1
|
Hoodeshenas S, Welle CL, Navin PJ, Dzyubak B, Eaton JE, Ehman RL, Venkatesh SK. Magnetic Resonance Elastography in Primary Sclerosing Cholangitis: Interobserver Agreement for Liver Stiffness Measurement with Manual and Automated Methods. Acad Radiol 2019; 26:1625-1632. [PMID: 30878345 DOI: 10.1016/j.acra.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVE Primary sclerosing cholangitis, a chronic liver disease causes heterogeneous parenchymal changes and fibrosis. Liver stiffness measurement (LSM) with magnetic resonance Elastography (MRE) may be affected by this heterogeneous distribution. We evaluated interobserver agreement of LSM in primary sclerosing cholangitis (PSC) with manual and automated methods to study the influence of heterogeneous changes. MATERIALS AND METHODS A total of 79 consecutive patients with PSC who had a liver MRI and MRE formed the study group. Three readers with 1-3 years' experience in MRE and a MRE expert (11 years' experience) independently performed LSM. Each reader manually drew free hand (fROI) and average (aROI) on stiffness maps. Automatic liver elasticity calculation (ALEC) was used to generate automated LSM. The expert fROI was the reference standard. Correlation analysis and absolute intra-class correlation coefficient (ICC) analysis was performed. RESULTS LSM data of 79 livers and 315 sections were evaluated. There was excellent ICC between expert and reader fROIs (0.989, 95% confidence interval, and 0.985-0.993) and aROIs (0.971, 95% confidence interval, and 0.953-0.983) and ALEC (0.972, 0.957-0.982) with fROI performing better. The areas measured with fROIs and ALEC had moderate ICC with Expert fROI (0.64 and 0.56, respectively) whereas aROI area had a poor ICC of 0.12. Comparison of multiple methods showed significant differences in LSM between expert fROI and aROI of two readers and no significant differences for fROIs of all three readers. CONCLUSION LSM with MRE in PSC patients shows excellent interobserver agreement with both fROI and aROI methods with better performance with fROI. fROI may therefore be preferred for LSM measurements in PSC.
Collapse
Affiliation(s)
- Safa Hoodeshenas
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Christopher L Welle
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Patrick J Navin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Bogdan Dzyubak
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - John E Eaton
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| |
Collapse
|
2
|
Giurazza F, Massaroni C, Silvestri S, Zobel BB, Schena E. Preliminary analysis of ultrasound elastography imaging-based thermometry on non-perfused ex vivo swine liver. J Ultrasound 2019; 23:69-75. [PMID: 31541360 DOI: 10.1007/s40477-019-00407-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/11/2019] [Indexed: 01/20/2023] Open
Abstract
AIMS Real-time monitoring of tissue temperature during percutaneous tumor ablation improves treatment efficacy, leading clinicians in adjustment of treatment settings. This study aims at assessing feasibility of ultrasound thermometry during laser ablation of biological tissue using a specific ultrasound imaging techniques based on elastography acoustic radiation force impulse (ARFI). METHODS ARFI uses high-intensity focused ultrasound pulses to generate 'radiation force' in tissue; this provokes tissue displacements trackable using correlation-based ultrasound methods: the sensitivity of shear waves velocity is able to detect temperature changes. Experiments were carried out using a Nd:YAG laser (power: 5 W) in three non-perfused ex vivo pig livers. In each organ, a thermocouple was placed close to the applicator tip (distance range 1.5-2.5 cm) used to record a reference temperature. Positioning of laser applicator and thermocouple was eco-guided. The organ was scanned by an echography system equipped with ARFI; propagation velocity was measured in a region of interest of 1 × 0.5 cm located close to thermocouple, to investigate influence of tissue temperature on shear waves velocity. RESULTS Shear wave velocity has a very low sensitivity to temperature up to 55-60 °C, and in all cases, velocity is < 5 m s-1; for temperature > 55-60 °C, velocity shows a steep increment. The system measures a value "over limit", meaning a velocity > 5 m s-1. CONCLUSIONS Ultrasound thermometry during laser ablation of biological tissue based on elastography shows an abrupt output change at temperatures > 55-60 °C. This issue can have a relevant clinical impact, considering tumor necrosis when temperature crosses 55 °C to define the boundary of damaged volume.
