtual TouchTM Quantification (VTQ) acoustic radiation force impulse (ARFI), and 3) transient elastography (TE) measured by Echosens FibroscanTM. METHODS 160 patients underwent liver stiffness measurements (LSM) with three SWE methods immediately prior to liver biopsy. RESULTS The number of LSM required for reliable studies could be reduced to 6 for ElastPQ and to 7 for VTQ from standard recommendations of 10. Significant fibrosis and interquartile range/median (IQR/M)> 30 were independent predictors for lower reliability for detection of liver fibrosis. Ordinal logistic regression corrected for age showed that there was a significant interaction between steatosis (p = 0.008) and lobular inflammation (p = 0.04) and VTQ (ARFI) and between lobular inflammation and TE (p = 0.006). CONCLUSIONS We showed variations in SWE measurements using different ARFI technologies. TE and ElastPQ achieved good diagnostic performance, whereas VTQ showed lower diagnostic accuracy. The number of measurements required for reliable studies can be reduced to 6 for ElastPQ and to 7 for VTQ, which have important clinical implications.
Collapse
Affiliation(s)
- Sebastiana M Atzori
- Liver Unit QEQM Wing St. Mary Hospital, Department of Surgery and Cancer, Imperial College London, South Wharf Road, London W1 1NY, United Kingdom; Department of Medicine, Sassari University Hospital, Via Enrico de Nicola, Sassari 07100, Italy.
| | - Yasmin Pasha
- Liver Unit QEQM Wing St. Mary Hospital, Department of Surgery and Cancer, Imperial College London, South Wharf Road, London W1 1NY, United Kingdom
| | - James B Maurice
- Liver Unit QEQM Wing St. Mary Hospital, Department of Surgery and Cancer, Imperial College London, South Wharf Road, London W1 1NY, United Kingdom; UCL Institute for Liver and Digestive Health, Royal Free Hospital Campus, London, Rowland Hill Street, NW3 2QG, United Kingdom
| | - Simon D Taylor-Robinson
- Liver Unit QEQM Wing St. Mary Hospital, Department of Surgery and Cancer, Imperial College London, South Wharf Road, London W1 1NY, United Kingdom
| | - Louise Campbell
- Liver Unit QEQM Wing St. Mary Hospital, Department of Surgery and Cancer, Imperial College London, South Wharf Road, London W1 1NY, United Kingdom; Office of the Clinical Director, Tawazun Health, 23 Harley Street, London W1G 9QN, United Kingdom
| | - Adrian K P Lim
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, United Kingdom
| |
Collapse
|
2
|
Suwała S, Białczyk A, Koperska K, Rajewska A, Krintus M, Junik R. Prevalence and Crucial Parameters in Diabesity-Related Liver Fibrosis: A Preliminary Study. J Clin Med 2023; 12:7760. [PMID: 38137829 PMCID: PMC10744287 DOI: 10.3390/jcm12247760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/28/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Diabetes and obesity have been recognized as confirmed risk factors for the occurrence of liver fibrosis. Despite the long-standing acknowledgment of "diabesity", the simultaneous existence of diabetes and obesity, scholarly literature has shown limited attention to this topic. The aim of this pilot study was to assess the prevalence of liver fibrosis among individuals with diabetes (specifically those who are obese) in order to identify the key factors associated with hepatofibrosis and determine the most important associations and differences between patients with and without liver fibrosis. The research included a total of 164 participants (48.17% had comorbid obesity). Liver elastography (Fibroscan) was performed on these individuals in addition to laboratory tests. Liver fibrosis was found in 34.76% of type 2 diabetes patients; male gender almost doubled the risk of hepatofibrosis (RR 1.81) and diabesity nearly tripled this risk (RR 2.81; however, in degree III of obesity, the risk was elevated to 3.65 times higher). Anisocytosis, thrombocytopenia, or elevated liver enzymes raised the incidence of liver fibrosis by 1.78 to 2.47 times. In these individuals, liver stiffness was negatively correlated with MCV, platelet count, and albumin concentration; GGTP activity and HbA1c percentage were positively correlated. The regression analysis results suggest that the concentration of albumin and the activity of GGTP are likely to have a substantial influence on the future management of liver fibrosis in patients with diabesity. The findings of this study can serve as the basis for subsequent investigations and actions focused on identifying potential therapeutic and diagnostic avenues.
Collapse
Affiliation(s)
- Szymon Suwała
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland;
| | - Aleksandra Białczyk
- Evidence-Based Medicine Students Scientific Club of Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland; (A.B.); (K.K.); (A.R.)
| | - Kinga Koperska
- Evidence-Based Medicine Students Scientific Club of Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland; (A.B.); (K.K.); (A.R.)
| | - Alicja Rajewska
- Evidence-Based Medicine Students Scientific Club of Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland; (A.B.); (K.K.); (A.R.)
| | - Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland;
| | - Roman Junik
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland;
| |
Collapse
|
3
|
Wang J, Qin T, Sun J, Li S, Cao L, Lu X. Non-invasive methods to evaluate liver fibrosis in patients with non-alcoholic fatty liver disease. Front Physiol 2022; 13:1046497. [PMID: 36589424 PMCID: PMC9794751 DOI: 10.3389/fphys.2022.1046497] [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: 09/16/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
Non-alcoholic Fatty Liver Disease (NAFLD) is a chronic liver disease that is strongly related to insulin resistance and metabolic syndrome, and it has become the most common liver disorder in developed countries. NAFLD embraces the full pathological process of three conditions: steatosis, non-alcoholic steatohepatitis, and finally, cirrhosis. As NAFLD progresses, symptoms will become increasingly severe as fibrosis develops. Therefore, evaluating the fibrosis stage is crucial for patients with NAFLD. A liver biopsy is currently considered the gold standard for staging fibrosis. However, due to the limitations of liver biopsy, non-invasive alternatives were extensively studied and validated in patients with NAFLD. The advantages of non-invasive methods include their high safety and convenience compared with other invasive approaches. This review introduces the non-invasive methods, summarizes their benefits and limitations, and assesses their diagnostic performance for NAFLD-induced fibrosis.
Collapse
Affiliation(s)
- Jincheng Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Qin
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinyu Sun
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shiwu Li
- Liver Disease Center, Qinhuangdao Third Hospital, Qinhuangdao, China
| | - Lihua Cao
- Liver Disease Center, Qinhuangdao Third Hospital, Qinhuangdao, China,*Correspondence: Xiaojie Lu, ; Lihua Cao,
| | - Xiaojie Lu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Xiaojie Lu, ; Lihua Cao,
| |
Collapse
|
4
|
Roccarina D, Iogna Prat L, Pallini G, Guerrero Misas M, Buzzetti E, Saffioti F, Aricò FM, Mantovani A, Koutli E, Goyale A, Rosselli M, Luong TV, Pinzani M, Tsochatzis EA. Comparison of point-shear wave elastography (ElastPQ) and transient elastography (FibroScan) for liver fibrosis staging in patients with non-alcoholic fatty liver disease. Liver Int 2022; 42:2195-2203. [PMID: 35635761 DOI: 10.1111/liv.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS ElastPQ is a point shear wave elastography technique used to non-invasively assess liver fibrosis. We compared liver stiffness measurements (LSM) by ElastPQ and fibroscan transient elastography (F-TE) in a cohort of patients with non-alcoholic fatty liver disease (NAFLD). We further evaluated the performance of ElastPQ in a subgroup of patients with available liver histology. MATERIALS AND METHODS We included patients with NAFLD who presented in a dedicated multidisciplinary clinic. Anthropometric parameters, blood tests and elastography measurements were obtained using F-TE and ElastPQ as part of routine clinical care. RESULTS We enrolled 671 patients with NAFLD, mean age 55.8 ± 13 years, body mass index (BMI) 31.5 ± 5.7 kg/m2 , 56.6% males, 41% diabetes, 53.7% hypertension, 68% dyslipidaemia. ElastPQ showed an excellent correlation with F-TE (Spearman's r = 0.80, p < .001), which was better for mild/moderate stages of fibrosis. Independent predictors of a >2 kPa discrepancy between the two techniques were a larger waist circumference and F-TE ≥10 kPa. In the subgroup of 159 patients with available histology, ElastPQ showed similar diagnostic accuracy with F-TE in staging liver fibrosis (ElastPQ area under the curves 0.84, 0.83, 0.86 and 0.95, for F ≥ 1, F ≥ 2, F ≥ 3 and F = 4 respectively). Optimal cut-off values of ElastPQ for individual fibrosis stages were lower than those of F-TE. CONCLUSIONS ElastPQ shows an excellent correlation with F-TE in patients with NAFLD, which was better for lower LSM. The optimal cut-off values of ElastPQ are lower than those of F-TE for individual stages of fibrosis. ElastPQ has similar diagnostic accuracy to F-TE for all stages of fibrosis.
Collapse
Affiliation(s)
- Davide Roccarina
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Laura Iogna Prat
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Giada Pallini
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Marta Guerrero Misas
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Elena Buzzetti
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Division of Medicine and CeMEF, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Saffioti
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Division of Clinical and Molecular Hepatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco M Aricò
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Department of Internal Medicine, University Hospital and School of Medicine of Messina, Messina, Italy
| | - Anna Mantovani
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Division of General Medicine and Hypertension, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Evangelia Koutli
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Atul Goyale
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Matteo Rosselli
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Tu Vinh Luong
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| |
Collapse
|
5
|
Pi Z, Wang M, Lin H, Guo Y, Chen S, Diao X, Xia H, Liu G, Zeng J, Zhang X, Chen X. Viscoelasticity measured by shear wave elastography in a rat model of nonalcoholic fatty liver disease: comparison with dynamic mechanical analysis. Biomed Eng Online 2021; 20:45. [PMID: 33941179 PMCID: PMC8091696 DOI: 10.1186/s12938-021-00879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/20/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming one of the most common liver diseases. Ultrasound elastography has been used for the diagnosis of NAFLD. However, clinical research on steatosis by elastography technology has mainly focused on steatosis with fibrosis or non-alcoholic steatohepatitis (NASH), while steatosis without fibrosis has been poorly studied. Moreover, the relationship between liver viscoelasticity and steatosis grade is not clear. In this study, we evaluated the degree of liver steatosis in a simple steatosis rat model using shear wave elastography (SWE). RESULTS The viscoelasticity values of 69 rats with hepatic steatosis were measured quantitatively by SWE in vivo and validated by a dynamic mechanical analysis (DMA) test. Pathological sections were used to determine the steatosis grade for each rat. The results showed that the elasticity values µ obtained by the two methods followed the same trend, and µ is significantly correlated with liver steatosis. The Pearson's correlation coefficients indicate that [Formula: see text] obtained by SWE is positively linear correlated with DMA (r = 0.628, p = 7.85 × 10-9). However, the viscosity values [Formula: see text] obtained by SWE were relatively independent of those obtained by DMA with a correlation coefficient of - 0.01. The combined Voigt elasticity measurements have high validity in the prediction of steatosis (S0 vs. S1-S4), with an AUROC of 0.755 (95% CI 0.6175-0.8925, p < 0.01) and the optimal cutoff value was 2.08 kPa with a sensitivity of 78% and specificity of 63%. CONCLUSION SWE might have the feasibility to be introduced as an auxiliary technique for NAFLD patients in clinical settings. However, the viscosity results measured by SWE and DMA are significantly different, because the two methods work in different frequency bands.
