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Simpson S, Breshears E, Basavalingu D, Khatri G, Chan S, Fite J, Swanson P, Dighe M. Review of imaging findings in hepatic veno-occlusive disease. Eur J Radiol 2024; 177:111526. [PMID: 38850721 DOI: 10.1016/j.ejrad.2024.111526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/22/2024] [Accepted: 05/23/2024] [Indexed: 06/10/2024]
Abstract
Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a potentially life-threatening complication of hematopoietic stem cell transplantation. Patients present with right upper-quadrant abdominal pain, jaundice, weight gain, and conjugated hyperbilirubinemia. Early diagnosis of VOD is essential to promptly initiate defibrotide therapy, which has been demonstrated to enhance survival and achieve complete resolution of disease in some patients. Historically, VOD was diagnosed by the modified Seattle or Baltimore criteria, which are both based on clinical symptoms. Alongside advancements in medical imaging over the last 40 years, the diagnosis of VOD has evolved to include the use of ultrasound, elastography, cross-sectional imaging, and image guided biopsy. Identification and interpretation of findings of VOD across imaging modalities is now a critical aspect of post-HSCT care. This review will outline the imaging findings and recommendations for the use of imaging in the management of VOD including gray-scale, color and spectral Doppler ultrasound, ultrasound elastography, CT, MRI, and liver biopsy.
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Affiliation(s)
- Samuel Simpson
- University of Washington School of Medicine, Seattle, WA, USA
| | - Elliot Breshears
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Garvit Khatri
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sherwin Chan
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - John Fite
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Paul Swanson
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, WA, USA.
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Lemine AS, Ahmad Z, Al-Thani NJ, Hasan A, Bhadra J. Mechanical properties of human hepatic tissues to develop liver-mimicking phantoms for medical applications. Biomech Model Mechanobiol 2024; 23:373-396. [PMID: 38072897 DOI: 10.1007/s10237-023-01785-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/17/2023] [Indexed: 03/26/2024]
Abstract
Using liver phantoms for mimicking human tissue in clinical training, disease diagnosis, and treatment planning is a common practice. The fabrication material of the liver phantom should exhibit mechanical properties similar to those of the real liver organ in the human body. This tissue-equivalent material is essential for qualitative and quantitative investigation of the liver mechanisms in producing nutrients, excretion of waste metabolites, and tissue deformity at mechanical stimulus. This paper reviews the mechanical properties of human hepatic tissues to develop liver-mimicking phantoms. These properties include viscosity, elasticity, acoustic impedance, sound speed, and attenuation. The advantages and disadvantages of the most common fabrication materials for developing liver tissue-mimicking phantoms are also highlighted. Such phantoms will give a better insight into the real tissue damage during the disease progression and preservation for transplantation. The liver tissue-mimicking phantom will raise the quality assurance of patient diagnostic and treatment precision and offer a definitive clinical trial data collection.
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Affiliation(s)
- Aicha S Lemine
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, 2713, Doha, Qatar
- Qatar University Young Scientists Center (QUYSC), Qatar University, 2713, Doha, Qatar
| | - Zubair Ahmad
- Qatar University Young Scientists Center (QUYSC), Qatar University, 2713, Doha, Qatar
- Center for Advanced Materials (CAM), Qatar University, PO Box 2713, Doha, Qatar
| | - Noora J Al-Thani
- Qatar University Young Scientists Center (QUYSC), Qatar University, 2713, Doha, Qatar
| | - Anwarul Hasan
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, 2713, Doha, Qatar
| | - Jolly Bhadra
- Qatar University Young Scientists Center (QUYSC), Qatar University, 2713, Doha, Qatar.
- Center for Advanced Materials (CAM), Qatar University, PO Box 2713, Doha, Qatar.
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3
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Su HZ, Yang JJ, Li ZY, Hong LC, Lin WJ, Chen C, Guo J, Fang ZY, Xue ES. A nomogram incorporating clinical, conventional ultrasound and shear wave elastography findings for distinguishing pleomorphic adenoma from Warthin's tumor of the major salivary glands. Dentomaxillofac Radiol 2023; 52:20230051. [PMID: 37395620 PMCID: PMC10552128 DOI: 10.1259/dmfr.20230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE Pre-operative differentiation between pleomorphic adenoma (PA) and Warthin's tumor (WT) of the major salivary glands is crucial for treatment decisions. The purpose of this study was to develop and validate a nomogram incorporating clinical, conventional ultrasound (CUS) and shear wave elastography (SWE) features to differentiate PA from WT. METHODS A total of 113 patients with histological diagnosis of PA or WT of the major salivary glands treated at Fujian Medical University Union Hospital were enrolled in training cohort (n = 75; PA = 41, WT = 34) and validation cohort (n = 38; PA = 22, WT = 16). The least absolute shrinkage and selection operator (LASSO) regression algorithm was used for screening the most optimal clinical, CUS, and SWE features. Different models, including the nomogram model, clinic-CUS (Clin+CUS) and SWE model, were built using logistic regression. The performance levels of the models were evaluated and validated on the training and validation cohorts, and then compared among the three models. RESULTS The nomogram incorporating the clinical, CUS and SWE features showed favorable predictive value for differentiating PA from WT, with the area under the curves (AUCs) of 0.947 and 0.903 for the training cohort and validation cohort, respectively. Decision curve analysis showed that the nomogram model outperformed the Clin+CUS model and SWE model in terms of clinical usefulness. CONCLUSIONS The nomogram had good performance in distinguishing major salivary PA from WT and held potential for optimizing the clinical decision-making process.
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Affiliation(s)
| | - Jia-Jia Yang
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhi-Yong Li
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Cheng Hong
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wen-Jin Lin
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Cong Chen
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jie Guo
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Zhen-Yan Fang
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - En-Sheng Xue
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
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Aktı S, Albayrak E. Evaluation of Liver and Spleen With Shear Wave Elastography in Adult Patients With Familial Mediterranean Fever. Ultrasound Q 2023; 39:165-170. [PMID: 36165616 DOI: 10.1097/ruq.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ABSTRACT Familial Mediterranean fever (FMF) is an autoinflammatory disease and an important health problem in countries bordering the eastern Mediterranean, including Turkey. In this study, we aimed to evaluate possible tissue stiffness changes that may develop in the liver and spleen in adult FMF patients with shear wave elastography (SWE), and its usability as an auxiliary imaging method that will be able to provide additional advantage in clinical follow-up. Seventy-five adult FMF patients and 73 adult volunteer were included in the study. Examination was performed through an intercostal space where the liver and spleen were clearly visible. The parenchymal stiffness degrees of the liver and spleen were quantified by shear modulus values in kilopascals. Differences in stiffness values of the liver and spleen between the 2 groups were examined. Liver stiffness value (LSV) was found to be statistically significantly higher in the FMF group. Although the spleen stiffness value (SSV) was found higher in the FMF group, the difference between the groups was not statistically significant. Increased LSVs in patients with FMF can be quantitatively demonstrated by the 2-dimensional SWE method, and SWE may be useful as an auxiliary imaging method in the follow-up of patients with FMF for this purpose. The LSV and SSV obtained in this study may be useful as reference stiffness values for both healthy individuals and those with FMF.
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Affiliation(s)
- Serdar Aktı
- Department of Radiology, Erbaa State Hospital
| | - Eda Albayrak
- Department of Radiology, Medical Faculty, Tokat Gaziosmanpasa University, Tokat, Turkey
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Tahmasebi A, Wessner CE, Guglielmo FF, Wang S, Vu T, Liu JB, Civan J, Lyshchik A, Forsberg F, Li H, Qu E, Eisenbrey JR. Comparison of Magnetic Resonance-Based Elastography and Ultrasound Shear Wave Elastography in Patients With Suspicion of Nonalcoholic Fatty Liver Disease. Ultrasound Q 2023; 39:100-108. [PMID: 36943721 DOI: 10.1097/ruq.0000000000000638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT This study investigated the correlation between magnetic resonance elastography (MRE) and shear wave ultrasound elastography (SWE) in patients with clinically diagnosed or suspected nonalcoholic fatty liver disease (NAFLD). Subjects with or at risk of NAFLD identified by magnetic resonance imaging (MRI) proton density fat fraction (PDFF) were prospectively enrolled. For each patient, 6 valid 2-dimensional SWE measurements were acquired using a Logiq E10 scanner (GE HealthCare, Waukesha, WI). A reliability criterion of an interquartile range to median ratio of ≤15% was used for SWE to indicate quality dataset. Magnetic resonance elastography, and MR-fat quantification data were collected the same day as part of the patient's clinical standard of care. Magnetic resonance imaging PDFF was used as a reference to quantify fat with >6.4% indicating NAFLD. Pearson correlation and t-test were performed for statistical analyses. A total of 140 patients were enrolled, 112 of which met SWE reliability measurement criteria. Magnetic resonance elastography and 2-dimensional SWE showed a positive correlation across all study subjects ( r = 0.27; P = 0.004). When patients were grouped according to steatosis and fibrosis state, a positive correlation was observed between MRE and SWE in patients with fibrosis ( r = 0.30; P = 0.03), without fibrosis ( r = 0.27; P = 0.03), and with NAFLD ( r = 0.28; P = 0.02). No elastography technique correlated with liver fat quantification ( P > 0.52). Magnetic resonance elastography was significantly different between patients with and without fibrosis ( P < 0.0001). However, this difference was not apparent with SWE ( P = 0.09). In patients with suspected or known NAFLD, MRE, and SWE demonstrated a positive correlation. In addition, these noninvasive imaging modalities may be useful adjunct techniques for monitoring NAFLD.