Collapse
Affiliation(s)
- Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital, Via Cardarelli 9, 80100, Naples, Italy.
| | - Carlo Massaroni
- Measurement and Biomedical Instrumentation Lab, Università Campus Bio-Medico di Roma, Via A. Del Portillo 200, 00198, Rome, Italy
| | - Sergio Silvestri
- Measurement and Biomedical Instrumentation Lab, Università Campus Bio-Medico di Roma, Via A. Del Portillo 200, 00198, Rome, Italy
| | - Bruno Beomonte Zobel
- Radiology Department, Università Campus Bio-Medico di Roma, Via A. Del Portillo 200, 00198, Rome, Italy
| | - Emiliano Schena
- Measurement and Biomedical Instrumentation Lab, Università Campus Bio-Medico di Roma, Via A. Del Portillo 200, 00198, Rome, Italy
| |
Collapse
|
3
|
Liver stiffness measurement by acoustic radiation forced impulse and transient elastography in patients with intrahepatic cholestasis. Eur J Gastroenterol Hepatol 2019; 31:520-527. [PMID: 30807445 DOI: 10.1097/meg.0000000000001327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transient elastography (TE) and acoustic radiation force impulse (ARFI) imaging enable a noninvasive assessment of liver stiffness measurement (LSM) and liver fibrosis/cirrhosis staging. However, their use in cholestatic diseases is still scarce. AIM The aim of this study was to evaluate the performance of TE and ARFI for the initial assessment of hepatic fibrosis in intrahepatic cholestatic (IHC) diseases and assess LSM changes after 3 months of specific therapy. PATIENTS AND METHODS This prospective study was carried out on 50 IHC patients. Assessment at baseline and after 3 months of LSM by TE and ARFI was performed. RESULTS Overall, 60% of the patients were women (36.5±9.2 years). IHC etiologies were 23 (46%) autoimmune hepatitis, eight (16%) primary sclerosing cholangitis, eight (16%) drug induced, and five (10%) primary biliary cirrhosis. TE could diagnose ≥F2, ≥F3, and F4 stages at cutoffs of at least 6.7, 9.4, and 14.0 kPa, sensitivity/specificity were 100/50% for ≥F2, 88.2/83% for ≥F3, and 90/100% for F4. Moreover, the sensitivity and specificity of ARFI were 93/50% for ≥F2 (cutoff: 1.53 m/s); 71/67% for ≥F3 (cutoff 1.77 m/s); and 90/100% for F4 (cutoff: 2.43 m/s).Follow-up showed a significant decrease in TE and ARFI values by 27 and 22.3% (P<0.001 and <0.001, respectively) and, accordingly, fibrosis stages decreased significantly by both TE and ARFI (P=0.002 and <0.001, respectively). CONCLUSION TE and ARFI represent noninvasive methods with adequate diagnostic performance for the assessment of fibrosis, and monitoring disease progression and treatment response in intrahepatic cholestasis.