Collapse
Affiliation(s)
- Zhaoke Pi
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China
| | - Mengke Wang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China
| | - Haoming Lin
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China
| | - Yanrong Guo
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China
| | - Siping Chen
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China
| | - Xianfen Diao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China
| | - Hui Xia
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, 100000, China
| | - Guoqiang Liu
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, 100000, China
| | - Jie Zeng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510000, China
| | - Xinyu Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China.
| | - Xin Chen
- School of Biomedical Engineering, Health Science Center, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, 518000, China.
| |
Collapse
|
6
|
Kimura Y, Taura K, Hai Nam N, Uemoto Y, Yoshino K, Ikeno Y, Okuda Y, Nishio T, Yamamoto G, Tanabe K, Koyama Y, Anazawa T, Fukumitsu K, Ito T, Yagi S, Kamo N, Seo S, Iwaisako K, Hata K, Imai T, Uemoto S. Utility of Mac-2 Binding Protein Glycosylation Isomer to Evaluate Graft Status After Liver Transplantation. Liver Transpl 2021; 27:403-415. [PMID: 32780942 DOI: 10.1002/lt.25870] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/12/2020] [Accepted: 07/28/2020] [Indexed: 01/13/2023]
Abstract
Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel liver fibrosis biomarker, but there are few studies on M2BPGi in liver transplantation (LT) recipients. This study aimed to evaluate the utility of M2BPGi measurement in LT recipients. We collected the clinicopathological data of 233 patients who underwent a liver biopsy at Kyoto University Hospital after LT between August 2015 and June 2019. The median values of M2BPGi in patients with METAVIR fibrosis stages F0, F1, F2, and ≥F3 were 0.61, 0.76, 1.16, and 1.47, respectively, whereas those in patients with METAVIR necroinflammatory indexes A0, A1, and ≥A2 were 0.53, 1.145, and 2.24, respectively. Spearman rank correlation test suggested that the necroinflammatory index had a stronger correlation to the M2BPGi value than the fibrosis stage. The area under the receiver operating characteristic curve of M2BPGi to predict ≥A1 was 0.75, which was significantly higher than that of any other liver fibrosis and inflammation marker. Patients with a rejection activity index (RAI) of ≥3 had a higher M2BPGi value than those with RAI ≤ 2 (P = 0.001). Patients with hepatitis C virus viremia had a higher M2BPGi value than sustained virological responders or those with other etiologies. In conclusion, the present study demonstrated that M2BPGi values are more strongly influenced by necroinflammatory activity and revealed M2BPGi, which has been thought to be a so-called fibrosis marker, as a disease activity marker in transplant recipients. M2BPGi measurement may be useful to detect early stage liver inflammation that cannot be detected by routine blood examination of LT recipients.
Collapse
Affiliation(s)
- Yusuke Kimura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Nguyen Hai Nam
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Yusuke Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Kenji Yoshino
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Yoshinobu Ikeno
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Yukihiro Okuda
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Takahiro Nishio
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Gen Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Kazutaka Tanabe
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Yukinori Koyama
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Takayuki Anazawa
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Ken Fukumitsu
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Naoko Kamo
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Keiko Iwaisako
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Koichiro Hata
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Takumi Imai
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| |
Collapse
|
7
|
Lee A, Joo DJ, Han WK, Jeong HJ, Oh MJ, Kim YS, Oh YT. Renal tissue elasticity by acoustic radiation force impulse: A prospective study of healthy kidney donors. Medicine (Baltimore) 2021; 100:e23561. [PMID: 33545931 PMCID: PMC7837974 DOI: 10.1097/md.0000000000023561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Some studies reported the correlations between renal parenchymal stiffness measured by transient elastography or acoustic radiation force impulse (ARFI) and the extent of interstitial fibrosis. This study was prospectively designed to evaluate the correlation between clinical, histological findings and the kidney shear wave velocity (SWV, m/s) assessed by ARFI elastography to identify factors affecting the kidney SWV in normal patients. METHODS Seventy-three adult living kidney transplantation donors were enrolled in our center between September 2010 and January 2013. Before transplantation, all donors were evaluated by ARFI elastography to identify the range of SWV in kidneys. Time-zero biopsies were performed on all graft kidneys before implantation. RESULTS Mean age of donors was 42.0 ± 11.3 years. The mean SWV and depth were 2.21 ± 0.58 m/s and 5.37 ± 1.06 cm. All histological findings showed mild degree of the Banff score, only grade I. In univariate analyses, the SWV was not associated with all histological parameters. Age (r = -0.274, P = .019) diastolic blood pressure (DBP, r = -0.255, P = .030) and depth for SWV measurement (r = -0.345, P = .003) were significantly correlated with the SWV. In multivariate linear regression analysis, age, gender, body mass index (BMI), and depth for SWV measurement were significantly correlated with the SWV (P = .003, .005, .002, and .004, respectively). CONCLUSIONS We demonstrated that all histological findings are not correlated with the SWV of donor kidney. Otherwise, factors influencing the kidney SWV assessed by ARFI elastography are age, gender, BMI, and depth for the SWV measurement in donors for kidney transplantation.
Collapse
Affiliation(s)
- Alan Lee
- Department of Surgery, Devision of surgical critical care and trauma, Korea University Guro hospital
- Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Joo
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System
- Research Institute for Transplantation, Yonsei University College of Medicine
| | - Woong Kyu Han
- Department of Urology, Severance Hospital, Yonsei University Health System
| | - Hyeon Joo Jeong
- Department of Pathology, Severance Hospital, Yonsei University Health System
| | - Min Jung Oh
- Biostatistics Collaboration Unit, Department of Humanities and Social Medicine, Ajou University School of Medicine, Suwon
| | - Yu Seun Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System
- Research Institute for Transplantation, Yonsei University College of Medicine
| | - Young Taik Oh
- Department of Radiology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| |
Collapse
|
8
|
Bende F, Sporea I, Şirli R, Nistorescu S, Fofiu R, Bâldea V, Popescu A. The Performance of a 2-Dimensional Shear-Wave Elastography Technique for Predicting Different Stages of Liver Fibrosis Using Transient Elastography as the Control Method. Ultrasound Q 2020; 37:97-104. [PMID: 33136935 DOI: 10.1097/ruq.0000000000000527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT The aim was to evaluate the performance of 2-dimensional (2D) shear-wave elastography from general electric (2D SWE-GE), implemented on the new LOGIQ S8 system, for the noninvasive assessment of liver fibrosis, and to identify liver stiffness (LS) cutoff values for predicting different stages of fibrosis using transient elastography (TE) as the control method. We included 179 consecutive subjects, with or without chronic hepatopathies, in whom LS was evaluated in the same session using 2 elastographic techniques: TE (FibroScan, EchoSens) and 2D SWE-GE (LOGIQ S8; GE Healthcare, Chalfont St Giles, United Kingdom). Reliable LS measurements were defined for TE: the median value of 10 measurements with a success rate of 60% or greater and an interquartile range/median ratio (IQR/M) < 0.30; for 2D SWE-GE: the median value of 10 measurements acquired in a homogenous area and IQR/M < 0.30. To discriminate between fibrosis stages by TE, we used the following cutoffs: F2-7; F3-9.5 and F4-12 kPa. Reliable LS measurements were obtained in 97.2% subjects by 2D SWE-GE and in 98.3% by TE (P = 0.72), so that 171 subjects were included for the final analysis. A good correlation was found between the LS values obtained by the 2 methods (r = 0.72, P < 0.0001). The best 2D SWE-GE cutoff value for F ≥ 2 was 6.9 kPa (areas under receiver operating characteristic [AUROC], 0.93; sensitivity, 85.8%; specificity, 90.2%), for F of 3 or greater, it was 8.2 kPa (AUROC, 0.93; sensitivity, 87.5%; specificity, 86.8%) and for F value of 4, it was 9.3 kPa (AUROC, 0.91; sensitivity, 85.7%; specificity, 81.2%). In conclusion, the best 2D SWE-GE (S8) cutoff values for predicting F2, F ≥ 3 and F = 4 were 6.9, 8.2, and 9.3 kPa.
Collapse
Affiliation(s)
- Felix Bende
- Department of Gastroenterology, Victor Babes University of Medicine and Pharmacy Timişoara, Romania
| | | | | | | | | | | | | |
Collapse
|
9
|
Guenat OT, Geiser T, Berthiaume F. Clinically Relevant Tissue Scale Responses as New Readouts from Organs-on-a-Chip for Precision Medicine. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2020; 13:111-133. [PMID: 31961712 DOI: 10.1146/annurev-anchem-061318-114919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Organs-on-chips (OOC) are widely seen as being the next generation in vitro models able to accurately recreate the biochemical-physical cues of the cellular microenvironment found in vivo. In addition, they make it possible to examine tissue-scale functional properties of multicellular systems dynamically and in a highly controlled manner. Here we summarize some of the most remarkable examples of OOC technology's ability to extract clinically relevant tissue-level information. The review is organized around the types of OOC outputs that can be measured from the cultured tissues and transferred to clinically meaningful information. First, the creation of functional tissues-on-chip is discussed, followed by the presentation of tissue-level readouts specific to OOC, such as morphological changes, vessel formation and function, tissue properties, and metabolic functions. In each case, the clinical relevance of the extracted information is highlighted.
Collapse
Affiliation(s)
- Olivier T Guenat
- ARTORG Center for Biomedical Engineering Research, Medical Faculty, University of Bern, CH-3008 Bern, Switzerland;
- Department of Pulmonary Medicine, University Hospital and University of Bern, CH-3008 Bern, Switzerland
- Thoracic Surgery Department, University Hospital of Bern, Switzerland
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital and University of Bern, CH-3008 Bern, Switzerland
| | - François Berthiaume
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey 08854, USA
| |
Collapse
|
10
|
Mărginean CO, Meliţ LE, Ghiga DV, Săsăran MO. Reference values of normal liver stiffness in healthy children by two methods: 2D shear wave and transient elastography. Sci Rep 2020; 10:7213. [PMID: 32350349 PMCID: PMC7190848 DOI: 10.1038/s41598-020-64320-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/09/2020] [Indexed: 12/03/2022] Open
Abstract
TE and 2D-SWE are well-documented in studies performed on adults, but those on pediatric patients are limited. The aim of this study was to establish pediatric reference values for liver stiffness using two elastography methods: 2D-SWE and TE. We performed an observational study on 206 healthy children. All children underwent anamnesis, clinical exam, laboratory tests, US exam, TE and 2D-SWE for liver stiffness assessment. The mean liver stiffness value by 2D-SWE for all children was 3.72 ± 0.48 kPa. The mean values ranged between 3.603 ± 0.2678 kPa (3–5 years of age) and 3.774 ± 0.4038 kPa (9–11 years). The reference values varied between 4.1386 kPa (3–5 years of age) and 4.88 kPa (12–15 years). The mean liver stiffness value by TE was 3.797 ± 0.4859 kPa. The values ranged between 3.638 ± 0.4088 kPa (6–8 years of age) and 3.961 ± 0.5695 kPa (15–18 years). The cutoff values varied from 4.4064 kPa (3–5 years of age) to 5.1 kPa (15–18 years). We found a significant positive correlation between E Median values by TE and age [95% CI: 0.1160 to 0.3798, r = 0.2526, p = 0.0002]. Our findings revealed that the mean values of liver stiffness for all children on 2D-SWE and TE were almost identical, 3.72 ± 0.48 kPa versus 3.797 ± 0.4859 kPa.