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Affiliation(s)
| | | | | | | | | | | | - Jesse Civan
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Hongbo Li
- Department of Ultrasound, The People's Hospital of Longhua, Southern Medical University, Shenzhen
| | - Enze Qu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Heo S, Lee SS, Kim SY, Lim YS, Park HJ, Yoon JS, Suk HI, Sung YS, Park B, Lee JS. Prediction of Decompensation and Death in Advanced Chronic Liver Disease Using Deep Learning Analysis of Gadoxetic Acid-Enhanced MRI. Korean J Radiol 2022; 23:1269-1280. [PMID: 36447415 PMCID: PMC9747270 DOI: 10.3348/kjr.2022.0494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/12/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the usefulness of quantitative indices obtained from deep learning analysis of gadoxetic acid-enhanced hepatobiliary phase (HBP) MRI and their longitudinal changes in predicting decompensation and death in patients with advanced chronic liver disease (ACLD). MATERIALS AND METHODS We included patients who underwent baseline and 1-year follow-up MRI from a prospective cohort that underwent gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance between November 2011 and August 2012 at a tertiary medical center. Baseline liver condition was categorized as non-ACLD, compensated ACLD, and decompensated ACLD. The liver-to-spleen signal intensity ratio (LS-SIR) and liver-to-spleen volume ratio (LS-VR) were automatically measured on the HBP images using a deep learning algorithm, and their percentage changes at the 1-year follow-up (ΔLS-SIR and ΔLS-VR) were calculated. The associations of the MRI indices with hepatic decompensation and a composite endpoint of liver-related death or transplantation were evaluated using a competing risk analysis with multivariable Fine and Gray regression models, including baseline parameters alone and both baseline and follow-up parameters. RESULTS Our study included 280 patients (153 male; mean age ± standard deviation, 57 ± 7.95 years) with non-ACLD, compensated ACLD, and decompensated ACLD in 32, 186, and 62 patients, respectively. Patients were followed for 11-117 months (median, 104 months). In patients with compensated ACLD, baseline LS-SIR (sub-distribution hazard ratio [sHR], 0.81; p = 0.034) and LS-VR (sHR, 0.71; p = 0.01) were independently associated with hepatic decompensation. The ΔLS-VR (sHR, 0.54; p = 0.002) was predictive of hepatic decompensation after adjusting for baseline variables. ΔLS-VR was an independent predictor of liver-related death or transplantation in patients with compensated ACLD (sHR, 0.46; p = 0.026) and decompensated ACLD (sHR, 0.61; p = 0.023). CONCLUSION MRI indices automatically derived from the deep learning analysis of gadoxetic acid-enhanced HBP MRI can be used as prognostic markers in patients with ACLD.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Seok Yoon
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Heung-Il Suk
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.,Department of Artificial Intelligence, Korea University, Seoul, Korea
| | - Yu Sub Sung
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Bumwoo Park
- Health Innovation Big Data Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ji Sung Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Guerri G, Palozzo A, Straticò P, Varasano V, Celani G, Di Francesco P, Vignoli M, Petrizzi L. 2D-SWE of the Metacarpophalangeal Joint Capsule in Horses. Vet Sci 2022; 9:vetsci9090478. [PMID: 36136694 PMCID: PMC9501397 DOI: 10.3390/vetsci9090478] [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] [Received: 07/05/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Two-dimensional shear wave elastography (2D-SWE) employs an ultrasound impulse to produce transversely oriented shear waves, which travel through the surrounding tissue according to the stiffness of the tissue itself. The study aimed to assess the reliability of 2D-SWE for evaluating the elastosonographic appearance of the distal attachment of the fetlock joint capsule (DJC) in sound horses and in horses with osteoarthritis (OA) (2). According to a thorough evaluation of metacarpophalangeal joint (MCPJ), adult horses were divided in a sound Group (H) and in OA Group (P). Thereafter, a 2D-SWE of MCPJs was performed. Shear wave velocity (m/sec) and Young’s modulus (kPa) were calculated independently by two operators at each selected ROI. Statistical analysis was performed with R software. (3) Results: 2D-SWE had good–excellent inter-CC and intra-CC in both groups. Differences in m/s and kPa between Groups H and P were found in transverse scans with lower values in Group P. No correlation with age or DJC thickness was found. (4) Conclusions: 2D-SWE was repeatable and reproducible. In Group H, DJC was statistically stiffer than in Group P only in transverse scan. The technique showed poor sensitivity and specificity in differentiating fetlocks affected by OA.
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Affiliation(s)
- Giulia Guerri
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Adriana Palozzo
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Paola Straticò
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
- Correspondence:
| | - Vincenzo Varasano
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Gianluca Celani
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | | | - Massimo Vignoli
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Lucio Petrizzi
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
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Zhou J, Yan F, Xu J, Lu Q, Zhu X, Gao B, Zhang H, Yang R, Luo Y. Diagnosis of steatohepatitis and fibrosis in biopsy-proven nonalcoholic fatty liver diseases: including two-dimension real-time shear wave elastography and noninvasive fibrotic biomarker scores. Quant Imaging Med Surg 2022; 12:1800-1814. [PMID: 35284290 PMCID: PMC8899947 DOI: 10.21037/qims-21-700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2023]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the accuracy of two-dimension real-time shear wave elastography (2D-SWE) for the diagnosis of steatohepatitis and fibrosis in a cohort patients confirmed nonalcoholic fatty liver diseases (NAFLD) by liver biopsy, and compare with four noninvasive fibrotic biomarker scores (NFS, FIB-4, BARD and APRI). METHODS 116 NAFLD patients and 23 normal control group were enrolled. The diagnostic performance of 2D-SWE and four noninvasive fibrotic biomarker scores was evaluated based on histopathological inflammation grades and fibrosis stages (F) according to Kleiner/Brunt et al.'s criteria classification. 5-fold cross validation and receiver operating characteristics curve (ROC) analyses were used to obtain an assessment of 2D-SWE and four noninvasive fibrotic biomarker scores; then cross validated area under the curves (AUCs) were compared using the test of Delong. Meanwhile, influence of steatosis on liver stiffness measurement (LSM) of 2D-SWE was also studied. RESULTS Liver stiffness measured by 2D-SWE proved to be an excellent diagnostic indicator for detecting steatohepatitis (AUROC =0.88), and fibrosis: ≥F2 stage (AUROC =0.86), ≥F3 stage (AUROC =0.89) and =F4 stage (AUROC =0.90) with the cutoff values were 7.3, 10.0, 11.6 and 12.6 kPa, respectively. Compared with fibrotic scores, 2D-SWE had the highest AUROC for predicting ≥F2, ≥F3, =F4 by Delong test (all P<0.05). No statistic differences of LSM were found among different steatosis levels (P=0.97). CONCLUSIONS The stiffness measured by 2D-SWE could be used to noninvasively identify steatohepatitis and stage fibrosis in NAFLD patients. Moreover, the diagnosis efficiency of the stiffness measured by 2D-SWE could not be influenced by steatosis.