Collapse
|
4
|
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
|
5
|
Goertz RS, GaBmann L, Strobel D, Wildner D, Schellhaas B, Neurath MF, Pfeifer L. Acoustic Radiation Force Impulse (ARFI) Elastography in Autoimmune and Cholestatic Liver Diseases. Ann Hepatol 2019; 18:23-29. [PMID: 31113596 DOI: 10.5604/01.3001.0012.7858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/17/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Acoustic Radiation Force Impulse (ARFI) elastography evaluates hepatic fibrosis non-invasively and has been mainly validated in viral hepatitis. Data on rare liver diseases such as autoimmune hepatitis (AIH), overlap syndrome, primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC) are sparse. MATERIAL AND METHODS 85 patients (including 31 AIH, 26 PBC, 16 PSC and 3 PSC-and 9 PBC-AIH-overlap syndromes) were retrospectively analysed pointing at ARFI elastography of the liver and the correlation with histologic Ishak fibrosis score (F0-6). Results of shear wave velocities (m/s) were expressed as mean ± standard deviation. RESULTS The mean shear wave velocity of all 85 patients showed 1.80 ± 0.84 m/s (0.74-3.98). The ARFI elastography values correlated with the degree of fibrosis in all patients overall and in patients with AIH, overlap syndrome and PSC, respectively. The subgroup of 26 patients with PBC (only with Ishak F > 3) revealed no correlation between ARFI and these early fibrosis stages (r = 0.019, p = 0.927). ARFI elastography correlated with bilirubin, AST, but not with patient age, body mass index or measurement depth. The cut-off of 2.04 m/s for detecting cirrhosis (Ishak F > 5) leads to a sensitivity of 90.0% and specificity of 74.7% (AUROC 87.2%). CONCLUSION ARFI elastography can evaluate fibrosis in AIH, PSC and PSC-/PBC-AIH-overlap syndrome with good accuracy for the detection of hepatic cirrhosis. Shear wave velocities in PBC should be interpreted with caution in early stages of fibrosis.
Collapse
Affiliation(s)
- Ruediger S Goertz
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany.
| | - Luise GaBmann
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany
| | - Deike Strobel
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany
| | - Dane Wildner
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany
| | - Barbara Schellhaas
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany
| | - Lukas Pfeifer
- Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany
| |
Collapse
|
6
|
Ferraioli G, Wong VWS, Castera L, Berzigotti A, Sporea I, Dietrich CF, Choi BI, Wilson SR, Kudo M, Barr RG. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2419-2440. [PMID: 30209008 DOI: 10.1016/j.ultrasmedbio.2018.07.008] [Citation(s) in RCA: 293] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver diseases. For each available technique, the reproducibility, results and limitations are analyzed, and recommendations are given. This set of guidelines updates the first version, published in 2015. Since the prior guidelines, there have been several advances in technology. The recommendations are based on the international published literature, and the strength of each recommendation is judged according to the Oxford Centre for Evidence-Based Medicine. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.
Collapse
Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Laurent Castera
- Service d'Hepatologie, Hopital Beaujon, Clichy, Assistance Publique-Hopitaux de Paris, INSERM UMR 1149 CRI, Universite Denis Diderot Paris-VII, Paris, France
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka Sayama, Japan
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University and Southwoods Imaging, Youngstown, Ohio, USA.
| |
Collapse
|
7
|
Jiang W, Huang S, Teng H, Wang P, Wu M, Zhou X, Ran H. Diagnostic accuracy of point shear wave elastography and transient elastography for staging hepatic fibrosis in patients with non-alcoholic fatty liver disease: a meta-analysis. BMJ Open 2018; 8:e021787. [PMID: 30139901 PMCID: PMC6112406 DOI: 10.1136/bmjopen-2018-021787] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to assess the accuracy of staging liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) usingpoint shear wave elastography (pSWE) and transient elastography (TE). SETTING Relevant records on NAFLD were retrieved from PubMed, Embase, Web of Science and the China National Knowledge Infrastructure databases up to 20 December 2017. A bivariate mixed-effects model was conducted to combine sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the summary receiver operating characteristic curve (AUC) between pSWE and TE. A sensitivity analysis was implemented to explore the source of heterogeneity. PARTICIPANTS Patients with NAFLD who had a liver stiffness measurement using pSWE and TE before liver biopsy were enrolled according to the following criteria: 2×2 contingency tables can be calculated via the reported number of cases; sensitivity and specificity were excluded according to the following criteria: history of other hepatic damage, such as chronic hepatitis C, concurrent active hepatitis B infection, autoimmune hepatitis, suspicious drug usage and alcohol abuse. RESULTS Nine pSWE studies comprising a total of 982 patients and 11 TE studies comprising a total of 1753 patients were included. For detection of significant fibrosis, advanced fibrosis and cirrhosis, the summary AUC was 0.86 (95% CI 0.83 to 0.89), 0.94 (95% CI 0.91 to 0.95) and 0.95 (95% CI 0.93 to 0.97) for pSWE, and the summary AUC was 0.85 (95% CI 0.82 to 0.88), 0.92 (95% CI 0.89 to 0.94) and 0.94 (95% CI 0.93 to 0.97) for TE, respectively. The proportion of failure measurement was over tenfold as common with TE using an M probe compared with pSWE. CONCLUSION pSWE and TE, providing precise non-invasive staging of liver fibrosis in NAFLD, are promising techniques, particularly for advanced fibrosis and cirrhosis.
