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Renard AS, Paisant A, Cartier V, Calès P, Goyet-Prelipcean M, Geagea E, Tasu JP, Silvain C, Wagner M, Cleach AL, Vilgrain V, Castera L, Bricault I, Decaens T, Savoye-Collet C, Montialoux H, Correas JM, Vallet-Pichard A, Boursier J, Aubé C. Validation of a screening algorithm for hepatic fibrosis by Doppler ultrasound and elastography in a general population. Acta Radiol 2023; 64:1730-1737. [PMID: 36617943 DOI: 10.1177/02841851221138519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early detection can prevent the initial stages of fibrosis from progressing to cirrhosis. PURPOSE To evaluate an algorithm combining three echographic indicators and elastographic measurements to screen for hepatic fibrosis in an unselected population. MATERIAL AND METHODS From May 2017 to June 2018, all patients with no history and no known chronic liver disease who were referred for an ultrasound (US) were prospectively included in eight hospitals. The indicators being sought were liver surface irregularity, demodulation of hepatic veins, and spleen length >110 mm. Patients presenting at least one of these underwent elastography measurements with virtual touch quantification (VTQ) or supersonic shear imaging (SSI). If elastography was positive, patients were referred to hepatologist for fibrosis evaluation. Reference standard was obtained by FibroMeterVCTE or biopsy. A FibroMeterVCTE result >0.384 indicated a "necessary referral" to a hepatologist. RESULTS Of the 1501 patients included, 504 (33.6%) were positive for at least one US indicator. All of them underwent US elastography, with 85 being positive. Of the patients, 58 (3.6%) had a consultation with a liver specialist: 21 had positive FibroMeterVCTE and nine had an indication of biopsy for suspicion of fibrosis. This screening algorithm made it possible to diagnose 1.6% of patients in our population with unknown fibrosis. Of the patients, 50% referred to the liver specialist were "necessary referrals." CONCLUSION Our study suggests that three simple US indicators with no systematic elastographic measurement could be applied in day-to-day practice to look for hepatic fibrosis in an unsuspected population allowing relevant referrals to a hepatologist.
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Affiliation(s)
| | - Anita Paisant
- Department of Radiology, Angers University Hospital, Angers, France.,HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France
| | - Victoire Cartier
- Department of Radiology, Angers University Hospital, Angers, France
| | - Paul Calès
- HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France.,Department of Hepatology, Angers University Hospital, Angers, France
| | | | - Edmond Geagea
- Department of Hepatology, Cholet Hospital, Cholet, France
| | | | | | - Mathilde Wagner
- UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | - Aline Le Cleach
- UPMC, Department of Hepatology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France.,University Paris Diderot. Sorbonne Paris Cité, INSERM U1149, CRI, Paris, France
| | - Laurent Castera
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Ivan Bricault
- Department of Radiology and Medical Imaging, University Hospital, Grenoble, France.,Laboratory of Techniques for Biomedical Engineering and Complexity Management, University Grenoble Alpes / National Center for Scientific Research, Grenoble, France.,Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research / Research Department, University Hospital, Grenoble, France
| | - Thomas Decaens
- Université Grenoble Alpes, Grenoble, France.,Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, La Tronche, France.,Department of Hepatology, Pôle Digidune, CHU Grenoble Alpes, La Tronche, France
| | - Céline Savoye-Collet
- Department of Radiology, Rouen University Hospital, Normandie Univ, UNIROUEN, Quantif-LITIS EA 4108, Rouen cedex, France
| | - Hélène Montialoux
- Department of Hepatology, Rouen University Hospital, Rouen cedex, France
| | - Jean-Michel Correas
- Department of Adult Radiology, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Anaïs Vallet-Pichard
- Department of Hepatology, AP-HP, université Paris Descartes, Sorbonne Paris Cité, groupe hospitalier Cochin Port Royal, Paris, France.,Institut Pasteur, U.1223, Inserm, Paris, France
| | - Jérôme Boursier
- HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France.,Department of Hepatology, Angers University Hospital, Angers, France
| | - Christophe Aubé
- Department of Radiology, Angers University Hospital, Angers, France.,HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France
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Bui HH, Vo VH, Nguyen CD, Phan ST, Quach PT, Nguyen DB. Diagnostic Performance of Acoustic Radiation Force Impulse Imaging in Evaluating Liver Fibrosis in Patients with Chronic Hepatitis B Infection: A Cross-Sectional Study. Indian J Radiol Imaging 2022; 32:287-293. [PMID: 36177272 PMCID: PMC9514909 DOI: 10.1055/s-0042-1755251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Acoustic radiation force impulse point shear wave elastography (ARFI-pSWE), measuring shear-wave velocity (SWV), has been utilized to examine the liver stiffness caused by different etiologies. However, information on its reliability in staging liver fibrosis in chronic hepatitis B (CHB) patients is scarce.