Collapse
Affiliation(s)
- Cristina Oana Mărginean
- Department of Pediatrics, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania
| | - Lorena Elena Meliţ
- Department of Pediatrics, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania.
| | - Dana Valentina Ghiga
- Department of Medical Informatics and Biostatistics, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania
| | - Maria Oana Săsăran
- Department of Pediatric Cardiology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania
| |
Collapse
|
11
|
Lashen SA, Elshafei MM, Hablass FH, Alsayed EA, Hassan AA. Liver stiffness as a predictor of hepatocellular carcinoma behavior in patients with hepatitis C related liver cirrhosis. Hepatobiliary Pancreat Dis Int 2020; 19:22-28. [PMID: 31831335 DOI: 10.1016/j.hbpd.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/25/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Risk stratification and prognostication of hepatocellular carcinoma (HCC) help to improve patient outcome. Herein we investigated the role of liver stiffness measurement (LSM) in the prediction of HCC behavior. METHODS Totally 121 naïve patients with HCC were included. HCC radiological evaluation and staging were done. LSM was measured using virtual touch quantification. Patients were divided into early to intermediate HCC (BCLC-0, A and B) and late HCC (BCLCC and D). HCC was treated according to the BCLC stage. HCC recurrence-free interval was estimated. RESULTS The mean LSM inside the tumor was significantly lower than the peri-tumoral area and the cirrhotic non-cancerous liver parts (P < 0.001). In late HCCs stage, the mean LSM inside the tumor and in the peri-tumoral tissue was lower than the corresponding values in the early to intermediate HCCs stage (P < 0.001). LSM inside the tumor and in the peri-tumoral tissue negatively correlated with serum AFP, tumor vascular invasion, and stage (P < 0.05). The recurrence-free interval was directly correlated to LSM inside the tumor and inversely to LSM in cirrhotic non tumorous liver part. Kaplan-Meier analysis showed that the recurrence-free interval was significantly longer in patients with LSM inside the tumor of ≥1.25 m/s compared to those with LSM inside the tumor of <1.25 m/s. CONCLUSIONS LSM can serve as a potential non-invasive predictor for HCC clinical behavior and the recurrence-free interval following loco-regional treatments.
Collapse
Affiliation(s)
- Sameh A Lashen
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - Mohamed M Elshafei
- Department of Radiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Fahmy H Hablass
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Eman A Alsayed
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Asmaa A Hassan
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, University of Alexandria, Alexandria, Egypt
| |
Collapse
|
12
|
Ueno A, Masugi Y, Yamazaki K, Kurebayashi Y, Tsujikawa H, Effendi K, Ojima H, Sakamoto M. Precision pathology analysis of the development and progression of hepatocellular carcinoma: Implication for precision diagnosis of hepatocellular carcinoma. Pathol Int 2020; 70:140-154. [PMID: 31908112 DOI: 10.1111/pin.12895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/11/2019] [Indexed: 12/25/2022]
Abstract
Outcomes for patients with hepatocellular carcinoma (HCC) remain poor because the condition is often unresponsive to the available treatments. Consequently, the early and precise diagnosis of HCC is crucial to achieve improvements in prognosis. For patients with chronic liver disease, the assessment of liver fibrosis is also important to ascertain both the staging of fibrosis and the risk of HCC occurrence. Early HCC was first described in 1991 in Japan and was defined internationally in 2009. As the concept of early HCC spread, the multistage hepatocarcinogenesis process became accepted. Consequently, improvements in imaging technology made the early diagnosis of HCC possible. At present, the most appropriate therapeutic strategy for HCC is determined using an integrated staging system that assesses the tumor burden, the degree of liver dysfunction and the patient performance status; however, pathological and molecular features are not taken into account. The recent introduction of several new therapeutic agents will change the treatment strategy for HCC. Against this background, HCC subclassification based on tumor cellular and microenvironmental characteristics will become increasingly important. In this review, we give an overview of how pathological analysis contributes to understanding the development and progression of HCC and establishing a precision diagnosis of HCC.
Collapse
Affiliation(s)
- Akihisa Ueno
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Ken Yamazaki
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kurebayashi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hanako Tsujikawa
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kathryn Effendi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hidenori Ojima
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
13
|
Wakui N, Nagai H, Yoshimine N, Amanuma M, Kobayashi K, Ogino Y, Matsui D, Mukozu T, Matsukiyo Y, Matsui T, Daido Y, Momiyama K, Shinohara M, Kudo T, Maruyama K, Sumino Y, Igarashi Y. Flash Imaging Used in the Post-vascular Phase of Contrast-Enhanced Ultrasonography is Useful for Assessing the Progression in Patients with Hepatitis C Virus-Related Liver Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1654-1662. [PMID: 31031037 DOI: 10.1016/j.ultrasmedbio.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 06/09/2023]
Abstract
Sonazoid is a commonly used contrast agent for characterizing liver tumors in ultrasonography (US). We performed flash imaging in the post-vascular phase of contrast-enhanced US (CEUS) to investigate associations between collapse of Sonazoid microbubbles (MB) and progression of liver disease. This study enrolled 409 patients (205 men, 204 women) with hepatitis C virus-related liver disease (CLD) between 2007 and 2017 (mean age 60 ± 14 y; range 20-90 y). In the post-vascular phase, 10 min after administering Sonazoid, flash imaging was performed to burst MB in the liver parenchyma; the range of bubble destruction was measured from the surface of the liver. The range of bubble destruction, stage of fibrosis, shear wave velocity (Vs), serologic markers and fibrosis-4 (FIB4) index were analyzed in 259 patients who underwent liver biopsy. Fibrosis stage was F0-1 in 108 patients, F2 in 73, F3 in 38 and F4 in 40. In 150 patients with cirrhosis, diagnosis was made based on imaging findings. The range of bubble destruction was 42.0 ± 10.4 mm in F0-1 patients, 42.9 ± 13.2 mm in F2, 51.5 ± 15.9 mm in F3 and 55.4 ± 17.3 mm in F4 and was significantly increased according to progression of fibrosis staging. The range of bubble destruction was positively correlated with Vs (r = 0.34; p < 0.01), total bilirubin (r = 0.25; p < 0.01) and FIB4 index (r = 0.38; p < 0.01). In contrast, the range of bubble destruction was negatively correlated with serum levels of albumin (r = -0.34; p < 0.01), platelet count (r = -0.35; p < 0.01) and prothrombin time (r = -0.36; p < 0.01). The results indicated that flash imaging in the post-vascular phase of CEUS was a non-invasive assessment and could predict disease progression in patients with CLD.
Collapse
Affiliation(s)
- Noritaka Wakui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
| | - Hidenari Nagai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Naoyuki Yoshimine
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Makoto Amanuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kojiro Kobayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yu Ogino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Daigo Matsui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Takanori Mukozu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yasushi Matsukiyo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Teppei Matsui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yasuko Daido
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Koichi Momiyama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Mie Shinohara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Takahide Kudo
- Division of Clinical Functional Physiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kenichi Maruyama
- Division of Clinical Functional Physiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Japan Community Health Care Organization (JCHO) Tokyo Kamata Hospital, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| |
Collapse
|
14
|
Lawrence AE, Dienhart M, Cooper JN, Lodwick D, Lopez JJ, Fung B, Smith S, Warren P, Mezoff E, Balint J, Minneci PC. Ultrasound Elastography as a Non-Invasive Method to Monitor Liver Disease in Children with Short Bowel Syndrome: Updated Results. J Pediatr Surg 2019; 54:1179-1183. [PMID: 30885560 DOI: 10.1016/j.jpedsurg.2019.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/21/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to determine the accuracy of acoustic radiation force impulse (ARFI) ultrasound elastography in assessing the degree of liver disease in children with short bowel syndrome (SBS). METHODS A prospective observational cohort study of patients with SBS who underwent a liver biopsy and ARFI elastography was performed. Mean shear wave speed (SWS) and stage of fibrosis was evaluated using t-tests. Receiver operating characteristic curves (ROC) were generated and the area under the curves (AUC) estimated in order to assess the accuracy of SWS measurements to discriminate between stages of fibrosis. RESULTS Thirty-seven paired elastography and biopsy samples from 31 patients were included. The median age was 0.6 years, and 61% were male. There was a significant positive correlation between stage of fibrosis and mean SWS (β=0.16 m/s increase per stage, p=<0.001). ROC analysis revealed that mean SWS had good accuracy for discriminating between mild liver fibrosis (F0-F1) and moderate to severe fibrosis (F2-F4) (AUC=0.80, 95% CI 0.65-0.95). In addition, ROC analysis demonstrated that mean SWS can also accurately discriminate between mild to moderate fibrosis (F0-F2) and more severe fibrosis (F3-F4) (AUC=0.84, 95% CI 0.71-0.96). CONCLUSION ARFI elastography is an accurate, non-invasive method to monitor liver disease in children with SBS. TYPE OF STUDY Retrospective Cohort Study LEVEL OF EVIDENCE: II.