Collapse
Affiliation(s)
- Weixi Jiang
- Ultrasound Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ultrasound Department, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Sirun Huang
- Ultrasound Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ultrasound Department, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Hua Teng
- Ultrasound Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ultrasound Department, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Peipei Wang
- Ultrasound Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ultrasound Department, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Meng Wu
- Ultrasound Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ultrasound Department, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Xia Zhou
- Ultrasound Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ultrasound Department, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Haitao Ran
- Ultrasound Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ultrasound Department, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| |
Collapse
|
8
|
Dong Y, Potthoff A, Klinger C, Barreiros AP, Pietrawski D, Dietrich CF. Ultrasound findings in autoimmune hepatitis. World J Gastroenterol 2018; 24:1583-1590. [PMID: 29686465 PMCID: PMC5910541 DOI: 10.3748/wjg.v24.i15.1583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 02/06/2023] Open
Abstract
Ultrasound findings in autoimmune hepatitis (AIH) have not been reported systematically so far. The use of reliable and accurate noninvasive methods for determining fibrosis stage is important in evaluation of treatment efficacy and fibrosis regression in AIH. Imaging plays an important role in detection of complications and ruling out other possible causes of chronic liver diseases. Ultrasound elastography cut-off values in AIH patients are not the same as those in patients with chronic viral hepatitis or non-alcoholic fatty liver disease. AIH is characterized by wide fluctuations in inflammatory activity. Here we report on current knowledge of ultrasound findings in AIH.
Collapse
Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover D-30625, Germany
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg D-71634, Germany
| | - Ana Paula Barreiros
- German Organ Transplantation Foundation, Region Mitte, Mainz D-55131, Germany
| | - Dariusz Pietrawski
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim D-97980, Germany
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim D-97980, Germany
| |
Collapse
|
9
|
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
|
10
|
Abstract
Autoimmune biliary diseases are poorly understood but important to recognize. Initially, autoimmune biliary diseases are asymptomatic but may lead to progressive cholestasis with associated ductopenia, portal hypertension, cirrhosis, and eventually liver failure. The three main forms of autoimmune biliary disease are primary biliary cirrhosis, primary sclerosing cholangitis, and IgG4-associated cholangitis. Although some overlap may occur between the three main autoimmune diseases of the bile ducts, each disease typically affects a distinct demographic group and requires a disease-specific diagnostic workup. For all the autoimmune biliary diseases, imaging provides a means to monitor disease progression, assess for complications, and screen for the development of hepatobiliary malignancies that are known to affect patients with these diseases. Imaging is also useful to suggest or corroborate the diagnosis of primary sclerosing cholangitis and IgG4-associated cholangitis. We review the current literature and emphasize radiological findings and considerations for these autoimmune diseases of the bile ducts.