Purpose
The aim of the study is to examine the diagnostic performance of ARFI-pSWE and determine the optimal SWV cut-off values to predict significant fibrosis (
F
≥2) and cirrhosis (F4) in CHB patients.
Material and Methods
All 114 adult CHB patients visiting the University Medical Center, Ho Chi Minh City, Vietnam between February 2019 and March 2021 underwent liver stiffness measurement using ARFI-pSWE and FibroScan. SWV results were tested against FibroScan for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The area under the receiver operating characteristic (AUROC) curve was used to identify the optimal SWV cut-off values.
Results
There was a strong agreement between ARFI-pSWE and FibroScan (
r
= 0.92,
p
<0.001). The optimal SWV cut-off value for detecting significant fibrosis was 1.37 m/s with an AUROC of 0.975, sensitivity of 83.3%, specificity of 100%, PPV of 100%, and NPV of 81%. The optimal cut-off value for predicting cirrhosis was 1.70 m/s with an AUROC of 0.986, sensitivity of 97%, specificity of 93%, PPV of 95%, and NPV of 96%.
Conclusion
ARFI-pSWE could be an effective technique for evaluating liver fibrosis in CHB patients. SWV cut-off values of 1.37 and 1.70 m/s could be used to diagnose significant fibrosis and cirrhosis, respectively.
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Affiliation(s)
- Hoang Huu Bui
- Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Internal Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Van Huy Vo
- Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam
| | - Chuong Dinh Nguyen
- Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam
| | - Sang The Phan
- Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam
| | - Phong Tien Quach
- Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam
| | - Dung Bich Nguyen
- Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam
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Farmakis SG, Buchanan PM, Guzman MA, Hardy AK, Jain AK, Teckman JH. Shear wave elastography correlates with liver fibrosis scores in pediatric patients with liver disease. Pediatr Radiol 2019; 49:1742-1753. [PMID: 31418057 DOI: 10.1007/s00247-019-04493-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/14/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND While liver biopsy remains the gold standard, given the procedure risks and sampling errors, there is a need for reliable noninvasive biomarkers of hepatic fibrosis. OBJECTIVE Determine the accuracy of two-dimensional shear wave elastography (2-D SWE) in predicting the histological severity of liver fibrosis in pediatric patients with known or suspected liver disease. MATERIALS AND METHODS Subjects 0-18 years old with known or suspected liver disease and liver biopsy within 30 days (n=70) were included. Comparisons by 2-D SWE were made to a control group (n=79). Two-dimensional SWE was performed using the GE LOGIQ E9 system. Liver biopsy specimens were scored according to METAVIR and Ishak scoring systems using Spearman's Rho correlation. Receiver operator characteristic (ROC) analysis, Kruskal-Wallis and Mann-Whitney U tests were conducted. RESULTS Control group median 2-D SWE measurements were lower than in subjects with any degree of liver fibrosis (P<0.001). Those with METAVIR F0 and Ishak 0 scores had significantly lower median 2-D SWE measurements (1.35 m/s; 1.36 m/s) than those with more advanced liver disease (F1-F3: 1.49-1.62 m/s; 1-4: 1.45-1.63 m/s) (P<0.05 for all), whereas the 2-D SWE in the higher scores were similar. Results did not differ between METAVIR and Ishak scores for any degree of fibrosis. Fibrosis scores moderately correlated with median 2-D SWE measurements (rs=0.43). The area under the curve for F1 compared to combined control/F0 was 0.89 (95% confidence interval [CI] 0.83-0.95; P<0.001) with sensitivity of 94.6% and specificity of 78.6%. Results for Ishak score 1 were similar. The ideal cutoff value for identifying fibrosis was determined to be 1.29 m/s. CONCLUSION The liver 2-D SWE measurements correlated with the histological liver fibrosis scores, regardless of the histopathological scoring system, although 2-D SWE was better at identifying patients with early fibrosis, not at distinguishing among the individual fibrosis levels. Two-dimensional SWE using the GE LOGIQ US system is useful for identifying pediatric patients at risk for liver fibrosis.
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Affiliation(s)
- Shannon G Farmakis
- Department of Radiology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO, 63110, USA.