Collapse
Affiliation(s)
- Amy E Lawrence
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Molly Dienhart
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Jennifer N Cooper
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Daniel Lodwick
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Joseph J Lopez
- Department of Surgery, New York Medical College, Valhalla, NY
| | - Bonita Fung
- Department of Pathology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Sally Smith
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Patrick Warren
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Ethan Mezoff
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Jane Balint
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Peter C Minneci
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
| |
Collapse
|
15
|
Yoshino K, Taura K, Okuda Y, Ikeno Y, Uemoto Y, Nishio T, Yamamoto G, Tanabe K, Koyama Y, Seo S, Kaido T, Okajima H, Imai T, Tanaka S, Uemoto S. Efficiency of acoustic radiation force impulse imaging for the staging of graft fibrosis after liver transplantation. Hepatol Res 2019; 49:394-403. [PMID: 30471140 DOI: 10.1111/hepr.13289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 02/07/2023]
Abstract
AIM Liver biopsy is the gold standard for assessing liver fibrosis (LF) after liver transplantation (LT), but its invasiveness limits its utility. This study aimed to evaluate the usefulness of liver stiffness measurement (LSM) using acoustic radiation force impulse (ARFI) imaging to assess LF after LT. METHODS Between September 2013 and January 2017, 278 patients who underwent liver biopsy after LT in Kyoto University Hospital (Kyoto, Japan) were prospectively enrolled. Liver stiffness measurement was carried out using ARFI imaging; its value was expressed as shear wave velocity (Vs) [m/s]. The LF was evaluated according to METAVIR score (F0-F4). The diagnostic performance of Vs for F2≤ and F3≤ was assessed and compared with that of laboratory tests using receiver operating characteristic (ROC) analysis. RESULTS The median Vs values increased according to the progression of LF (F0, 1.18 (0.78-1.92); F1, 1.35 (0.72-3.54); F2, 1.55 (1.05-3.37); F3, 1.84 (1.41-2.97)). The Vs had the highest area under the ROC curve (AUROC) for the prediction of both F2 ≤ and F3 ≤ fibrosis (F2, 0.77; and F3, 0.85). With the cut-off value of Vs >1.31, sensitivity, specificity, positive predictive value, and negative predictive value were 89.4%, 53.3%, 37.3%, and 94.2% in predicting F2≤, respectively. Shear wave velocity diagnosed LF better than any laboratory tests regardless of the type of primary disease. CONCLUSIONS Acoustic radiation force impulse helps to assess graft LF after LT. The high sensitivity suggested that ARFI might reduce the frequency of liver biopsies by detecting patients who are unlikely to have significant fibrosis after LT. (Unique trial no. UMIN R000028296.).
Collapse
Affiliation(s)
- Kenji Yoshino
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Yukihiro Okuda
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Yoshinobu Ikeno
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Yusuke Uemoto
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Takahiro Nishio
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Gen Yamamoto
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Kazutaka Tanabe
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Yukinori Koyama
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Hideaki Okajima
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Takumi Imai
- Department of Clinical Biostatistics/Clinical Biostatistics Course, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics/Clinical Biostatistics Course, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| |
Collapse
|
16
|
Park DW, Lee YJ, Chang W, Park JH, Lee KH, Kim YH, Kang NK, Chung JW, Jang HY, Ahn S, Kim H, Jeong SH, Kim JW, Jang ES. Diagnostic performance of a point shear wave elastography (pSWE) for hepatic fibrosis in patients with autoimmune liver disease. PLoS One 2019; 14:e0212771. [PMID: 30856201 PMCID: PMC6411150 DOI: 10.1371/journal.pone.0212771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 02/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Elastography point quantification is a convenient method for measuring liver stiffness. It can be performed simultaneously with conventional ultrasonography. This study aimed to evaluate its diagnostic performance for assessing hepatic fibrosis in patients with autoimmune liver disease (AILD), including autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). METHODS The diagnostic performance of elastography point quantification (ElastPQ) was evaluated and compared with that of serum fibrosis markers, including the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4), using the receiver operating characteristics analysis with histologic evaluation as the reference standard. RESULTS In 49 AIH patients, sensitivity and specificity of ElastPQ were 93.6% and 44.4%, respectively, for significant fibrosis (≥ F2, cutoff 4.47 kPa), and 63.6% and 86.8% for cirrhosis (F4, cutoff 9.28 kPa). In 41 PBC patients, they were 81.8% and 73.3%, respectively, for significant fibrosis (≥ F2, cutoff 5.56 kPa), and 100% and 81.6%, respectively, for advanced fibrosis (≥ F3, cutoff 6.04 kPa). The areas under the receiver operating characteristic curves of ElastPQ for significant fibrosis (0.77, 95% CI 0.67-0.86) and cirrhosis (0.81, 95% CI 0.65-0.96) were higher than those of APRI and FIB-4 in AILD patients. According to the multivariable analysis, histological activity, steatosis, and body max index (BMI) were not significant factors that influenced the result of ElastPQ. CONCLUSIONS ElastPQ exhibited better diagnostic performance-without the influence of confounding factors-for assessing hepatic fibrosis in AILD patients than serum fibrosis markers.
Collapse
Affiliation(s)
- Dong Won Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Nam Kyu Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jung Wha Chung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee Yoon Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Soomin Ahn
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
17
|
Guo Y, Lin H, Dong C, Zhang X, Wen H, Shen Y, Wang T, Chen S, Liu Y, Chen X. Role of acoustic radiation force impulse imaging elastography in the assessment of steatohepatitis and fibrosis in rat models. Med Eng Phys 2018; 59:30-35. [PMID: 30042031 DOI: 10.1016/j.medengphy.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 04/20/2018] [Accepted: 06/11/2018] [Indexed: 02/06/2023]
Abstract
Acoustic radiation force impulse (ARFI) elastography is a non-invasive method for performing liver assessment via liver shear wave velocity (SWV) measurements. The aim of this study was to evaluate the performance of the ARFI technique in the diagnosis of nonalcoholic steatohepatitis (NASH) and fibrosis and to investigate the effect of steatosis and inflammation on liver fibrosis SWV measurements in a rat model of nonalcoholic fatty liver disease (NAFLD). The ex vivo right liver lobes from 110 rats were processed and embedded in a fabricated gelatin phantom, and the other lobes were used for histologic assessment. The SWV induced by acoustic radiation force was derived to evaluate liver stiffness. The experimental results showed that the liver SWV value could be used to differentiate non-NASH rats from NASH-presenting rats and NASH from cirrhosis, and these comparisons showed areas under the receiver operating characteristic curves (AUROC) of 0.951 and 0.980, respectively. The diagnostic performances of ARFI elastography in predicting severe fibrosis (F ≥ 3) and cirrhosis (F ≥ 4) showed AUROC values of 0.997 and 0.993, respectively. In rats with mild fibrosis (F0-F1), severe steatosis had a significant effect on the mean SWV values. In rats with significant fibrosis (F2-F4), severe lobular inflammation had significant effects on the mean SWV values. Our findings indicate that ARFI elastography is a promising method for differentiating non-NASH rats from NASH rats and for staging hepatic fibrosis in NASH. The presence of severe steatosis and severe lobular inflammation are significant factors for evaluating fibrosis stages.
Collapse
Affiliation(s)
- Yanrong Guo
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Haoming Lin
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Changfeng Dong
- Shenzhen Institute of Hepatology, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Xinyu Zhang
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Huiying Wen
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Yuanyuan Shen
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Tianfu Wang
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Siping Chen
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Yingxia Liu
- Shenzhen Institute of Hepatology, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Xin Chen
- School of Biomedical Engineering, Shenzhen University, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.
| |
Collapse
|
18
|
Abstract
NAFLD is a global epidemic. The prevalence of NAFLD is 20-30% in North America, northern Europe, Australia, Japan, India and China. It is crucial that patients with NAFLD receive an assessment for their risk of advanced fibrosis, which increases the risk of hepatocellular carcinoma and other complications of cirrhosis. Risk stratification that is efficient, cost-effective, patient-centred and evidence-based is one of the most important issues facing clinicians who care for those with liver disease. Given patients' preference to avoid liver biopsy, noninvasive alternatives to assess liver fibrosis are in high demand. The most accurate noninvasive methods are based on liver elastography. Research on these techniques - which include vibration-controlled transient elastography (VCTE), magnetic resonance elastography (MRE), shear-wave elastography and acoustic radiation force impulse - has proliferated. Unfortunately, the literature has not kept pace with clinical practice. There is limited guidance for how clinicians should anticipate and manage the pitfalls of these tests. Furthermore, guidance is unavailable for clinicians regarding the optimal incorporation of VCTE, MRE or the emerging elastographic techniques into their clinical strategy, particularly for patients with NAFLD. In this Review, we summarize the available evidence, highlight gaps to address in further research and explore optimization of these techniques in clinical practice.
Collapse
|
19
|
Huang TL, Chen TY, Tsang LC, Ou HY, Yu CY, Hsu HW, Lim WX, Cheng YF, Chen CL. Acoustic Radiation Force Impulse Elastography in Post-transplant Recurrent Hepatitis C in Living Donor Liver Transplantation. Transplant Proc 2018; 50:2695-2698. [PMID: 30401379 DOI: 10.1016/j.transproceed.2018.04.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the efficacy of liver fibrosis (LF) with acoustic radiation force impulse (ARFI) elastography for post-transplant (post-LT) HCV recurrence. PATIENTS AND METHODS We enrolled 89 adult recipients of living donor liver transplantation (LDLT) who had HCV, with or without post-LT HCV recurrence and treated or not treated. The post-LT HCV recurrence was diagnosed on the basis of RNA viral load present. ARFI examination was performed every 3 months for all patients, with shear wave velocity (SWV) obtained quantitatively in m/s and correlated with histopathologic fibrosis scoring of liver biopsy (LB). RESULTS There were 50 (50 of 89) patients without HCV recurrence and 39 (39 of 89) with post-LT recurrence in the 89 patients studied. The recurrent group had significantly higher median SWVs (1.87 ± 0.52 vs 1.37 ± 0.52 m/s, P < .0001), in which 18 (18 of 39) patients had antiviral drug treatment and obtained significant improvement with SWVs from 1.83 ± 0.49 to 1.68 ± 0.56 m/s, P = .043. The correlations of LF staging between ARFI elastography and Ishak histopathologic LF scores showed great significance, P = .045. The HCV RNA titer after antiviral treatment decreased from 3,831,750 to 0, P < .0001, but the RNA titer of nontreated patients remained high and the median SWV increased. The Ishak LF staging in the nontreated group progressed from stage 1 to 2, P = .012 and SWV increased from 1.69 ± 0.54 to 1.91 ± 0.66 m/s, P = .085 at 1-year follow-up. CONCLUSION ARFI elastography has efficient quantitative LF monitoring correlated with histopathologic staging for post-LT HCV recurrence. It could be an alternative, noninvasive method for frequent LB in the disease follow-up.