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Affiliation(s)
- Jie Zhou
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
| | - Feng Yan
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
| | - Jinshun Xu
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Lu
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
| | - Xianglan Zhu
- Pathology Department of West China Hospital of Sichuan University, Chengdu, China
| | - Binyang Gao
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
| | - Huan Zhang
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
| | - Rui Yang
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
| | - Yan Luo
- Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China
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Brunnert L, Puasa ID, Garten A, Penke M, Gaul S, Grafe N, Karlas T, Kiess W, Flemming G, Vogel M. Pediatric percentiles for transient elastography measurements - effects of age, sex, weight status and pubertal stage. Front Endocrinol (Lausanne) 2022; 13:1030809. [PMID: 36237190 PMCID: PMC9551398 DOI: 10.3389/fendo.2022.1030809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS Transient Elastography is a non-invasive, cost-efficient, non-ionizing, observer-independent and reliable method to detect liver fibrosis using Liver Stiffness Measurement (LSM) and the degree of fat accumulation in the liver using Controlled Attenuation Parameter (CAP). This study aims to derive reference values for both measures from healthy children and adolescents. Further, we aim to assess the potential influence of age, sex, puberty, and BMI-SDS on CAP and LSM. METHODS Within the LIFE Child study, amongst others, anthropometric data and pubertal status were assessed. Transient Elastography (TE) was performed using the FibroScan® device in a population-based cohort at 982 study visits of 482 healthy children aged between 10 and 18 years. Percentiles for LSM and CAP were estimated, and the effects of age, sex, puberty and weight status were assessed through hierarchical regression models. RESULTS There was a strong age dependency for LSM with higher values for older children, most pronounced in the upper percentiles in boys. Contrarily, CAP was relatively stable across the age span without considerable difference between boys and girls. We found a significant positive correlation between BMI-SDS and both CAP and LSM for BMI-SDS >1.28. For BMI-SDS < 1.28, the association was also positive but reached statistical significance only for CAP. Further, the association between BMI-SDS and CAP was significantly stronger in younger than in older children. There was no association between pubertal status and CAP. For LSM, we found that children with a high BMI-SDS but not children with normal weight had significantly higher LSM values in Tanner stage 4. CONCLUSIONS Age, sex, pubertal status and weight status should be considered when interpreting LSM and CAP in pediatric patients to facilitate and improve early detection of abnormal liver function, which is associated with common pathologies, such as NAFLD.
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Affiliation(s)
- Lina Brunnert
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Ika Damayanti Puasa
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Antje Garten
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Melanie Penke
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Susanne Gaul
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
- Clinic and Polyclinic for Cardiology, Leipzig University Medical Center, Leipzig, Germany
| | - Nico Grafe
- Leipzig Research Center for Civilization Diseases, LIFE Child, Leipzig, Germany
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
- Leipzig Research Center for Civilization Diseases, LIFE Child, Leipzig, Germany
| | - Gunter Flemming
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Mandy Vogel
- Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany
- Leipzig Research Center for Civilization Diseases, LIFE Child, Leipzig, Germany
- *Correspondence: Mandy Vogel,
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10
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Laroia ST, Vellore Srinivasan S, Yadav K, Rastogi A, Kumar S, Kumar G, Kumar M. Performance of shear wave elastography: A single centre pilot study of mixed etiology liver disease patients with normal BMI. Australas J Ultrasound Med 2021; 24:120-136. [PMID: 34765422 DOI: 10.1002/ajum.12244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/21/2021] [Accepted: 03/28/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To assess the performance of shear wave ultrasound elastography (SWE) for non-invasive grading of fibrosis in normal BMI patients with varied aetiology chronic liver disease. Method Prospective SWE liver and spleen stiffness (LS, SS respectively) of 124 patients (94 men, mean age 45.4 ± 12.4 years, mean BMI 19.66 ± 1.49) with CLD of mixed aetiology, who underwent liver biopsy, between January 2019-20 was analysed using receiver operating curve (ROC) and classification analysis regression tree (CART) to determine fibrosis cut-off values and nominal logistical regression to quantify fibrosis. Results Of 124 patients, 50 (40%) had non-alcoholic steatohepatitis (NASH), 31 (25%) chronic hepatitis B (CHB) and 43 (35%) alcoholic liver disease (ALD) on biopsy. Overall mean LS and SS of the study population was 11.81 ± 5.9 and 16.88 ± 10.8 kPa, respectively. LS cut-off value <8 kPa was consistent with F0, 9-14 kPa for F1-F2 and >14.9 kPa for F3-F4 fibrosis on biopsy. On application of CART, LS value < 5.3 kPa was discriminative for NASH, 5.32 to <12.64 kPa for CHB, >12.64 kPa for ALD, SS <15.3 kPa was discriminative for NASH, 15.3-30 kPa for CHB and >30 kPa for ALD in our study population. Conclusion SWE is a viable non-invasive tool for assessment of liver fibrosis grading in a population of mixed aetiology CLD. LS values in conjunction with SS are promising predictors of F2-F3 fibrosis with potential to discriminate select categories like CHB and NASH in such a population.
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Affiliation(s)
- Shalini Thapar Laroia
- Department of Radiology Institute of Liver and Biliary Sciences Sector D-1 Vasant Kunj New Delhi 110070 India
| | - Shyam Vellore Srinivasan
- Department of Radiology Institute of Liver and Biliary Sciences Sector D-1 Vasant Kunj New Delhi 110070 India
| | - Komal Yadav
- Department of Radiology Institute of Liver and Biliary Sciences Sector D-1 Vasant Kunj New Delhi 110070 India
| | - Archana Rastogi
- Department of Clinical and Hepato-Pathology Institute of Liver and Biliary Sciences Sector D-1 Vasant Kunj New Delhi 110070 India
| | - Senthil Kumar
- Department of HPB Surgery and Liver Transplantation Institute of Liver & Biliary Sciences Sector D-1 Vasant Kunj New Delhi 110070 India
| | - Guresh Kumar
- Department of Research Institute of Liver & Biliary Sciences Sector D-1 Vasant Kunj New Delhi 110070 India
| | - Manoj Kumar
- Department of Hepatology Institute of Liver & Biliary Sciences Sector D-1 Vasant Kunj New Delhi 110070 India
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11
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Huang H, Li B, Song J, Ye G, Tang X, Qu T, Yan L, Wen T, Li B, Wang W, Wu H, Xu M, Yang J, Luo Y. Can ultrasound elastography assess liver quality in brain-dead donors and predict early allograft dysfunction after transplantation? Acad Radiol 2021; 28 Suppl 1:S112-S117. [PMID: 34756817 DOI: 10.1016/j.acra.2020.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the role of two-dimensional shear wave elastography (2D SWE) in assessing graft quality before liver transplantation and the relationship between donor liver stiffness (LS) and early allograft dysfunction (EAD) after transplantation. METHODS Eighty-three donors from January 2018 to December 2018 were involved in this prospective study. Liver stiffness measurements (LSMs) were performed using 2D SWE. The differences in LS values between discarded and transplanted grafts were analyzed. The relationship of donor LS with recipient EAD was also evaluated. RESULTS Our results suggest that the donor LS values were higher in discarded grafts than in transplanted grafts (24.0 ± 10.9 kPa vs 10.0 ± 2.6 kPa, p < 0.001). LSM failed in one donor. According to multivariate logistic regression analysis, the donor LS values ≥10.9 kPa (odds ratio [OR] 4.042, 95% confidence interval [CI] 1.133-14.421, p = 0.031), BMI (OR 1.287, 95% CI 1.025-1.616, p = 0.030) and INR (OR 6.703, 95% CI 1.338-33.589, p = 0.021) were independently associated with EAD. CONCLUSION Donor LSM conducted by 2D SWE might represent an effective quantitative method to evaluate graft quality. Donor LS might predict recipient EAD after liver transplantation.
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Affiliation(s)
- He Huang
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Bo Li
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Jiulin Song
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Guilin Ye
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Xiao Tang
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China; Department of Ultrasound, Chengdu Second People's Hospital, No. 10 Qingyun South Street, Chengdu, 610017, Sichuan Province, China
| | - Tingting Qu
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Lunan Yan
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Tianfu Wen
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Bo Li
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Wentao Wang
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Hong Wu
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Mingqing Xu
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Jiayin Yang
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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12
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Wang H, Zheng P, Wang X, Sang L. Effect of Q-Box size on liver stiffness measurement by two-dimensional shear wave elastography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:978-983. [PMID: 34609006 DOI: 10.1002/jcu.23075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To investigate the effect of the Q-Box size on liver stiffness (LS) measurement by two-dimensional shear wave elastography (2D SWE). METHODS Ninety-eight patients with chronic liver disease were enrolled. Each patient was continuously measured five times. The Q-Box diameter was adjusted to 10, 20, and 30 mm each time. The liver stiffness values (LSVs) at different diameters were compared in the following groups: LSVs ≤6.2 kPa, 6.2 kPa < LSVs ≤11 kPa, LSVs >11 kPa. The reliability and repeatability of LS measurement at different diameters were evaluated. RESULTS The differences in LSVs at different Q-Box diameters were statistically significant only when LSV ≤6.2 kPa (p = 0.004). There were no statistically significant differences in standard deviation (SD), SD/median, coefficient of variation (CV), and interquartile range (IQR)/median at different Q-Box diameters (p > 0.05). There were statistical differences in minimum LSVs and percentage of minimum LSVs ≤0.2 kPa as well as in stability index (SI) and percentage of SI <90% at different Q-Box diameters (p < 0.05). The intraclass correlation coefficients (ICCs) were up to 0.98 at Q-Box diameters of 10, 20, and 30 mm. CONCLUSIONS Our study showed that Q-Box size may lead to significant differences in LSVs, especially when LSVs ≤6.2 kPa. The Q-Box size had a large effect on the reliability of a single LS measurement but did not affect the repeatability of multiple measurements.