Collapse
|
11
|
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
|
12
|
Hao L, Tu JZ, Wang XH, Shi Y, Liu XL, Zhang HH. Effect of Inflammation on Fibrosis Staging Measured by Quantitative Elasticity Parameters in Rats With Immune Hepatitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1223-1231. [PMID: 27126399 DOI: 10.7863/ultra.15.03001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate the effect of inflammation on fibrosis staging measured by quantitative elasticity parameters in rats with immune hepatitis. METHODS Fifty-two rats were injected with swine serum as a model group, whereas 8 rats were injected with saline as a control group. Rats were randomly subjected to real-time tissue elastography biweekly. Tissue dispersion quantitative analysis was performed to obtain 12 quantitative elasticity parameters: relative mean value, standard deviation, blue area percentage, complexity, kurtosis, skewness, contrast, entropy, inverse difference moment, angular second moment, correlation, and liver fibrosis index. Subsequently, rats were euthanized, and liver specimens were taken for pathologic examination. The Kruskal-Wallis test was used for comparisons among groups. Spearman rank correlation analysis was used for correlation analysis. Receiver operating characteristic curves were used to optimize cutoff values and evaluate the diagnostic performance of the liver fibrosis index. RESULTS Except for complexity, kurtosis, and correlation, the other 9 parameters had statistical differences (P < .05), and among these 9 parameters, the liver fibrosis index had the strongest correlation with fibrosis staging (r = 0.809; P < .05). Except for kurtosis and correlation, the other 10 parameters had statistical differences (P < .05), and among these 10 parameters, the liver fibrosis index had the highest correlation with inflammation grading (r= 0.766; P< .05). The fibrosis index cutoff values were 2.35 for stage S1 or higher (area under the curve [AUC], 0.940; sensitivity, 97.1%; specificity, 73.3%), 2.99 for stage S2 or higher (AUC, 0.865; sensitivity, 78.6%; specificity, 81.0%), 3.48 for stage S3 or higher (AUC, 0.924; sensitivity, 94.4%; specificity, 87.1%), and 4.05 for stage S4 (AUC, 0.933; sensitivity, 87.5%; specificity, 95.1%). CONCLUSIONS Real-time elastography could be used to noninvasively evaluate fibrosis staging in rats with immune hepatitis. However, inflammation had an effect on the accuracy of this technique.
Collapse
Affiliation(s)
- Lei Hao
- Department of Ultrasound, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ji-Zheng Tu
- Department of Ultrasound, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xing-Hua Wang
- Department of Ultrasound, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Shi
- Department of Ultrasound, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Li Liu
- Department of Pathology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Huan-Hu Zhang
- Department of Liver Disease, Second Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
13
|
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
|
14
|
Guo Y, Parthasarathy S, Goyal P, McCarthy RJ, Larson AC, Miller FH. Magnetic resonance elastography and acoustic radiation force impulse for staging hepatic fibrosis: a meta-analysis. ACTA ACUST UNITED AC 2015; 40:818-34. [PMID: 24711064 DOI: 10.1007/s00261-014-0137-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Elastography is a non-invasive method to quantify fibrosis based on tissue mechanical properties. We performed a meta-analysis to assess the diagnostic accuracy of two such techniques: Acoustic Radiation Force Impulse Imaging (ARFI) or Magnetic Resonance Elastography (MRE) for staging hepatic fibrosis. MATERIALS AND METHODS Literature databases were searched until June 2013. Inclusion criteria were evaluation of MRE or ARFI, liver biopsy, and reported sensitivity and specificity. A random effects model was used to combine sensitivity and specificity, from which positive (LR+) and negative (LR-) likelihood ratios, diagnostic odds ratios, and area under receiver operating characteristics curve (AUROC) were derived. Differences between MRE and ARFI were compared with t tests (P < 0.05 considered significant). RESULTS Eleven MRE studies including 982 patients and fifteen ARFI studies including 2,128 patients were selected. AUROC for MRE staging fibrosis were 0.94, 0.97, 0.96, and 0.97 for F1-F4, respectively, whereas AUROC for ARFI staging were 0.82, 0.85, 0.94, and 0.94 for F1-F4, respectively. Significance was found in AUROC between MRE and ARFI for the diagnosis of stage 1 and 2 fibrosis. CONCLUSION MRE is more accurate than ARFI with a higher combination of sensitivity, specificity, LR, and AUROC particularly in diagnosing early stages of hepatic fibrosis.