Collapse
Affiliation(s)
- T-L Huang
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan.
| | - T-Y Chen
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| | - L-C Tsang
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| | - H-Y Ou
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| | - C-Y Yu
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| | - H-W Hsu
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| | - W-X Lim
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| | - Y-F Cheng
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| | - C-L Chen
- Department of Diagnostic Radiology and Liver Transplantation Program, Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung 83305, Taiwan
| |
Collapse
|
20
|
Ippolito D, Schiavone V, Talei Franzesi CR, Casiraghi AS, Drago SG, Riva L, Sironi S. Real-Time Elastography: Noninvasive Diagnostic Tool in the Evaluation of Liver Stiffness in Patients with Chronic Viral Hepatitis, Correlation with Histological Examination. Dig Dis 2018; 36:289-297. [PMID: 29698947 DOI: 10.1159/000480699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/14/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine the value of real-time elastography (RTE) in the assessment of liver stiffness in patients with chronic viral hepatitis, correlating RTE data with the extent of fibrosis based on biopsy findings (Ishak score). METHODS We evaluated 98 patients (45-75 years) with chronic viral hepatitis (51 HCV, 47 HBV) by using ultrasonography (US) study combined with RTE analysis. In the RTE images, relative tissue stiffness is expressed, according to color scale, with soft areas represented in green/red colors and hard areas in blue. We divided the patients into 2 groups based on the fibrosis degree: soft degree (D1, corresponding to F1-F3 Ishak score) and hard degree (D2, corresponding to F4-F6). Before RTE, all patients underwent a US-guided percutaneous liver biopsy (right lobe). RESULTS Quantitative RTE data were compared with liver biopsy by using the Spearman correlation coefficient in order to assess the correlation between the RTE (D) and fibrosis, according to Ishak score (F) at histology. At RTE, out of 98 patients 55 had degree D1 and 43 had degree D2; at histological analysis, we observed the following: 15 patients with F1, 28 with F2, 17 with F3, 16 with F4, 12 with F5, and 10 with F6. The Spearman's coefficient showed significant correlation between D and F degree, obtaining rho = 0.573, p = 0.003. CONCLUSIONS RTE analysis showed high diagnostic accuracy in the assessment of fibrosis, and it appears to be a useful diagnostic tool for noninvasive quantification of fibrosis in patients with chronic viral hepatitis.
Collapse
Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Monza, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Monza, Italy
| | - Valentina Schiavone
- School of Medicine, University of Milano-Bicocca, Monza, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Monza, Italy
| | - Cammillo Roberto Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Monza, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Monza, Italy
| | - Alessandra Silvia Casiraghi
- School of Medicine, University of Milano-Bicocca, Monza, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Monza, Italy
| | - Silvia Girolama Drago
- School of Medicine, University of Milano-Bicocca, Monza, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Monza, Italy
| | - Luca Riva
- School of Medicine, University of Milano-Bicocca, Monza, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Monza, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Monza, Italy
- Department of Diagnostic Radiology, H. Papa Giovanni XXIII, Piazza OMS, Bergamo, Italy
| |
Collapse
|
21
|
Guo Y, Dong C, Lin H, Zhang X, Wen H, Shen Y, Wang T, Chen S, Liu Y, Chen X. Evaluation of Non-alcoholic Fatty Liver Disease Using Acoustic Radiation Force Impulse Imaging Elastography in Rat Models. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2619-2628. [PMID: 28811064 DOI: 10.1016/j.ultrasmedbio.2017.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study is to evaluate the utility of acoustic radiation force impulse (ARFI) elastography for assessing hepatic fibrosis stage and non-alcoholic fatty liver disease (NAFLD) severity, as well as the relationship among hepatic histologic changes using shear wave velocity (SWV). Animal models with various degrees of NAFLD were established in 110 rats. The right liver lobe was processed and embedded in a fabricated gelatin solution (porcine skin). Liver mechanics were measured using SWV induced by acoustic radiation force. Among the histologic findings, liver elasticity could be used to differentiate normal rats from rats with simple steatosis (SS) as well as distinguish SS from non-alcoholic steatohepatitis (NASH), with areas under the receiver operating characteristic curves (AUROC) of 0.963 (95% confidence interval = 0.871-0.973) and 0.882 (95% confidence interval = 0.807-0.956), respectively. For NAFLD rats, the diagnostic performance of ARFI elastography in predicting significant fibrosis (F ≥ 2) had an AUROC of 0.963. For evaluating steatosis severity, we found a progressive increase in ARFI velocity proportional to steatotic severity in NAFLD rat models, but we observed no significant differences for steatotic severity after excluding the rats with fibrosis. ARFI elastography may be used to differentiate among degrees of severity of NAFLD and hepatic fibrotic stages in NAFLD rat models.
Collapse
Affiliation(s)
- Yanrong Guo
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Changfeng Dong
- State Key Discipline of Infectious Diseases, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Haoming Lin
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Xinyu Zhang
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Huiying Wen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Yuanyuan Shen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Tianfu Wang
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Siping Chen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Yingxia Liu
- State Key Discipline of Infectious Diseases, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Xin Chen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.
| |
Collapse
|
22
|
Lei B, Liu Y, Dong C, Chen X, Zhang X, Diao X, Yang G, Liu J, Yao S, Li H, Yuan J, Li S, Le X, Lin Y, Zeng W. Assessment of liver fibrosis in chronic hepatitis B via multimodal data. Neurocomputing 2017. [DOI: 10.1016/j.neucom.2016.09.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
23
|
Usefulness of Multiparametric Ultrasound for Evaluating Structural Abnormality of Transplanted Kidney: Can We Predict Histologic Abnormality on Renal Biopsy in Advance? AJR Am J Roentgenol 2017; 209:W139-W144. [PMID: 28705060 DOI: 10.2214/ajr.16.17397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the associations between microscopic abnormalities of transplanted kidneys and sonography-based imaging biomarkers, including elasticity, venous impedance index, arterial resistive index, and size. MATERIALS AND METHODS Between 2011 and 2015, 159 recipients underwent sonography and biopsy of a transplanted kidney at our institution; 104 adult patients were included in this study. The maximal longitudinal length on gray-scale images, arterial resistive index, and venous impedance index on Doppler images and shear wave velocity on acoustic radiation force impulse imaging or Young modulus on supersonic shear imaging were measured before biopsy. The Banff criteria (2009 update), an international standardized classification and scoring system for renal allograft pathology, were used to evaluate the biopsy samples. Sonography parameters and clinical variables were analyzed with individual and summed Banff scores. RESULTS Spearman rank correlation coefficients and ordinal logistic regression showed no association between sonography parameters and summed Banff scores. Only the interval between transplant and biopsy was significantly associated with summed Banff scores (p < 0.05). Univariate logistic regression analysis with individual Banff scores showed associations of one Banff feature with arterial resistive index, three with venous impedance index, and six with interval between transplant and biopsy (p < 0.05). Sonoelastography parameters were not associated with any individual Banff score. CONCLUSION Neither sonoelastography parameter was associated with any histopathologic change of renal allografts. Although arterial resistive index and venous impedance index were related to a few individual Banff scores, length of time between transplant and biopsy showed stronger correlation than any imaging biomarkers with renal allograft deterioration.
Collapse
|
24
|
Development of a Simple Noninvasive Model to Predict Significant Fibrosis in Patients with Chronic Hepatitis B: Combination of Ultrasound Elastography, Serum Biomarkers, and Individual Characteristics. Clin Transl Gastroenterol 2017; 8:e84. [PMID: 28383564 PMCID: PMC5415893 DOI: 10.1038/ctg.2017.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/24/2017] [Indexed: 12/14/2022] Open
Abstract
Objectives: The accurate assessment of liver fibrosis is clinically important in patients with chronic hepatitis B (CHB). Blood tests and elastography are now widely used for the noninvasive diagnosis of liver fibrosis in CHB patients. The aim of this study was to develop a new and more accurate predictive model, which combines elastography data, serum biomarkers, and individual characteristics, to discriminate between CHB patients with and without significant liver fibrosis. Methods: Two noninvasive methods, specifically, an ultrasound elastography technique termed acoustic radiation force impulse imaging (ARFI) and a blood test, were used to assess a cohort of 345 patients (estimation group, 218 patients; validation group, 127 patients) with CHB. Multivariate logistic regression analysis revealed that ARFI, the aspartate aminotransferase (AST) to platelet ratio, and age were significantly associated with fibrosis. Based on these results, we constructed and validated a model for the diagnosis of significant hepatic fibrosis. Results: The area under the receiver operating characteristic (ROC) curve was 0.921 for the estimation group and 0.929 for the validation group, significantly higher than those for ARFI (0.887, 0.893) and for the AST-to-platelet ratio index (APRI; 0.811, 0.859). Using an optimal cutoff of 3.05 in the validation group, all the indices of the proposed model, including accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio, were better than those for ARFI or APRI. Conclusions: We developed a simple noninvasive model that used ultrasound elastography, routine serum biomarkers, and individual characteristics to accurately differentiate significant fibrosis in patients with CHB. Compared with elastography or the biomarker index alone, this model was significantly more accurate and robust.
Collapse
|
25
|
Wang J, Malik N, Yin M, Smyrk TC, Czaja AJ, Ehman RL, Venkatesh SK. Magnetic resonance elastography is accurate in detecting advanced fibrosis in autoimmune hepatitis. World J Gastroenterol 2017; 23:859-868. [PMID: 28223730 PMCID: PMC5296202 DOI: 10.3748/wjg.v23.i5.859] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/20/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the value of magnetic resonance elastography (MRE) in detecting advanced fibrosis/cirrhosis in autoimmune hepatitis (AIH).
METHODS In this retrospective study, 36 patients (19 treated and 17 untreated) with histologically confirmed AIH and liver biopsy performed within 3 mo of MRE were identified at a tertiary care referral center. Liver stiffness (LS) with MRE was calculated by a radiologist, and inflammation grade and fibrosis stage in liver biopsy was assessed by a pathologist in a blinded fashion. Two radiologists evaluated morphological features of cirrhosis on conventional magnetic resonance imaging (MRI). Accuracy of MRE was compared to laboratory markers and MRI for detection of advanced fibrosis/cirrhosis.
RESULTS Liver fibrosis stages of 0, 1, 2, 3 and 4 were present in 4, 6, 7, 6 and 13 patients respectively. There were no significant differences in distribution of fibrosis stage and inflammation grade between treated and untreated patient groups. LS with MRE demonstrated stronger correlation with liver fibrosis stage in comparison to laboratory markers for chronic liver disease (r = 0.88 vs -0.48-0.70). A trend of decreased mean LS in treated patients compared to untreated patients was observed (3.7 kPa vs 3.84 kPa) but was not statistically significant. MRE had an accuracy/sensitivity/specificity/positive predictive value/negative predictive value of 0.97/90%/100%/100%/90% and 0.98/92.3%/96%/92.3%/96% for detection of advanced fibrosis and cirrhosis, respectively. The performance of MRE was significantly better than laboratory tests for detection of advanced fibrosis (0.97 vs 0.53-0.80, P < 0.01), and cirrhosis (0.98 vs 0.58-0.80, P < 0.01) and better than conventional MRI for diagnosis of cirrhosis (0.98 vs 0.78, P = 0.002).
CONCLUSION MRE is a promising modality for detection of advanced fibrosis and cirrhosis in patients with AIH with superior diagnostic accuracy compared to laboratory assessment and MRI.