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Affiliation(s)
- Huipeng Wang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Pengchao Zheng
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xuemei Wang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Liang Sang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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13
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Bayramoglu Z, Akyol Sari ZN, Koker O, Adaletli I, Eker Omeroglu R. Shear wave elastography evaluation of liver, pancreas, spleen and kidneys in patients with familial mediterranean fever and amyloidosis. Br J Radiol 2021; 94:20210237. [PMID: 34520686 DOI: 10.1259/bjr.20210237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Amyloid deposits in a visceral organ can contribute to tissue stiffness that could be measured with shear wave elastography (SWE). We aimed to investigate changes in organ stiffness in conjunction with laboratory parameters in patients with Familial Mediterranean Fever (FMF) and amyloidosis. METHODS This prospective study included 27 FMF patients, 11 patients with amyloidosis, and 38 healthy controls. Median shear wave elasticity values of the liver, spleen, both kidneys, and pancreas on SWE were compared among study and control groups. The mean values of CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) were compared by the t-test and the median of SAA (serum amyloid A protein) was compared with the Mann-Whitney U test between FMF groups with and without amyloidosis. Spearman's correlation analysis was performed to reveal the association between stiffness values and laboratory parameters. RESULTS The median liver, spleen, kidney, and pancreas elasticity values were significantly higher in the FMF group with amyloidosis compared to control subjects. The median kidney stiffness values in the FMF group with or without amyloidosis were significantly higher compared to control subjects. Median liver stiffness values in FMF patients with amyloidosis were significantly higher than FMF patients without amyloidosis. There were statistically significant positive correlations between the CRP (p = 0.001, r = 0.56), ESR (p = 0.001, r = 0.61), and SAA (p = 0.002, r = 0.53) levels with spleen stiffness, and CRP (p = 0.006, r = 0.48) and ESR (p = 0.001,r = 0.61) levels with pancreas stiffness, and ESR (p = 0.004, r = 0.51) levels with the left kidney stiffness. CONCLUSION SWE could be a potential tool for noninvasive follow-up of FMF patients and also amyloid deposition. ADVANCES IN KNOWLEDGE Both acute inflammation and amyloidosis in the FMF patients could increase organ stiffness.
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Affiliation(s)
- Zuhal Bayramoglu
- Pediatric Radiology Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Zeynep Nur Akyol Sari
- Pediatric Radiology Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Oya Koker
- Pediatric Rheumatology Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Pediatric Radiology Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Rukiye Eker Omeroglu
- Pediatric Rheumatology Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Boeken T, Lucidarme O, Mbarki E, Scatton O, Savier E, Wagner M. Association of shear-wave elastography with clinical outcomes post-liver transplantation. Clin Res Hepatol Gastroenterol 2021; 45:101554. [PMID: 33172788 DOI: 10.1016/j.clinre.2020.09.015] [Citation(s) in RCA: 3] [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: 08/28/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Two-dimensional shear-wave elastography (2D-SWE) assessment of liver stiffness has the advantage of being obtained during conventional ultrasound. Liver-stiffness values on 2D-SWE for grafted livers are unknown, as are their potential link to post-transplantation morbidity. This study was undertaken to determine liver-stiffness values on 2D-SWE for grafted livers without complications, and examine relationships between liver-stiffness values on 2D-SWE and early post-operative arterial or biliary complications. METHODS In our facility, all liver-transplant recipients are entered in a comprehensive surgical database, where donor, procedure and recipient characteristics are described. All patients underwent systematic 2D-SWE assessment. Potential relationships were analyzed between liver-stiffness findings and donor, procedure and recipient characteristics, and follow-up events, including death, arterial or biliary complications, graft removal and allograft-dysfunction scores. RESULTS Liver-stiffness values on 2D-SWE of 337 ultrasound examinations from 165 liver-transplant recipients were collected retrospectively. Median time from transplantation to 2D-SWE examination was 149 days, with median follow-up at 36 months. The mean±SD stiffness value for grafts without complications was 7.3±2.3kPa; it was significantly higher during the first 90 days (8.2±2.5kPa) post-transplant than after 1year (7.0±2.4kPa) (P=0.01). Patients with biliary complications during the first-year post-transplantation had significantly higher mean liver-stiffness values on 2D-SWE than those without, respectively: 9.8±7.0 vs 7.5±1.8kPa (P=0.01). CONCLUSIONS Post-transplantation patients without complications had stiffer livers than the general population, with higher values during the first 90 days after surgery. Liver-stiffness values on 2D-SWE were significantly higher for patients with biliary, but not arterial, complications.
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Affiliation(s)
- Tom Boeken
- Université Paris Descartes - Sorbonne - Paris Cité, France; Radiologie Polyvalente et Oncologique, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651 Paris Cedex 13, France.
| | - Olivier Lucidarme
- Radiologie Polyvalente et Oncologique, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651 Paris Cedex 13, France; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Elsa Mbarki
- Université Paris Descartes - Sorbonne - Paris Cité, France; Radiologie Polyvalente et Oncologique, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651 Paris Cedex 13, France
| | - Olivier Scatton
- Chirurgie Digestive et Hépato-BIlio-Pancréatique, Hôpital Pitié-Salpêtrière, 47 blvd de l'Hôpital, 75013, Paris, France; Service de chirurgie digestive hépato-bilio-pancréatique transplantation hépatique, Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition, ICAN, Centre de Recherche Saint-Antoine, CRSA, AP-HP, CHU Pitie-Salpetriere, Paris, France
| | - Eric Savier
- Chirurgie Digestive et Hépato-BIlio-Pancréatique, Hôpital Pitié-Salpêtrière, 47 blvd de l'Hôpital, 75013, Paris, France; Service de chirurgie digestive hépato-bilio-pancréatique transplantation hépatique, Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition, ICAN, Centre de Recherche Saint-Antoine, CRSA, AP-HP, CHU Pitie-Salpetriere, Paris, France
| | - Mathilde Wagner
- Radiologie Polyvalente et Oncologique, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651 Paris Cedex 13, France; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
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15
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Qiu Y, Xing Z, Yang Q, Luo Y. Diagnostic value of supersonic shear impulse elastography for malignant cervical lymph nodes: a Bayesian analysis. Ultrasonography 2021; 41:279-290. [PMID: 34696539 PMCID: PMC8942728 DOI: 10.14366/usg.21107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/31/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose This study aimed to assess the diagnostic performance of supersonic impulse (SSI) elastography in differentiating malignant and benign cervical lymph nodes. Methods The Medline, Embase, and Cochrane Central databases were searched until December 1, 2020. Two different reviewers checked the studies and extracted the data. The diagnostic yields were quantitatively synthesized using a Bayesian bivariate model with an integrated nested Laplace approximation in R. Results In total, 590 patients with 892 cervical lymph nodes who underwent SSI elastography were included. The total prevalence of malignancy was 33.7% (301/892), and the four elastic modulus values (mean, maximum, minimum, and standard deviation) were significantly different between malignant and benign lymph nodes. For the mean elastic modulus, the summary estimates for sensitivity and specificity were 0.720 (95% credible interval [CrI], 0.592 to 0.824) and 0.877 (95% CrI, 0.727 to 0.969), respectively. The estimated area under the curve (AUC) was 0.845 (95% CrI, 0.672 to 0.914). For the maximum elastic modulus, the sensitivity and specificity were estimated to be 0.809 (95% CrI, 0.698 to 0.899) and 0.816 (95% CrI, 0.643 to 0.924), respectively. The estimated AUC was 0.834 (95% CrI, 0.579 to 0.938). The minimum and standard deviation of the elastic modulus and the outcomes of the positive and negative likelihood ratio, diagnostic odds ratio, and risk difference were also calculated. Conclusion SSI elastography is an acceptable imaging technique for diagnosing malignant cervical lymph nodes, and it can play a complementary role today. Both maximum and mean elastic modulus values should be taken into consideration to make a clinical judgment.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China.,Center of Thyroid & Parathyroid Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Qianru Yang
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China
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16
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Boulais L, Jellali R, Pereira U, Leclerc E, Bencherif SA, Legallais C. Cryogel-Integrated Biochip for Liver Tissue Engineering. ACS APPLIED BIO MATERIALS 2021; 4:5617-5626. [PMID: 35006744 DOI: 10.1021/acsabm.1c00425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Microfluidic systems and polymer hydrogels have been widely developed for tissue engineering. Yet, only a few tools combining both approaches, especially for in vitro liver models, are being explored. In this study, an alginate-based cryogel-integrated biochip was engineered for dynamic hepatoma cell line culture in three dimensions (3D). The alginate cryogel was covalently cross-linked in the biochip at subzero temperatures (T < 0 °C) to create a scaffold with high mechanical stability and an interconnected macroporous network. By varying the alginate concentration and the cross-linker ratio, Young's modulus of the cryogel can be fine-tuned between 1.5 and 29 kPa, corresponding to the range of stiffness of the different physiological states of the liver. We demonstrated that HepG2/C3A cells can be cultured and maintained as viable under dynamic conditions in this device up to 6 days. Albumin synthesis and glucose consumption increased over the cell culture days. Moreover, a 3D cell structure was observed across the entire height of the biochip, which was preserved following alginate lyase treatment to remove the cryogel-based scaffold. In summary, these results represent a proof of concept of an interesting cell culture technology that should be further investigated to engineer healthy and cirrhotic liver models.