Collapse
Affiliation(s)
- Yang Guo
- Department of Radiology, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 800, 676 N Saint Clair, Chicago, IL, 60611, USA
| | | | | | | | | | | |
Collapse
|
15
|
Angiotensin-converting enzyme for noninvasive assessment of liver fibrosis in autoimmune hepatitis. Eur J Gastroenterol Hepatol 2015; 27:649-54. [PMID: 25860719 DOI: 10.1097/meg.0000000000000355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM There are no validated noninvasive markers of liver fibrosis in autoimmune hepatitis (AIH). An activated renin-angiotensin system (RAS) and its key element angiotensin-converting enzyme (ACE) have been implicated in the pathogenesis of hepatic fibrogenesis. We aimed to study the assumed role of activated RAS in the fibrogenic process and whether the serum concentration of ACE can predict different fibrosis stages in AIH. PATIENTS AND METHODS Serum samples of 73 consecutive patients who were diagnosed with AIH were analysed for ACE concentration. All patients underwent a liver biopsy. RESULTS Serum ACE levels increased significantly for each fibrosis score. The median ACE was 45 U/l in patients with fibrosis score I, 54 U/l in patients with fibrosis score II, 68 U/l in patients with fibrosis score III and 87 U/l in patients with fibrosis score IV. For significant fibrosis (≤F2), a 56 U/l cut-off value of ACE had 95.5% sensitivity and 74.5% specificity, and receiver-operating characteristic curves showed an area under the curve (AUC) of 0.89. For advanced fibrosis (≤F3), a 64 U/l cut-off level of ACE had 85.2% sensitivity and 94.8% specificity, and AUC was 0.91. For cirrhosis, a 68 U/l cut-off level of ACE had 100% sensitivity and 84.4% specificity, and AUC was 0.95. CONCLUSION Our results suggest that activated RAS may sustain hepatic fibrogenesis in AIH. Measurement of serum ACE offers an easy, accurate and inexpensive noninvasive method that differentiates significant from nonsignificant liver fibrosis in AIH. Blockade of RAS may exert beneficial effects on fibrosis progression in AIH.
Collapse
|
16
|
De Robertis R, D’Onofrio M, Demozzi E, Crosara S, Canestrini S, Pozzi Mucelli R. Noninvasive diagnosis of cirrhosis: A review of different imaging modalities. World J Gastroenterol 2014; 20:7231-7241. [PMID: 24966594 PMCID: PMC4064069 DOI: 10.3748/wjg.v20.i23.7231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/08/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Progressive hepatic fibrosis can lead to cirrhosis, so its early detection is fundamental. Staging fibrosis is also critical for prognosis and management. The gold standard for these aims is liver biopsy, but it has several drawbacks, as it is invasive, expensive, has poor acceptance, is prone to inter observer variability and sampling errors, has poor repeatability, and has a risk of complications and mortality. Therefore, non-invasive imaging tests have been developed. This review mainly focuses on the role of transient elastography, acoustic radiation force impulse imaging, and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis.
Collapse
|
17
|
Zhang DK, Chen M, Liu Y, Wang RF, Liu LP, Li M. Acoustic radiation force impulse elastography for non-invasive assessment of disease stage in patients with primary biliary cirrhosis: A preliminary study. Clin Radiol 2014; 69:836-40. [PMID: 24837697 DOI: 10.1016/j.crad.2014.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 12/22/2022]
Abstract
AIM To investigate the diagnostic performance of the acoustic radiation force impulse (ARFI) elastography for the assessment of primary biliary cirrhosis (PBC) stage. MATERIALS AND METHODS Sixty-one patients with PBC in which liver biopsy and ARFI elastography measurements were performed in the same session were included in the study. The diagnostic performance of ARFI elastography for predicting the PBC stage was determined from the area under receiver operating characteristics (AUROC) curve analysis. RESULTS ARFI elastography correlated significantly with histological stage (r = 0.74, p < 0.001) in patients with PBC. The AUROC of ARFI elastography for predicting histological stage equal to or higher than II, III, and equal to IV were 0.83, 0.93, and 0.91, respectively. The optimal cut-off values of ARFI elastography were 1.51 m/s, 1.79 m/s, and 2.01 m/s for PBC stage equal to or higher than II, III, and equal to IV, respectively. CONCLUSION ARFI elastography is an acceptable and powerful technique for quantitative assessment of PBC stage.