Collapse
|
26
|
Guo Y, Dong C, Lin H, Zhang X, Wen H, Shen Y, Wang T, Chen S, Liu Y, Chen X. Ex vivo study of acoustic radiation force impulse imaging elastography for evaluation of rat liver with steatosis. ULTRASONICS 2017; 74:161-166. [PMID: 27814485 DOI: 10.1016/j.ultras.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/29/2016] [Accepted: 10/16/2016] [Indexed: 06/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in developed countries. Accurate, noninvasive tests for diagnosing NAFLD are urgently needed. The goals of this study were to evaluate the utility of acoustic radiation force impulse (ARFI) elastography for determining the severity grade of steatosis in rat livers, and to investigate the changes in various histologic and biochemical characteristics. Steatosis was induced in the livers of 57 rats by gavage feeding of a high fat emulsion; 12 rats received a standard diet only and served as controls. Liver mechanics were measured ex vivo using shear wave velocity (SWV) induced by acoustic radiation force. The measured mean values of liver SWV ranged from 1.33 to 3.85m/s for different grades of steatosis. The area under the receiver operative characteristic curve (⩾S1) was equal to 0.82 (95% CI=0.69, 0.96) between the steatosis group and the normal group, and the optimal cutoff value was 2.59 with sensitivity of 88% and specificity of 76%. However, there are no significant differences in SWV measurements between the steatosis grades. SWV values did not correlate with the early grade of inflammation. In conclusion, ARFI elastography is a promising method for differentiating normal rat liver from rat liver with steatosis, but it cannot reliably predict the grade of steatosis in rat livers. The early grade of inflammation activity did not significantly affect the SWV measurements.
Collapse
Affiliation(s)
- Yanrong Guo
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China
| | - Changfeng Dong
- Shenzhen Institute of Hepatology, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Haoming Lin
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China
| | - Xinyu Zhang
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China
| | - Huiying Wen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China
| | - Yuanyuan Shen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China
| | - Tianfu Wang
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China
| | - Siping Chen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China
| | - Yingxia Liu
- Shenzhen Institute of Hepatology, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Xin Chen
- School of Biomedical Engineering, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, China.
| |
Collapse
|
27
|
Abstract
Hepatic fibrosis develops or progresses in 25 % of patients with autoimmune hepatitis despite corticosteroid therapy. Current management regimens lack reliable noninvasive methods to assess changes in hepatic fibrosis and interventions that disrupt fibrotic pathways. The goals of this review are to indicate promising noninvasive methods to monitor hepatic fibrosis in autoimmune hepatitis and identify anti-fibrotic interventions that warrant evaluation. Laboratory methods can differentiate cirrhosis from non-cirrhosis, but their accuracy in distinguishing changes in histological stage is uncertain. Radiological methods include transient elastography, acoustic radiation force impulse imaging, and magnetic resonance elastography. Methods based on ultrasonography are comparable in detecting advanced fibrosis and cirrhosis, but their performances may be compromised by hepatic inflammation and obesity. Magnetic resonance elastography has excellent performance parameters for all histological stages in diverse liver diseases, is uninfluenced by inflammatory activity or body habitus, has been superior to other radiological methods in nonalcoholic fatty liver disease, and may emerge as the preferred instrument to evaluate fibrosis in autoimmune hepatitis. Promising anti-fibrotic interventions are site- and organelle-specific agents, especially inhibitors of nicotinamide adenine dinucleotide phosphate oxidases, transforming growth factor beta, inducible nitric oxide synthase, lysyl oxidases, and C-C chemokine receptors types 2 and 5. Autoimmune hepatitis has a pro-fibrotic propensity, and noninvasive radiological methods, especially magnetic resonance elastography, and site- and organelle-specific interventions, especially selective antioxidants and inhibitors of collagen cross-linkage, may emerge to strengthen current management strategies.
Collapse
|
28
|
Elhosary YA, Saleh SM, Ezzat WM, Clevert DA. Diagnostic Accuracy of Acoustic Radiation Force Impulse (ARFI) in Diagnosis of Liver Fibrosis among Egyptian Patients with Chronic HCV Infection. Open Access Maced J Med Sci 2016; 4:374-380. [PMID: 27703558 PMCID: PMC5042618 DOI: 10.3889/oamjms.2016.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/14/2016] [Accepted: 05/15/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND: Acoustic radiation force impulse (ARFI) evaluates liver stiffness non-invasively and was invented recently. This technique can easily and accurately assess the degree of liver fibrosis in clinical practice. AIM: The aim of this study was to detect the diagnostic performance of ARFI elastography in the staging of fibrosis in some Egyptian patients with chronic HCV infection. PATIENTS AND METHODS: One hundred ninety patients with chronic HCV infection; 142 men and 48 women were enrolled in the study. They underwent liver biopsy examination for liver fibrosis detection. All demographic; clinical and biochemical data were recoded. ARFI examination was done for all subjects to detect liver stiffness measurement in relation to liver fibrosis detected by pathological examination of liver biopsies. RESULTS: Medians of liver stiffness measurement by shear wave velocity showed a significant increase as a grade of liver fibrosis increases (p ≤ 0.0001, highly significant). Liver stiffness was directly correlated to age, AST; ALT; INR and liver steatosis (p values were: 0.009; 0.0001; 0.013; 0.006 and 0.04 respectively, significant). On the other hand, liver stiffness was inversely correlated to albumin; prothrombin concentration and platelets (p values were: 0.0001; 0.001, and 0.0001, respectively, significant). We found that shear wave velocity can predict F1; F2; F3 and F4 at cut-off values: 1.22; 1.32; 1.44 and 1.8 respectively. CONCLUSION: ARFI is a diagnostic noninvasive promising technique for liver fibrosis diagnosis among Egyptian patients with chronic HCV infection.
Collapse
Affiliation(s)
- Yasser A Elhosary
- Department of Internal Medicine, National Research Center, Cairo, Egypt
| | - Saleh M Saleh
- Department of Internal Medicine, National Liver Institute, Menoufia, Egypt
| | - Wafaa M Ezzat
- Department of Internal Medicine, National Research Center, Cairo, Egypt
| | - Dirk-André Clevert
- Department of Clinical Radiology, Munich University Hospital, Munich, Germany
| |
Collapse
|
29
|
Diagnosing native liver fibrosis and esophageal varices using liver and spleen stiffness measurements in biliary atresia: a pilot study. Pediatr Radiol 2016; 46:1409-17. [PMID: 27300741 DOI: 10.1007/s00247-016-3637-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/01/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biliary atresia commonly leads to liver fibrosis and cirrhotic complications, including esophageal varices. OBJECTIVE To evaluate liver and spleen stiffness measurements using acoustic radiation force impulse (ARFI) imaging for diagnosing grade of liver fibrosis and predicting the presence of esophageal varices in patients treated for biliary atresia. MATERIALS AND METHODS ARFI imaging of the spleen and native liver was performed in 28 patients with biliary atresia. We studied the relation between ARFI imaging values and liver histology findings (n=22), upper gastrointestinal endoscopy findings (n=16) and several noninvasive test results. Diagnostic accuracy was assessed using receiver operating characteristic curve analyses. RESULTS Liver stiffness measurements exhibited a significant difference among the different grades of liver fibrosis (P=0.009), and showed higher values in patients with high-risk esophageal varices than in the other patients (P=0.04). The areas under the receiver operating characteristic curves of liver stiffness measurements for liver fibrosis grades ≥ F2, ≥F3 and = F4 were 0.83, 0.93 and 0.94, respectively. Patients with high-risk esophageal varices were preferentially diagnosed by the combined liver and spleen stiffness measurements (area under the curve, 0.92). CONCLUSION Liver and spleen stiffness measurements using ARFI imaging are potential noninvasive markers for liver fibrosis and esophageal varices in patients treated for biliary atresia.
Collapse
|
30
|
Alkhouri N, Feldstein AE. Noninvasive diagnosis of nonalcoholic fatty liver disease: Are we there yet? Metabolism 2016; 65:1087-95. [PMID: 26972222 PMCID: PMC4931968 DOI: 10.1016/j.metabol.2016.01.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/22/2015] [Accepted: 01/07/2016] [Indexed: 12/15/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has rapidly become the most common form of chronic liver disease in the United States affecting approximately 80-100 million Americans. NAFLD includes a spectrum of diseases ranging from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) to fibrosis and eventually cirrhosis. Patients with NASH and significant fibrosis on liver biopsy have an increased risk for liver-related morbidity and mortality compared to those with NAFL. Due to the high prevalence of NAFLD and its progressive nature, there has been an urgent need to develop reliable noninvasive tests that can accurately predict the presence of advanced disease without the need for liver biopsy. These tests can be divided into those that predict the presence of NASH and those that predict the presence of fibrosis. In this review, we provide a concise overview of different noninvasive methods for staging the severity of NAFLD.
Collapse
Affiliation(s)
- Naim Alkhouri
- Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA; Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ariel E Feldstein
- Department of Pediatrics, University of California San Diego (UCSD), CA, USA.
| |
Collapse
|
31
|
Chin JL, Pavlides M, Moolla A, Ryan JD. Non-invasive Markers of Liver Fibrosis: Adjuncts or Alternatives to Liver Biopsy? Front Pharmacol 2016; 7:159. [PMID: 27378924 PMCID: PMC4913110 DOI: 10.3389/fphar.2016.00159] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/31/2016] [Indexed: 12/13/2022] Open
Abstract
Liver fibrosis reflects sustained liver injury often from multiple, simultaneous factors. Whilst the presence of mild fibrosis on biopsy can be a reassuring finding, the identification of advanced fibrosis is critical to the management of patients with chronic liver disease. This necessity has lead to a reliance on liver biopsy which itself is an imperfect test and poorly accepted by patients. The development of robust tools to non-invasively assess liver fibrosis has dramatically enhanced clinical decision making in patients with chronic liver disease, allowing a rapid and informed judgment of disease stage and prognosis. Should a liver biopsy be required, the appropriateness is clearer and the diagnostic yield is greater with the use of these adjuncts. While a number of non-invasive liver fibrosis markers are now used in routine practice, a steady stream of innovative approaches exists. With improvement in the reliability, reproducibility and feasibility of these markers, their potential role in disease management is increasing. Moreover, their adoption into clinical trials as outcome measures reflects their validity and dynamic nature. This review will summarize and appraise the current and novel non-invasive markers of liver fibrosis, both blood and imaging based, and look at their prospective application in everyday clinical care.
Collapse
Affiliation(s)
- Jun L Chin
- School of Medicine and Medical Science, University College Dublin Dublin, Ireland
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford Oxford, UK
| | - Ahmad Moolla
- Radcliffe Department of Medicine, University of Oxford Oxford, UK
| | - John D Ryan
- Translational Gastroenterology Unit, University of Oxford Oxford, UK
| |
Collapse
|
32
|
Festi D, Schiumerini R, Marasco G, Scaioli E, Pasqui F, Colecchia A. Non-invasive diagnostic approach to non-alcoholic fatty liver disease: current evidence and future perspectives. Expert Rev Gastroenterol Hepatol 2016; 9:1039-53. [PMID: 25993881 DOI: 10.1586/17474124.2015.1049155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Non-alcoholic fatty liver disease is a new epidemic liver disease, thus, its early diagnosis and the identification of those patients with the worst prognosis is mandatory. Liver biopsy is still the diagnostic gold standard, even if it is associated to a significant rate of complications; moreover, the interpretation of histological samples is not always univocal. Several non-invasive alternative scores have been proposed for the diagnostic approach to non-alcoholic fatty liver disease. This article evaluates the performance of the currently available non-invasive diagnostic strategies. The authors also suggest a potential diagnostic algorithm, with two or more non-invasive techniques, to increase the overall accuracy for identifying patients with worst prognosis, and to minimize the recourse to liver biopsy.