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Affiliation(s)
- Lilandra Boulais
- Université de Technologie de Compiègne, UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherche de Royallieu, Compiègne 60203, France
| | - Rachid Jellali
- Université de Technologie de Compiègne, UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherche de Royallieu, Compiègne 60203, France
| | - Ulysse Pereira
- Université de Technologie de Compiègne, UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherche de Royallieu, Compiègne 60203, France
| | - Eric Leclerc
- Université de Technologie de Compiègne, UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherche de Royallieu, Compiègne 60203, France
| | - Sidi A Bencherif
- Université de Technologie de Compiègne, UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherche de Royallieu, Compiègne 60203, France.,Department of Chemical Engineering, Northeastern University, Boston, Massachusetts 02115-5005, United States.,Department of Bioengineering, Northeastern University, Boston, Massachusetts 02115-5005, United States.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Cécile Legallais
- Université de Technologie de Compiègne, UMR CNRS 7338 Biomécanique et Bioingénierie, Centre de Recherche de Royallieu, Compiègne 60203, France
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Xie X, Feng Y, Lyu Z, Wang L, Yang Y, Bai Y, Liu C, Wu H, Ren W, Zhu Q. Liver stiffness as measured by two-dimensional shear wave elastography overestimates the stage of fibrosis in patients with chronic hepatitis B and hepatic steatosis. Clin Res Hepatol Gastroenterol 2021; 45:101421. [PMID: 32312597 DOI: 10.1016/j.clinre.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
Two-dimensional shear wave elastography (2D-SWE) is a non-invasive technique for measuring liver stiffness (LS) and is used to assess the degree of hepatic fibrosis in patients with chronic hepatitis B (CHB). Despite its usefulness, several factors, other than hepatic fibrosis, can affect its diagnostic accuracy. Hepatic steatosis (HS) is a common lesion in CHB that has increasingly been getting attention in the field of disease development; however, its influence on the measurement of LS remains unclear. We aimed to determine whether HS affects the diagnostic accuracy of 2D-SWE in patients with CHB. Serum parameters and LS values were obtained from 161 patients with CHB. The degrees of hepatic fibrosis and inflammatory activity were estimated based on the METAVIR Cooperative Study Group criteria, and the extent of HS was defined as the percentage of hepatocytes containing fat droplets using oil red staining. We found that LS values were independently correlated with HS in the early stages of hepatic fibrosis (F0-F2 or F0-3). Furthermore, LS values in patients with significant steatosis (S≥10%) were higher than the counterpart in fibrosis stages F0-2 (6.82±1.57 vs. 7.92±1.99; p=0.010) and F0-3 (7.18±1.84 vs. 8.25±1.91; p=0.007). Therefore, false positive rates (FPRs) in the diagnosis of advanced fibrosis (16.00% vs. 37.04%, p=0.037) and cirrhosis (6.67% vs. 21.62%, p=0.030) were higher in patients with significant steatosis. In conclusion, the use of 2D-SWE in the measurement of LS overestimates the stage of hepatic fibrosis in CHB patients with HS>10%. This should be taken into consideration to combine LS results with other non-invasive parameters to improve its accuracy.
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Affiliation(s)
- Xiaoyu Xie
- Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Yuemin Feng
- Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Zhuozhen Lyu
- Department of Infectious Disease, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Le Wang
- Department of Geriatrics, Department of Geriatric, Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Yao Yang
- Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Yuping Bai
- Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Chenxi Liu
- Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Hao Wu
- Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Wanhua Ren
- Department of Infectious Disease, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.
| | - Qiang Zhu
- Department of Gastroenterology, Shangdong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.
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Fang C, Sidhu PS. Ultrasound-based liver elastography: current results and future perspectives. Abdom Radiol (NY) 2020; 45:3463-3472. [PMID: 32918106 PMCID: PMC7593307 DOI: 10.1007/s00261-020-02717-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/03/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
Chronic liver disease affects 185 million population worldwide. It encompasses a heterogenous disease spectrum, but all can lead to the development of liver fibrosis. The degree of liver fibrosis is not only a prognosticator, but has also been used to guide the treatment strategy and to evaluate treatment response. Traditionally, staging of liver fibrosis is determined on histological analysis using samples obtained from an invasive liver biopsy. Ultrasound-based liver elastography is a non-invasive method of assessing diffuse liver disease in patients with known chronic liver disease. The use of liver elastography has led to a significant reduction in the number of liver biopsies performed to assess the severity of liver fibrosis and a liver biopsy is now reserved for only select sub-groups of patients. The aim of this review article is to discuss the key findings and current evidence for ultrasound-based elastography in diffuse liver disease as well as the technical challenges and to evaluate the potential research direction.
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19
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Kim DW, Suh CH, Kim KW, Pyo J, Park C, Jung SC. Technical Performance of Two-Dimensional Shear Wave Elastography for Measuring Liver Stiffness: A Systematic Review and Meta-Analysis. Korean J Radiol 2020; 20:880-893. [PMID: 31132814 PMCID: PMC6536798 DOI: 10.3348/kjr.2018.0812] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
Objective To assess the technical performance of two-dimensional shear wave elastography (2D-SWE) for measuring liver stiffness. Materials and Methods The Ovid-MEDLINE and EMBASE databases were searched for studies reporting the technical performance of 2D-SWE, including concerns with technical failures, unreliable measurements, interobserver reliability, and/or intraobserver reliability, published until June 30, 2018. The pooled proportion of technical failure and unreliable measurements was calculated using meta-analytic pooling via the random-effects model and inverse variance method for calculating weights. Subgroup analyses were performed to explore potential causes of heterogeneity. The pooled intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated using the Hedges-Olkin method with Fisher's Z transformation of the correlation coefficient. Results The search yielded 34 articles. From 20 2D-SWE studies including 6196 patients, the pooled proportion of technical failure was 2.3% (95% confidence interval [CI], 1.3–3.9%). The pooled proportion of unreliable measurements from 20 studies including 6961 patients was 7.5% (95% CI, 4.7–11.7%). In the subgroup analyses, studies conducting more than three measurements showed fewer unreliable measurements than did those with three measurements or less, but no intergroup difference was found in technical failure. The pooled ICCs for interobserver reliability (from 10 studies including 517 patients) and intraobserver reliability (from 7 studies including 679 patients) were 0.87 (95% CI, 0.82–0.90) and 0.93 (95% CI, 0.89–0.95), respectively, suggesting good to excellent reliability. Conclusion 2D-SWE shows good technical performance for assessing liver stiffness, with high technical success and reliability. Future studies should establish the quality criteria and optimal number of measurements.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Junhee Pyo
- WHO Collaborating Center for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science, Utrecht University, Utrecht, Netherlands
| | - Chan Park
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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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.