| | - Paula M Buchanan
- Center of Health Outcomes Research, St. Louis University, St. Louis, MO, USA
| | - Miguel A Guzman
- Department of Pathology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
| | - Anna K Hardy
- Department of Radiology, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Ajay K Jain
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
| | - Jeffrey H Teckman
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
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Wu S, Tu R, Liang X. Patchy echogenicity of the liver in patients with chronic hepatitis B does not indicate poorer elasticity. Ultrasonography 2019; 38:327-335. [PMID: 31302950 PMCID: PMC6769196 DOI: 10.14366/usg.18071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/14/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose This study was conducted to investigate whether the presence of patchy echogenicity in the liver of patients with chronic hepatitis B (CHB) is predictive of liver stiffness. Methods A total of 200 CHB patients with and without patchy echogenicity of the liver were assigned to two groups, with 100 patients in each group, and 32 of them underwent liver biopsy. Additionally, 80 healthy subjects, 100 inactive HBV carriers, and 100 patients with decompensated hepatic cirrhosis were assigned to the control groups. Laboratory tests and clinical data were collected, and shear wave velocity (SWV) of the liver was measured for all 480 subjects. Results The median SWV in patients with a normal liver, inactive hepatitis B virus carriers, CHB patients with and without patchy echogenicity, and decompensated hepatic cirrhosis were 1.07 m/sec, 1.08 m/sec, 1.16 m/sec, 1.16 m/sec, and 2.02 m/sec, respectively; there was no significant difference in SWV values between CHB patients with patchy echogenicity and those without patchy echogenicity. Furthermore, among CHB patients with and without patchy echogenicity, no significant difference in SWV was found according to fibrosis stage. Conclusion The presence of patchy echogenicity of the liver does not indicate a higher degree of liver stiffness.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Rong Tu
- Department of Radiology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xian Liang
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
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Gonzales E, Matarazzo L, Franchi-Abella S, Dabadie A, Cohen J, Habes D, Hillaire S, Guettier C, Taburet AM, Myara A, Jacquemin E. Cholic acid for primary bile acid synthesis defects: a life-saving therapy allowing a favorable outcome in adulthood. Orphanet J Rare Dis 2018; 13:190. [PMID: 30373615 PMCID: PMC6206929 DOI: 10.1186/s13023-018-0920-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023] Open
Abstract
Background Oral cholic acid (CA) replacement has been shown to be an effective therapy in children with primary bile acid synthesis defects, which are rare and severe genetic liver diseases. To date there has been no report of the effects of this therapy in children reaching adulthood. The aim of the study was to evaluate the long-term effectiveness and safety of CA therapy. Methods Fifteen patients with either 3β-hydroxy-Δ5-C27-steroid oxidoreductase (3β-HSD) (n = 13) or Δ4–3-oxosteroid 5β-reductase (Δ4–3-oxo-R) (n = 2) deficiency confirmed by mass spectrometry and gene sequencing received oral CA and were followed prospectively. Results The median age at last follow-up and the median time of follow-up with treatment were 24.3 years (range: 15.3–37.2) and 21.4 years (range: 14.6–24.1), respectively. At last evaluation, physical examination findings and blood laboratory test results were normal in all patients. Liver sonograms were normal in most patients. Mean daily CA dose was 6.9 mg/kg of body weight. Mass spectrometry analysis of urine showed that excretion of the atypical metabolites remained low or traces in amount with CA therapy. Liver fibrosis scored in liver biopsies or assessed by elastography in 14 patients, after 10 to 24 years with CA therapy, showed a marked improvement with disappearance of cirrhosis (median score < F1; range: F0-F2). CA was well tolerated in all patients, including five women having 10 uneventful pregnancies during treatment. Conclusions Oral CA therapy is a safe and effective long-term treatment of 3β-HSD and Δ4–3-oxo-R deficiencies and allows affected children to reach adulthood in good health condition without the need for a liver transplantation.
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Affiliation(s)
- Emmanuel Gonzales
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, National Reference Centre for rare pediatric liver diseases and Filfoie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France.,Faculty of Medicine Paris - Sud, University Paris - Sud / Paris - Saclay, Paris, France.,INSERM UMR-S1174 and Hepatinov, University Paris -Sud / Paris - Saclay, Orsay, France.,Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Hôpital Bicêtre, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, France
| | | | - Stéphanie Franchi-Abella
- Faculty of Medicine Paris - Sud, University Paris - Sud / Paris - Saclay, Paris, France.,Pediatric Radiology Unit, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alain Dabadie
- Department of Pediatrics, Hôpital Sud, Rennes, France
| | - Joseph Cohen
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, National Reference Centre for rare pediatric liver diseases and Filfoie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dalila Habes
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, National Reference Centre for rare pediatric liver diseases and Filfoie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Hillaire
- Hepatology Unit, Hôpital Foch, and Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Catherine Guettier
- Faculty of Medicine Paris - Sud, University Paris - Sud / Paris - Saclay, Paris, France.,Pathology Unit, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anne-Marie Taburet
- Pharmacy Unit, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anne Myara
- Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Emmanuel Jacquemin
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, National Reference Centre for rare pediatric liver diseases and Filfoie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Faculty of Medicine Paris - Sud, University Paris - Sud / Paris - Saclay, Paris, France. .,INSERM UMR-S1174 and Hepatinov, University Paris -Sud / Paris - Saclay, Orsay, France.
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6
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Virtual Special Issue - Chronic liver disease. Clin Radiol 2017; 72:429-432. [PMID: 28438323 DOI: 10.1016/j.crad.2017.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/22/2022]
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