Collapse
Affiliation(s)
- Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | | | | | | | | | | |
Collapse
|
33
|
Renal elasticity quantification by acoustic radiation force impulse applied to the evaluation of kidney diseases: a review. J Investig Med 2016; 63:605-12. [PMID: 25738649 DOI: 10.1097/jim.0000000000000186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
For centuries, clinicians have used palpation to evaluate abdominal organs. After exploring almost all the different methods of interaction between x-rays, ultrasound, and magnetic fields on tissues, recent interest has focused on the evaluation of their mechanical properties.Acoustic radiation force impulse (ARFI) is a recent, established ultrasound-based diagnostic technique that allows physicians to obtain a measure of the elastic properties of an organ. Shear wave velocity, obtained by the ARFI technique, depends on the elasticity of tissues.To date, there are studies on the ARFI technique applied to normal kidneys, chronic kidney diseases, and kidney transplants. Mechanical properties of the kidney, such as stiffness and deformity, depend on various conditions that alter its histology, in particular the amount of fibrosis in the renal parenchyma; urinary pressure and renal blood perfusion may be other important contributing factors. Unfortunately, the ARFI technique applied to native renal pathologies is still limited, and not all studies are comparable because they used different methods. Therefore, the results reported in recent literature encourage further improvement of this method and the drawing up of standardized guidelines of investigation.
Collapse
|
34
|
Staging of fibrosis in experimental non-alcoholic steatohepatitis by quantitative molecular imaging in rat models. Nucl Med Biol 2016; 43:179-87. [DOI: 10.1016/j.nucmedbio.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/06/2015] [Accepted: 11/18/2015] [Indexed: 01/06/2023]
|
35
|
Nishio T, Taura K, Koyama Y, Tanabe K, Yamamoto G, Okuda Y, Ikeno Y, Seo S, Yasuchika K, Hatano E, Okajima H, Kaido T, Tanaka S, Uemoto S. Prediction of posthepatectomy liver failure based on liver stiffness measurement in patients with hepatocellular carcinoma. Surgery 2016. [DOI: 10.1016/j.surg.2015.06.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
36
|
Abstract
Ultrasound elastography, also termed sonoelastography, is being used increasingly in clinical practice to aid the diagnosis and management of diffuse liver disease. Elastography has been shown to be capable of differentiating advanced and early-stage liver fibrosis, and consequently a major application in clinical liver care includes progression to cirrhosis risk stratification through (1) assessment of liver fibrosis stage in HCV and HBV patients, (2) distinguishing non-alcoholic steatohepatitis from simple steatosis in non-alcoholic fatty liver disease patients, and (3) prognostic evaluation of liver disease is autoimmune liver disease. In addition, elastographic characterization of focal liver lesions and evaluation of clinically significant portal hypertension have the potential to be clinically useful and are areas of active clinical research.
Collapse
Affiliation(s)
- Manish Dhyani
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA,
| | | | | |
Collapse
|
37
|
Lee J, Oh YT, Joo DJ, Ma BG, Lee AL, Lee JG, Song SH, Kim SU, Jung DC, Chung YE, Kim YS. Acoustic Radiation Force Impulse Measurement in Renal Transplantation: A Prospective, Longitudinal Study With Protocol Biopsies. Medicine (Baltimore) 2015; 94:e1590. [PMID: 26426636 PMCID: PMC4616853 DOI: 10.1097/md.0000000000001590] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Interstitial fibrosis and tubular atrophy (IF/TA) is a common cause of kidney allograft loss. Several noninvasive techniques developed to assess tissue fibrosis are widely used to examine the liver. However, relatively few studies have investigated the use of elastographic methods to assess transplanted kidneys. The aim of this study was to explore the clinical implications of the acoustic radiation force impulse (ARFI) technique in renal transplant patients. A total of 91 patients who underwent living donor renal transplantation between September 2010 and January 2013 were included in this prospective study. Shear wave velocity (SWV) was measured by ARFI at baseline and predetermined time points (1 week and 6 and 12 months after transplantation). Protocol biopsies were performed at 12 months. Instead of reflecting IF/TA, SWVs were found to be related to time elapsed after transplantation. Mean SWV increased continuously during the first postoperative year (P < 0.001). In addition, mixed model analysis showed no correlation existed between SWV and serum creatinine (r = -0.2426, P = 0.0771). There was also no evidence of a relationship between IF/TA and serum creatinine (odds ratio [OR] = 1.220, P = 0.7648). Furthermore, SWV temporal patterns were dependent on the kidney weight to body weight ratio (KW/BW). In patients with a KW/BW < 3.5 g/kg, mean SWV continuously increased for 12 months, whereas it decreased after 6 months in those with a KW/BW ≥ 3.5 g/kg.No significant correlation was observed between SWV and IF/TA or renal dysfunction. However, SWV was found to be related to the time after transplantation. Renal hemodynamics influenced by KW/BW might impact SWV values.
Collapse
Affiliation(s)
- Juhan Lee
- From the Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System (JL, DJJ, AL, JGL, SHS, YSK); The Research Institute for Transplantation, Yonsei University College of Medicine (DJJ, YSK); Department of Radiology, Severance Hospital, Yonsei University Health System (YTO, DCJ, YEC); Biostatistics Collaboration Unit, Yonsei University College of Medicine (BGM); and Department of Internal Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea (SUK)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Gerber L, Kasper D, Fitting D, Knop V, Vermehren A, Sprinzl K, Hansmann ML, Herrmann E, Bojunga J, Albert J, Sarrazin C, Zeuzem S, Friedrich-Rust M. Assessment of liver fibrosis with 2-D shear wave elastography in comparison to transient elastography and acoustic radiation force impulse imaging in patients with chronic liver disease. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2350-2359. [PMID: 26116161 DOI: 10.1016/j.ultrasmedbio.2015.04.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 06/04/2023]
Abstract
Two-dimensional shear wave elastography (2-D SWE) is an ultrasound-based elastography method integrated into a conventional ultrasound machine. It can evaluate larger regions of interest and, therefore, might be better at determining the overall fibrosis distribution. The aim of this prospective study was to compare 2-D SWE with the two best evaluated liver elastography methods, transient elastography and acoustic radiation force impulse (point SWE using acoustic radiation force impulse) imaging, in the same population group. The study included 132 patients with chronic hepatopathies, in which liver stiffness was evaluated using transient elastography, acoustic radiation force impulse imaging and 2-D SWE. The reference methods were liver biopsy for the assessment of liver fibrosis (n = 101) and magnetic resonance imaging/computed tomography for the diagnosis of liver cirrhosis (n = 31). No significant difference in diagnostic accuracy, assessed as the area under the receiver operating characteristic curve (AUROC), was found between the three elastography methods (2-D SWE, transient elastography, acoustic radiation force impulse imaging) for the diagnosis of significant and advanced fibrosis and liver cirrhosis in the "per protocol" (AUROCs for fibrosis stages ≥2: 0.90, 0.95 and 0.91; for fibrosis stage [F] ≥3: 0.93, 0.95 and 0.94; for F = 4: 0.92, 0.96 and 0.92) and "intention to diagnose" cohort (AUROCs for F ≥2: 0.87, 0.92 and 0.91; for F ≥3: 0.91, 0.93 and 0.94; for F = 4: 0.88, 0.90 and 0.89). Therefore, 2-D SWE, ARFI imaging and transient elastography seem to be comparably good methods for non-invasive assessment of liver fibrosis.
Collapse
Affiliation(s)
- Ludmila Gerber
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany.
| | - Daniela Kasper
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Daniel Fitting
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Viola Knop
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Annika Vermehren
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Kathrin Sprinzl
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Martin L Hansmann
- Institute of Pathology, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J. W. Goethe University, Frankfurt, Germany
| | - Joerg Bojunga
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Joerg Albert
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Frankfurt, Germany
| |
Collapse
|
39
|
Caballeria J, Caballeria L. Hígado graso no alcohólico. Papel de los médicos de atención primaria. Med Clin (Barc) 2015; 145:112-4. [DOI: 10.1016/j.medcli.2015.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022]
|
40
|
EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63:237-64. [PMID: 25911335 DOI: 10.1016/j.jhep.2015.04.006] [Citation(s) in RCA: 1215] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023]
|
41
|
Picó Aliaga S, Muro Velilla D, García-Martí G, Sangüesa Nebot C, Martí-Bonmatí L. La elastografía mediante técnica Acoustic radiation force impulse es eficaz en la detección de fibrosis hepática en el niño. RADIOLOGIA 2015; 57:314-20. [DOI: 10.1016/j.rx.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 03/24/2014] [Accepted: 04/01/2014] [Indexed: 12/23/2022]
|
42
|
Acoustic radiation force impulse imaging elastography is efficacious in detecting hepatic fibrosis in children. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
43
|
Zeng X, Xu C, He D, Zhang H, Xia J, Shi D, Kong L, He X, Wang Y. Influence of Hepatic Inflammation on FibroScan Findings in Diagnosing Fibrosis in Patients with Chronic Hepatitis B. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1538-1544. [PMID: 25724309 DOI: 10.1016/j.ultrasmedbio.2015.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/04/2015] [Accepted: 01/16/2015] [Indexed: 06/04/2023]
Abstract
Hepatic inflammation may affect the performance of FibroScan. This prospective study investigated the influence of hepatic inflammation on liver stiffness measurement (LSM) values by assessing FibroScan and liver biopsy findings in 325 patients with chronic hepatitis B. Liver fibrosis and inflammation were classified into five stages (S0-S4) and grades (G0-G4) according to the Scheuer scoring system. LSM values were correlated with fibrosis stage and inflammation grade (r = 0.479, p < 0.001, and r = 0.522, p < 0.001, respectively). Although LSM values increased in parallel with inflammation grade, no significant differences were found between patients with significant fibrosis (S2-S4) (p > 0.05). For inflammation grades G0, G1, G2 and G3, areas under receiver operating characteristic curves of FibroScan for significant fibrosis were 0.8267 (p < 0.001), 0.6956 (p < 0.001), 0.709 (p = 0.0012) and 0.6947 (p = 0.137), respectively. Inflammation has a significant influence on LSM values in patients with chronic hepatitis B with mild fibrosis, but not in those with significant fibrosis.