Collapse
Affiliation(s)
- D-K Zhang
- Department of Ultrasound, The 302 Hospital of PLA, 100039 Beijing, China.
| | - M Chen
- Department of Ultrasound, The 302 Hospital of PLA, 100039 Beijing, China
| | - Y Liu
- Department of Ultrasound, The 302 Hospital of PLA, 100039 Beijing, China
| | - R-F Wang
- Department of Ultrasound, The 302 Hospital of PLA, 100039 Beijing, China
| | - L-P Liu
- Department of Ultrasound, The First Hospital Affiliated to Shanxi Medical University, 030001 Taiyuan, China
| | - M Li
- Department of Ultrasound, The 302 Hospital of PLA, 100039 Beijing, China
| |
Collapse
|
18
|
Schiavon LDL, Narciso-Schiavon JL, Carvalho-Filho RJD. Non-invasive diagnosis of liver fibrosis in chronic hepatitis C. World J Gastroenterol 2014; 20:2854-2866. [PMID: 24659877 PMCID: PMC3961992 DOI: 10.3748/wjg.v20.i11.2854] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/20/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Assessment of liver fibrosis in chronic hepatitis C virus (HCV) infection is considered a relevant part of patient care and key for decision making. Although liver biopsy has been considered the gold standard for staging liver fibrosis, it is an invasive technique and subject to sampling errors and significant intra- and inter-observer variability. Over the last decade, several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection, with variable performance. Besides the clear advantage of being noninvasive, a more objective interpretation of test results may overcome the mentioned intra- and inter-observer variability of liver biopsy. In addition, these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk. However, in general, these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extra-hepatic conditions. These methods are either serum markers (usually combined in a mathematical model) or imaging modalities that can be used separately or combined in algorithms to improve accuracy. In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C, their advantages, limitations and application in clinical practice.
Collapse
|
19
|
Karlsen TH, Vesterhus M, Boberg KM. Review article: controversies in the management of primary biliary cirrhosis and primary sclerosing cholangitis. Aliment Pharmacol Ther 2014; 39:282-301. [PMID: 24372568 DOI: 10.1111/apt.12581] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 10/09/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite considerable advances over the last two decades in the molecular understanding of cholestasis and cholestatic liver disease, little improvement has been made in diagnostic tools and therapeutic strategies. AIMS To critically review controversial aspects of the scientific basis for common clinical practice in primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) and to discuss key ongoing challenges to improve patient management. METHODS We performed a literature search using PubMed and by examining the reference lists of relevant review articles related to the clinical management of PBC and PSC. Articles were considered on the background of the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) practice guidelines and clinical experience of the authors. RESULTS Ongoing challenges in PBC mainly pertain to the improvement of medical therapy, particularly for patients with a suboptimal response to ursodeoxycholic acid. In PSC, development of medical therapies and sensitive screening protocols for cholangiocarcinoma represent areas of intense research. To rationally improve patient management, a better understanding of pathogenesis, including complications like pruritis and fatigue, is needed and there is a need to identify biomarker end-points for treatment effect and prognosis. Timing of liver transplantation and determining optimal regimens of immunosuppression post-liver transplantation will also benefit from better appreciation of pre-transplant disease mechanisms. CONCLUSION Controversies in the management of PBC and PSC relate to topics where evidence for current practice is weak and further research is needed.
Collapse
Affiliation(s)
- T H Karlsen
- Norwegian PSC Research Center, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | |
Collapse
|
20
|
Czaja AJ. Review article: The prevention and reversal of hepatic fibrosis in autoimmune hepatitis. Aliment Pharmacol Ther 2014; 39:385-406. [PMID: 24387318 DOI: 10.1111/apt.12592] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/29/2013] [Accepted: 12/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti-fibrotic effects are inconsistent secondary gains. AIM To describe the anti-fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti-fibrotic interventions, indicate the non-invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities. METHODS Studies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti-fibrotic therapy and non-invasive tests of hepatic fibrosis were selected. RESULTS Hepatic fibrosis improves in 53-57% of corticosteroid-treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non-invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non-invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti-fibrotic therapies are poised for study in this disease. CONCLUSIONS The prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti-fibrotic interventions, must be evaluated.
Collapse
Affiliation(s)
- A J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| |
Collapse
|