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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
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Wang H, Zheng P, Sang L, Wang X. Does Operator Experience and the Q-Box Diameter Affect the Repeatability of Liver Stiffness Measurements Obtained by 2-Dimensional Shear Wave Elastography? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:741-747. [PMID: 31626345 DOI: 10.1002/jum.15153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The purpose of this research was to evaluate whether operator experience and the quantitative analysis system (Q-Box; SuperSonic Imagine, Aix-en-Provence, France) diameter affect the repeatability of liver stiffness measurements. METHODS We enrolled 417 outpatients. All measurements were performed by 2 operators, including an expert and a novice. Each patient was continuously measured 3 times by the 2 operators. The Q-Box diameter was adjusted to 10, 20, and 30 mm each time, and the mean elasticity values were recorded. Intraobserver repeatability was evaluated by the intraclass correlation coefficient (ICC). Interobserver repeatability was evaluated by the ICC, coefficient of variation (CV), and Bland-Altman plots. RESULTS The study group included 241 male and 176 female patients. The expert operator had higher ICCs than the novice operator at each Q-Box diameter. The overall interobserver agreement was excellent, and the results showed that compared to other groups, the ICC was the lowest and the CV was the largest for the 30-mm-diameter group. The ICC and CV values were similar between the 10- and 20 mm-diameter groups. The Bland-Altman plots showed that the mean difference was -0.2 kPa for the 10-, 20-, and 30 mm-diameter groups. However, the limits of agreement were the largest in the 30-mm-diameter group and were similar between the 10- and 20-mm-diameter groups. CONCLUSIONS The repeatability of liver stiffness measurements is affected not only by experience but also by the Q-Box diameter.
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Affiliation(s)
- Huipeng Wang
- Department of Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Pengchao Zheng
- Department of Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Liang Sang
- Department of Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Xuemei Wang
- Department of Ultrasound, First Hospital of China Medical University, Shenyang, China
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Precise fibrosis staging with shear wave elastography in chronic hepatitis B depends on liver inflammation and steatosis. Hepatol Int 2020; 14:190-201. [PMID: 32078141 DOI: 10.1007/s12072-020-10017-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Two-dimensional shear wave elastography (2D-SWE) is the latest generation of ultrasound elastography for the non-invasive assessment of liver fibrosis in chronic hepatitis B (CHB). We aimed to identify confounders of 2D-SWE in fibrosis grading. METHODS A prospective cohort of 440 CHB patients (286 with liver biopsy and 154 with clinical decompensated cirrhosis) was consecutively enrolled from a clinical trial (registration number: ChiCTR-DCD-15006000) aimed at optimizing 2D-SWE assessments from 2015 to 2018. All patients underwent 2D-SWE examination, anthropometric measurement, and serum biomarker assessment. Steatosis was graded by the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF). RESULTS Overall, the prevalence of incorrect fibrosis staging by 2D-SWE was 26.1% (n = 115), with 43.5% of patients under-staged and 56.5% over-staged. In multivariate analysis, the steatosis degree was an independent predictor of 2D-SWE discordance in the overall cohort, with moderate-severe steatosis for underestimation (odds ratio, [OR] = 4.3, 95% confidence interval [CI] 1.2-18.2, p = 0.049) and overestimation (OR = 8.2, 95% CI 2.9-23.5, p < 0.001), and mild steatosis for overestimation (OR = 3.7, 95% CI 1.5-9.0, p = 0.004). In patients with liver biopsy, both histological inflammation activity over 2 (OR = 5.0, 95% CI 2.0-25.3, p = 0.048) and moderate-severe steatosis (OR = 5.2, 95% CI 2.1-13.4, p < 0.001) were independent factors associated with discordance. For the risk of 2D-SWE mis-staging, a nomogram that integrated these confounders was established and the area under the receiver operating characteristic curve of the model was 0.861. CONCLUSIONS Steatosis and inflammation activities were confounders for 2D-SWE. The combination of these confounders could predict mis-staging risks of CHB-related fibrosis with 2D-SWE and may be valuable to decision-making on liver biopsy for fibrosis staging.
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Fang C, Lim A, Sidhu PS. Ultrasound-based liver elastography in the assessment of fibrosis. Clin Radiol 2020; 75:822-831. [PMID: 32067699 DOI: 10.1016/j.crad.2020.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
Ultrasound-based elastography has rapidly replaced the need for liver biopsy in most patients with chronic liver disease in recent years. The technique is now widely supported by many manufacturers. This review will introduce various current ultrasound-based elastography techniques, review the physics and scanning techniques, discuss potential cofounding factors as well as summarising the evidence for its use in staging liver fibrosis using shear-wave elastography among different disease aetiologies. Future challenges and directions will be also be discussed.
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Affiliation(s)
- C Fang
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK.
| | - A Lim
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - P S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
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Dioguardi Burgio M, Ronot M, Reizine E, Rautou PE, Castera L, Paradis V, Garteiser P, Van Beers B, Vilgrain V. Quantification of hepatic steatosis with ultrasound: promising role of attenuation imaging coefficient in a biopsy-proven cohort. Eur Radiol 2019; 30:2293-2301. [PMID: 31822978 DOI: 10.1007/s00330-019-06480-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/30/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To prospectively assess the role of the US attenuation imaging coefficient (AC) for the diagnosis and quantification of hepatic steatosis. METHODS One hundred and one patients underwent liver biopsy and US-AC measurement on the same day. Liver steatosis was graded according to biopsy as absent (S0 < 5%), mild (S1 5-33%), moderate (S2 33-66%), or severe (S3 > 66%); liver fibrosis was graded from F0 to F4. The correlation between AC and steatosis on pathology (%) was calculated using the Pearson correlation coefficient. The Student t or Mann-Whitney U test was used to compare continuous variables and ROC curve analysis was used to assess diagnostic performance of AC in diagnosing steatosis. RESULTS Overall, 43 (42%), 35 (35%), 12 (12%), and 11 (11%) patients were classified as S0, S1, S2, and S3, respectively. The AC was positively correlated with steatosis as a continuous variable (%) on pathology (r = 0.58, p < 0.01). Patients with steatosis of any grade had a higher AC than those without steatosis (mean 0.77 ± 0.13 vs. 0.63 ± 0.09 dB/cm/MHz, respectively; p < 0.01, AUROC = 0.805). Patients with S2-S3 had a higher AC than patients with S0-1 (0.85 ± 0.11 vs. 0.67 ± 0.11 dB/cm/MHz, respectively; p < 0.01, AUROC = 0.892). AC > 0.69 dB/cm/MHz had a sensitivity and specificity of 76% and 86%, respectively, for diagnosing any grade of steatosis (S1-S3), and AC > 0.72 dB/cm/MHz had a sensitivity and specificity of 96% and 74%, respectively, for diagnosing S2-S3. The presence of advanced fibrosis (F3-F4) did not affect the calculated AC. CONCLUSIONS The attenuation imaging coefficient is a promising quantitative technique for the non-invasive diagnosis and quantification of hepatic steatosis. KEY POINTS • Measurement of the attenuation coefficient is achieved with a very high rate of technical success. • We found a significant positive correlation between the attenuation coefficient and the grade of steatosis on pathology. • The attenuation imaging coefficient is a promising quantitative technique for the noninvasive diagnosis and quantification of hepatic steatosis.
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Affiliation(s)
- Marco Dioguardi Burgio
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Edouard Reizine
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Pierre-Emmanuel Rautou
- Department of Hepatology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Laurent Castera
- Department of Hepatology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Valérie Paradis
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Philippe Garteiser
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Bernard Van Beers
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Accuracy and precision of ultrasound shear wave elasticity measurements according to target elasticity and acquisition depth: A phantom study. PLoS One 2019; 14:e0219621. [PMID: 31295308 PMCID: PMC6622533 DOI: 10.1371/journal.pone.0219621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the accuracy and precision of ultrasound shear wave elasticity measurements as a function of target elasticity and acquisition depth. MATERIALS AND METHODS Using five ultrasound systems (VTQ, VTIQ, EPIQ 5, Aixplorer, and Aplio 500), two operators independently measured shear wave elasticities in two phantoms containing five different target elasticities (8±3, 14±4, 25±6, 45±8, and 80±12 kPa) at depths of 15, 30, 35, and 60 mm. Accuracy was assessed by evaluating measurement errors and the proportions of outliers, while factors affecting accuracy were assessed using logistic regression analysis. Measurement errors were defined as differences between the measured values and 1) the margins of the target elasticity, and 2) the median values of the target elasticity. Outliers were defined as measured values outside the margins of the target elasticity. Precision was assessed by calculating the reproducibility of measurements using the within-subject coefficient of variation (wCV). RESULTS Mean measurement errors and the proportions of outliers were higher for high than for low target elasticities (p<0.001), but did not differ in relation to acquisition depth, either within an elastography system or across the different systems. Logistic regression analysis showed that target elasticity (p<0.001) significantly affected accuracy, whereas acquisition depth (p>0.05) did not. The wCV for the 80±12 kPa target (31.33%) was significantly higher than that for lower elasticity targets (6.96-10.43 kPa; p<0.001). The wCV did not differ across acquisition depths. The individual elastography systems showed consistent results. CONCLUSIONS Targets with high elasticity showed lower accuracy and lower precision than targets with low elasticity, while acquisition depth did not show consistent patterns in either accuracy or precision.