Collapse
Affiliation(s)
- Xianghua Zeng
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China
| | - Cheng Xu
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China
| | - Dengming He
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China; Liver Diagnosis and Treatment Center, 88th Hospital of Chinese People's Liberation Army, Tai'an, Shandong Province, China
| | - Huiyan Zhang
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China
| | - Jie Xia
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China
| | - Dairong Shi
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China
| | - Lingjun Kong
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China
| | - Xiaoqin He
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China
| | - Yuming Wang
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory for Research on Infectious Diseases, Chongqing, China.
| |
Collapse
|
44
|
Tai DI, Tsay PK, Jeng WJ, Weng CC, Huang SF, Huang CH, Lin SM, Chiu CT, Chen WT, Wan YL. Differences in liver fibrosis between patients with chronic hepatitis B and C: evaluation by acoustic radiation force impulse measurements at 2 locations. JOURNAL OF ULTRASOUND IN MEDICINE 2015; 34:813-21. [PMID: 25911714 DOI: 10.7863/ultra.34.5.813] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate liver fibrosis by acoustic radiation force impulse (ARFI) measurements at 2 locations in patients with chronic hepatitis B and C. METHODS A total of 204 consecutive patients (146 male and 58 female) with chronic hepatitis B (n = 121) and C (n = 83) who underwent liver biopsy were enrolled. All patients received ARFI measurements at 2 locations in the right intercostal space on the same day as biopsy. RESULTS There was no difference in median ARFI values between detection locations. However, a significant difference was found for low and high values between locations (median ± SD, 1.38 ± 0.43 versus 1.56 ± 0.55 m/s; P < .001). By receiver operating characteristic (ROC) curve analysis for a METAVIR fibrosis score of F4 (cirrhosis), the lower value of 2 measurements had the highest area under the ROC curve (0.750), followed by the mean value (0.744) and the higher value (0.730). Patients with hepatitis C had a higher area under the ROC curve than patients with hepatitis B (0.824 versus 0.707) for predicting liver cirrhosis. By logistic regression analysis, ARFI was the best modality for predicting liver cirrhosis in hepatitis C, and conventional sonography was the best modality in hepatitis B (P < .001). The ARFI value in patients with hepatitis B was significantly influenced by liver inflammation (P = .019). CONCLUSIONS Acoustic radiation force impulse imaging is the modality of choice for predicting liver cirrhosis in chronic hepatitis C, whereas conventional sonography is still the modality of choice in chronic hepatitis B.
Collapse
Affiliation(s)
- Dar-In Tai
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Pei-Kwei Tsay
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Wen-Juei Jeng
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Chia-Chan Weng
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Shiu-Feng Huang
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Chien-Hao Huang
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Shi-Ming Lin
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Cheng-Tang Chiu
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Wei-Ting Chen
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| | - Yung-Liang Wan
- Departments of Gastroenterology and Hepatology (D.-I.T., W.-J.J., C.-C.W., C.-H.H., S.-M.L., C.-T.C., W.-T.C.) and Medical Imaging and Intervention (Y.-L.W.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (P.-K.T.); Division of Molecular and Genomic Medicine, National Health Research Institute, Taipei, Taiwan (S.-F.H.); and Department of Medical Imaging and Radiological Sciences, College of Medicine, Institute for Radiological Research, Chang Gung University, Tao-Yuan, Taiwan (Y.-L.W.)
| |
Collapse
|
45
|
Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions. AJR Am J Roentgenol 2015; 205:33-40. [PMID: 25905762 DOI: 10.2214/ajr.15.14553] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of the article is to review the diagnostic performance of ultra-sound and MR elastography techniques for detection and staging of liver fibrosis, the main current clinical applications of elastography in the abdomen. CONCLUSION Technical and instrument-related factors and biologic and patient-related factors may constitute potential confounders of stiffness measurements for assessment of liver fibrosis. Future developments may expand the scope of elastography for monitoring liver fibrosis and predict complications of chronic liver disease.
Collapse
|
46
|
Papagianni M, Sofogianni A, Tziomalos K. Non-invasive methods for the diagnosis of nonalcoholic fatty liver disease. World J Hepatol 2015; 7:638-648. [PMID: 25866601 PMCID: PMC4388992 DOI: 10.4254/wjh.v7.i4.638] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/13/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease and includes simple steatosis and nonalcoholic steatohepatitis (NASH). Since NASH progresses to cirrhosis more frequently and increases liver-related and cardiovascular disease risk substantially more than simple steatosis, there is a great need to differentiate the two entities. Liver biopsy is the gold standard for the diagnosis of NAFLD but its disadvantages, including the risk of complications and sampling bias, stress the need for developing alternative diagnostic methods. Accordingly, several non-invasive markers have been evaluated for the diagnosis of simple steatosis and NASH, including both serological indices and imaging methods. The present review summarizes the current knowledge on the role of these markers in the diagnosis of NAFLD. Current data suggest that ultrasound and the fibrosis-4 score are probably the most appealing methods for detecting steatosis and for distinguishing NASH from simple steatosis, respectively, because of their low cost and relatively high accuracy. However, currently available methods, both serologic and imaging, cannot obviate the need for liver biopsy for diagnosing NASH due to their substantial false positive and false negative rates. Therefore, the current role of these methods is probably limited in patients who are unwilling or have contraindications for undergoing biopsy.
Collapse
|
47
|
Serai SD, Yin M, Wang H, Ehman RL, Podberesky DJ. Cross-vendor validation of liver magnetic resonance elastography. ABDOMINAL IMAGING 2015; 40:789-94. [PMID: 25476489 PMCID: PMC4523216 DOI: 10.1007/s00261-014-0282-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate and validate the reproducibility of MR Elastography (MRE)-derived liver stiffness values on two different MR vendor platforms performed on the same subject on the same day. METHODS This investigation was approved by the hospital IRB. MRE exams were performed twice in identical fashion in eight volunteers and in five clinical patients on two different 1.5 T MR scanners-once on a Philips MR scanner and immediately afterward in back-to-back fashion on a General Electric MR scanner, or vice versa. All scan parameters were kept identical on the two platforms to the best extent possible. After the MRE magnitude and phase images were obtained, the data were converted into quantitative images displaying the stiffness of the liver parenchyma. Mean liver stiffness values between the two platforms were compared using interclass correlation with a p value <0.05 considered statistically significant. RESULTS Interclass correlation coefficient (ICC) value of 0.994 was obtained for 13 subjects with p value <0.001 indicating a significantly positive correlation. CONCLUSION As MRE gains in acceptance and as its availability becomes more widespread, it is important to ascertain and confirm that liver stiffness values obtained on different MRE vendor platforms are consistent and reproducible. In this small pilot investigation, we demonstrate that liver stiffness measurement with MRE is reproducible and has very good consistency across two vendor platforms.
Collapse
Affiliation(s)
- Suraj D Serai
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,
| | | | | | | | | |
Collapse
|
48
|
Abe T, Hashiguchi A, Yamazaki K, Ebinuma H, Saito H, Kumada H, Izumi N, Masaki N, Sakamoto M. Quantification of collagen and elastic fibers using whole-slide images of liver biopsy specimens. Pathol Int 2015; 63:305-10. [PMID: 23782332 DOI: 10.1111/pin.12064] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 05/02/2013] [Indexed: 12/19/2022]
Abstract
Histological evaluation of fibrosis after a liver biopsy is crucial for evaluating the pathology of patients with chronic liver disease. Previous studies have reported quantitative analyses of fibrosis using images of collagen-stained sections. However, analysis of these studies requires manual selection of the region of interest. In addition, the quantification of elastic fibers is not considered. The present study was conducted in order to measure both the collagen and elastic fiber area ratios using Elastica van Gieson-stained whole-slide images (WSIs) of liver biopsy specimens. High-resolution WSIs provide precise color classification, enabling accurate detection of even fine collagen and elastic fibers. To minimize the influence of pre-existing fibrous tissue, median area ratios of the collagen and elastic fibers were independently calculated from the image tiles of the WSIs. These median area ratios were highly concordant with area ratios after the pre-existing fibrous tissues were manually trimmed from the WSI. Further, these median area ratios were correlated with liver stiffness as measured by transient elastography (collagen: r = 0.73 [P < 0.01], elastic: r = 0.53 [P < 0.01]). Our approach to quantifying liver fibrosis will serve as an effective tool to evaluate liver diseases in routine practice.
Collapse
Affiliation(s)
- Tokiya Abe
- Department of Pathology, School of Medicine, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Pacana T, Sanyal AJ. Recent advances in understanding/management of non-alcoholic steatohepatitis. F1000PRIME REPORTS 2015; 7:28. [PMID: 25926979 PMCID: PMC4371374 DOI: 10.12703/p7-28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-alcoholic steatohepatitis (NASH) can lead to advanced fibrosis, hepatocellular carcinoma, and end-stage liver disease requiring liver transplantation. A myriad of pathways and genetic influence contribute to NASH pathogenesis and liver disease progression. Diagnosing patients with NASH and advanced fibrosis is critical prior to treatment and prognostication. There has been ongoing interest in developing non-invasive biomarkers and tools for identifying NASH and advanced fibrosis. To date, there has been no approved therapy for NASH. Recently, the FLINT (Farnesoid X Receptor [FXR] Ligand Obeticholic Acid in NASH Treatment) trial provided promising results of the efficacy of obeticholic acid, a farnesoid X receptor agonist, in improving histological features of NASH and fibrosis. Long-term studies are needed to assess the safety of obeticholic acid and its effects on liver- and cardiovascular-related outcomes.
Collapse
|
50
|
Liu Y, Dong CF, Yang G, Liu J, Yao S, Li HY, Yuan J, Li S, Le X, Lin Y, Zeng W, Lin H, Zhang X, Chen X. Optimal linear combination of ARFI, transient elastography and APRI for the assessment of fibrosis in chronic hepatitis B. Liver Int 2015; 35:816-25. [PMID: 24751289 DOI: 10.1111/liv.12564] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/12/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Accurate assessment of liver fibrosis in patients with chronic hepatitis B (CHB) is necessary not only to predict the long-term clinical course but also to determine an appropriate antiviral therapy scheme. Several noninvasive approaches - serum markers and elastography - have been proposed as alternatives for the histopathological analysis of liver biopsies. The aim of this study was to evaluate two ultrasound elastography methods (ARFI and TE) and one biochemical test (APRI), as well as their optimal linear combination, in the assessment of liver fibrosis in CHB. METHODS Ninety five patients with CHB and 16 volunteers underwent ARFI, TE and APRI; and liver fibrosis was staged in the patients by a liver biopsy. An optimal linear combination of the three methods was developed, and its diagnostic performance was evaluated by a 10-fold cross-validation. RESULTS The accuracy of the linear combination was 83.86% and 91.88% for significant fibrosis (≥F2) and cirrhosis (F4), respectively, higher than those obtained for ARFI (83.50%, 88.76%), TE (75.27%, 87.61%) and APRI (73.29% and 81.67%). The combination also increased the sensitivity and the negative predictive values for the diagnosis of significant fibrosis and cirrhosis. CONCLUSIONS The optimal linear combination algorithm is effective for noninvasive staging of liver fibrosis in CHB. However, linear combination has its own limitations; nonlinear methods may eventually reveal even clearer diagnostic results.
Collapse
Affiliation(s)
- Yingxia Liu
- Shenzhen Institute of Hepatology, Shenzhen Third People's Hospital, Shenzhen, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|