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Petzold G, Hofer J, Ellenrieder V, Neesse A, Kunsch S. Liver Stiffness Measured by 2-Dimensional Shear Wave Elastography: Prospective Evaluation of Healthy Volunteers and Patients With Liver Cirrhosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1769-1777. [PMID: 30536601 DOI: 10.1002/jum.14866] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aimed to establish normal values for liver stiffness measurement, performed by 2-dimensional shear wave elastography (LOGIQ E9; GE Healthcare, Wauwatosa, WI), in healthy volunteers, patients with nonhepatic morbidities, and patients with histologically confirmed liver cirrhosis. METHODS A total of 175 participants were included between July 2016 and February 2018. Three cohorts were analyzed: healthy volunteers (n = 68), patients with healthy livers but nonhepatic morbidities (n = 57), and patients with liver cirrhosis (n = 50). Liver stiffness measurement was performed by 2 observers with different levels of experience to determine interobserver agreement. RESULTS Of the 175 participants included, 91 were male, and the mean age ± SD was 44.4 ± 19.4 years. The success rate for 175 liver stiffness measurements was 95.4%. The number of unsuccessful measurements was significantly higher in the liver cirrhosis cohort (P = .04). The interobserver agreement was excellent (intraclass correlation coefficient, 0.87). Liver stiffness in the healthy-liver patient cohort (4.93 ± 0.83 kPa) was not significantly different from that in the healthy-volunteer cohort (5.19 ± 1.03 kPa; P = .13). Apart from male sex in the healthy-volunteer cohort, age, body mass index, mild steatosis, and nonhepatic morbidities had no significant impact on liver stiffness. Liver stiffness values in participants without liver disease (healthy volunteers and healthy-liver patients; n = 125) ranged from 3.62 to 7.02 kPa (2.5th-97.5th percentiles). Notably, there was no overlap of liver stiffness measurements between the patients without liver disease and the cirrhosis cohort (13.29 ± 3.27 kPa [7.76-19.49 kPa]). CONCLUSIONS Liver stiffness values in healthy individuals vary widely and are not dependent on age, body mass index, or specific nonhepatic comorbidities. Liver stiffness values within the normal range can noninvasively rule out cirrhosis, as liver stiffness is significantly higher in cirrhotic patients (P < .001). Two-dimensional shear wave elastography has excellent interobserver agreement.
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Affiliation(s)
- Golo Petzold
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Johannes Hofer
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Volker Ellenrieder
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Albrecht Neesse
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Steffen Kunsch
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
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Ultrasound elastography techniques for diagnosis and follow-up of hepatic veno-occlusive disease. Bone Marrow Transplant 2019; 54:1145-1147. [PMID: 30679827 PMCID: PMC6760678 DOI: 10.1038/s41409-019-0432-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023]
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Performance of two--dimensional ultrasound shear wave elastography: reference values of normal liver stiffness in children. Pediatr Radiol 2019; 49:91-98. [PMID: 30267166 DOI: 10.1007/s00247-018-4244-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/14/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Two-dimensional (2-D) shear wave elastography is a new sonographic elastography method for noninvasive measurement of liver stiffness. OBJECTIVE The aim of this study was to establish reference values of normal liver stiffness on 2-D shear wave elastography in children. MATERIALS AND METHODS Two-dimensional shear wave elastography values were measured in 202 children with no liver disease from the neonatal period to puberty, who were divided into 4 age groups: newborns and infants, preschoolers, elementary school children and adolescents. We investigated the effects of age, depth of elastography measurement, transducer, number of measurements per child, liver size and Doppler parameters of hepatic blood flow on liver elasticity values. RESULTS The mean normal liver elasticity value in the study population was: 4.29±0.59 kilopascals (kPa). In neonates and infants, mean liver elasticity value was 4.63 (± 0.6) kPa, in preschoolers and elementary school children, 4.05 (± 0.57) kPa and 4.15 (± 0.52) kPa, respectively, and in adolescents, 4.39 (± 0.55) kPa. Values in neonates and infants as well as adolescents were significantly higher than in preschoolers and elementary school children (Kruskal-Wallis, P<0.001; Mann-Whitney U tests, P<0.05). There was no significant association between liver elasticity values and size of the right lobe or Doppler parameters of hepatic blood flow. Different depths and the number of elastography measurements had no effect on liver elasticity values. CONCLUSION Two-dimensional shear wave elastography is achievable in a wide range of age in children. We established the reference values of normal liver stiffness on 2-D shear wave elastography in children.
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Jeong JY, Cho YS, Sohn JH. Role of two-dimensional shear wave elastography in chronic liver diseases: A narrative review. World J Gastroenterol 2018; 24:3849-3860. [PMID: 30228779 PMCID: PMC6141332 DOI: 10.3748/wjg.v24.i34.3849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
Liver biopsy is the gold standard for evaluating the degree of liver fibrosis in patients with chronic liver disease. However, due to the many limitations of liver biopsy, there has been much interest in the use of noninvasive techniques for this purpose. Among these techniques real-time two-dimensional shear wave elastography (2D-SWE) has the advantage of measuring tissue elasticity with the guidance of B-mode images. Recently, many studies have been conducted on the application of 2D-SWE in patients with various liver diseases, and their validity has been confirmed. Here, we briefly discuss the role of 2D-SWE in patients with chronic liver diseases, particularly aspects of the examination techniques and clinical applications.
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Affiliation(s)
- Jae Yoon Jeong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
| | - Young Seo Cho
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
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Davis LC, Baumer TG, Bey MJ, Holsbeeck MV. Clinical utilization of shear wave elastography in the musculoskeletal system. Ultrasonography 2018; 38:2-12. [PMID: 30343557 PMCID: PMC6323314 DOI: 10.14366/usg.18039] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/23/2018] [Indexed: 01/02/2023] Open
Abstract
Shear wave elastography (SWE) is an emerging technology that provides information about the inherent elasticity of tissues by producing an acoustic radiofrequency force impulse, sometimes called an "acoustic wind," which generates transversely-oriented shear waves that propagate through the surrounding tissue and provide biomechanical information about tissue quality. Although SWE has the potential to revolutionize bone and joint imaging, its clinical application has been hindered by technical and artifactual challenges. Many of the stumbling blocks encountered during musculoskeletal SWE imaging are readily recognizable and can be overcome, but progressive advances in technology and a better understanding of image acquisition are required before SWE can reliably be used in musculoskeletal imaging.
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Affiliation(s)
- Leah C Davis
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC, USA.,Department of Radiology, Henry Ford Health Systems, Detroit, MI, USA
| | - Timothy G Baumer
- Department of Orthopaedic Surgery, Henry Ford Health Systems, Bone and Joint Center, Detroit, MI, USA
| | - Michael J Bey
- Department of Orthopaedic Surgery, Henry Ford Health Systems, Bone and Joint Center, Detroit, MI, USA
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Value of Two-Dimensional Shear Wave Elastography for Assessing Acute Liver Congestion in a Bama Mini-Pig Model. Dig Dis Sci 2018; 63:1851-1859. [PMID: 29736835 DOI: 10.1007/s10620-018-5085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To date, liver congestion is one of the most significant clinical diseases. However, few studies have profoundly investigated the development, pathology, and prognosis of the important problems associated with acute hepatic congestion. AIMS To explore the value of noninvasive two-dimensional shear wave elastography (2D-SWE) for assessing acute liver congestion in an animal model. METHODS Six healthy Bama mini-pigs were used for this research and randomly divided into the experimental group and control group. We measured the basal liver stiffness (LS) by 2D-SWE and then clamped the inferior vena cava (IVC). LS was measured after 1, 5, 10, and 15 min. We reopened the IVC of experimental group pigs and detected the LS again. All pigs were killed and obtained for a pathological microscopic examination. RESULTS LS was distinctly increased from 7.03 ± 0.48 to 17.18 ± 3.40 kPa (p < 0.01) within 15 min and reversed to almost normal values of 7.59 ± 0.77 kPa (p < 0.01) within 5 min. In addition, two-dimensional ultrasound images demonstrated the interesting phenomenon of spontaneous echo contrast. Most importantly, the pathologic results of experimental group pigs showed the central veins of the hepatic lobules and hepatic sinusoids were enlarged and filled with numerous erythrocytes; central lobular hepatocytic necrosis and edema were noted. CONCLUSIONS In conclusion, 2D-SWE is a valuable, reliable, and quantitative approach to successfully assess acute liver congestion, and it is well consistent with histopathological characteristics. Besides, acute liver congestion is an important factor influencing LS that increases LS in a reversible way.
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Wang HW, Shi HN, Cheng J, Xie F, Luo YK, Tang J. Real-time shear wave elastography (SWE) assessment of short- and long-term treatment outcome in Budd-Chiari syndrome: A pilot study. PLoS One 2018; 13:e0197550. [PMID: 29847588 PMCID: PMC5976180 DOI: 10.1371/journal.pone.0197550] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/19/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose The first aim of this study was to analyze the relationships between liver stiffness measurement, hepatic venous pressure and liver fibrosis. The second aim was to demonstrate the utility of real-time shear wave elastography for evaluation of Budd-Chiari syndrome patients before and after balloon hepatic venous angioplasty. Materials and methods A total of 32 patients with Budd-Chiari syndrome slated for successful balloon angioplasty met the inclusion and exclusion criteria. Shear wave elastography was used to generate dynamic liver stiffness measurement 2 days before angioplasty and 2 days, 3 months, and 6 months after angioplasty. Hepatic venous pressures were measured during balloon angioplasty. Correlations among liver stiffness, hepatic venous pressure, and fibrosis were assessed. Result Mean liver stiffness was 35.17 ± 10.60 kPa, 20.15 ± 5.47 kPa, 15.36 ± 4.34 kPa and 15.68 ± 5.58 kPa at baseline and 2 days, 3 months, and 6 months after angioplasty, respectively. Liver stiffness measured at 2 days and 3 months after angioplasty was significantly decreased (P < 0.001); liver stiffness measured at 6 months after angioplasty was not significantly different from that measured at 3 months after angioplasty (P = 0.636). Analysis of liver stiffness measurement and hepatic venous pressure before balloon angioplasty yielded a coefficient of correlation r = 0.701 (P < 0.001). Before and 2d after angioplasty, liver stiffness measurement did not correlated with fibrosis (r = − 0.170, P = 0.22), (r = 0.223, P = 0.220), respectively, while the LSM difference before and 2 days after angioplasty negatively correlated with stiffness severity (r = − 0.502, P = 0.003). Liver stiffness measured at 2 days and 3 months after angioplasty was significantly decreased (P < 0.001), remaining stable at 3 months, though still in the cirrhotic range. Conclusions The liver stiffness of Budd-Chiari syndrome patients, measured by shear wave elastography, decreased considerably after hepatic venous recanalization, and significantly correlated with hepatic venous pressure though not with degree of fibrosis. Shear wave elastography may be effective in monitoring short- and long-term treatment outcomes in Budd-Chiari syndrome.
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Affiliation(s)
- Hong-Wei Wang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
- Department of Ultrasound, Yong Liang Hospital, Baoding, China
| | - Hua-Ning Shi
- Department of Ultrasound, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Jia Cheng
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang Xie
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yu-Kun Luo
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
- * E-mail: (YKL); (JT)
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
- * E-mail: (YKL); (JT)
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The Evaluation of Liver Fibrosis in the Real-Time Shear Wave Elastography Technique in Chronic Hepatitis B and C Patients: How Many Measurements Are Necessary to Assign Patients to METAVIR Score Properly? HEPATITIS MONTHLY 2018. [DOI: 10.5812/hepatmon.61189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Shear Wave Elastography as a Quantitative Biomarker of Clinically Significant Portal Hypertension: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 210:W185-W195. [PMID: 29570374 DOI: 10.2214/ajr.17.18367] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To qualify shear wave elastography (SWE) as a biomarker for clinically significant portal hypertension (CSPH) beyond proof of concept, we aimed to accumulate and summarize the current evidence through systematic review and meta-analysis. MATERIALS AND METHODS A computerized literature search was performed to identify studies from MEDLINE and EMBASE up to February 9, 2017. Studies on the diagnostic performance of liver stiffness measurements using SWE for CSPH with hepatic venous pressure gradient (HVPG) as the reference standard were included. Various aspects of SWE were comprehensively assessed. The summary diagnostic performance of SWE for the diagnosis of CSPH and the summary correlation coefficient between liver stiffness measured using SWE and HVPG were evaluated through a meta-analysis. RESULTS Nine articles (including 746 patients) were retrieved. The diagnostic performance of SWE for the diagnosis of CSPH was fairly good, with a summary sensitivity of 85% (95% CI, 75-91%; I2 = 78.56%) and summary specificity of 85% (95% CI, 77-90%; I2 = 0%); the area under the ROC curve was 0.88 (95% CI, 0.85-0.91). The summary correlation coefficient between liver stiffness and HVPG measurements was 0.741 (95% CI, 0.658-0.825; I2 = 0%). These results support the value of SWE as a diagnostic biomarker for CSPH. However, there was significant heterogeneity in the imaging devices, protocols, liver stiffness measurement methods, and cutoff values used, which suggests that standardization is required. CONCLUSION The consistent evidence favoring SWE as a biomarker for CSPH should be considered in the biomarker qualification process and management of patients with CSPH.
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Xie LT, Yan CH, Zhao QY, He MN, Jiang TA. Quantitative and noninvasive assessment of chronic liver diseases using two-dimensional shear wave elastography. World J Gastroenterol 2018; 24:957-970. [PMID: 29531460 PMCID: PMC5840471 DOI: 10.3748/wjg.v24.i9.957] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 02/06/2023] Open
Abstract
Two-dimensional shear wave elastography (2D-SWE) is a rapid, simple and novel noninvasive method that has been proposed for assessing hepatic fibrosis in patients with chronic liver diseases (CLDs) based on measurements of liver stiffness. 2D-SWE can be performed easily at the bedside or in an outpatient clinic and yields immediate results with good reproducibility. Furthermore, 2D-SWE was an efficient method for evaluating liver fibrosis in small to moderately sized clinical trials. However, the quality criteria for the staging of liver fibrosis are not yet well defined. Liver fibrosis is the main pathological basis of liver stiffness and a key step in the progression from CLD to cirrhosis; thus, the management of CLD largely depends on the extent and progression of liver fibrosis. 2D-SWE appears to be an excellent tool for the early detection of cirrhosis and may have prognostic value in this context. Because 2D-SWE has high patient acceptance, it could be useful for monitoring fibrosis progression and regression in individual cases. However, multicenter data are needed to support its use. This study reviews the current status and future perspectives of 2D-SWE for assessments of liver fibrosis and discusses the technical advantages and limitations that impact its effective and rational clinical use.
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Affiliation(s)
- Li-Ting Xie
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Chun-Hong Yan
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Qi-Yu Zhao
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Meng-Na He
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Tian-An Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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3D Co-Culture with Vascular Cells Supports Long-Term Hepatocyte Phenotype and Function In Vitro. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2018. [DOI: 10.1007/s40883-018-0046-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bende F, Mulabecirovic A, Sporea I, Popescu A, Sirli R, Gilja OH, Vesterhus M, Havre RF. Assessing Liver Stiffness by 2-D Shear Wave Elastography in a Healthy Cohort. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:332-341. [PMID: 29249457 DOI: 10.1016/j.ultrasmedbio.2017.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to assess the normal ranges of liver stiffness measurements (LSMs) in participants with healthy livers, using General Electric 2-D shear wave elastography (2-D-SWE-GE) compared with transient elastography (TE). We included 80 participants with healthy livers and without known liver disease, in whom liver stiffness was evaluated in the same session using two elastographic methods, TE and 2-D-SWE-GE. Reliable LSMs were defined for TE as the median of 10 measurements with a success rate of ≥60% and an interquartile range (IQR) < 30%, and for 2-D-SWE-GE, as the median of 10 measurements acquired in a homogenous area and an IQR < 30%. Participants with LSMs > 6.5 kPa by TE were excluded. Reliable LSMs were obtained in 79 participants (98.7%) by means of 2-D-SWE-GE and in 80 participants (100%) by means of TE (p = 0.9). The mean LSM obtained by 2-D-SWE-GE in our cohort of participants with healthy livers was 5.1 ± 1.3 kPa, which was significantly higher than the LSM assessed by TE (4.3 ± 0.9 kPa, p < 0.0001). In 2-D SWE-GE, mean LSMs were significantly higher for men than for women, 5.9 ± 1.2 kPa versus 4.7 ± 1.2 kPa (p = 0.0005). In conclusion, 2-D-SWE-GE has very good feasibility (98.7%) in healthy persons. The mean LSM determined by 2-D-SWE-GE in healthy participants was 5.1 ± 1.3 kPa. LSMs obtained by means of 2-D-SWE-GE were higher than those obtained by TE in participants with healthy livers.
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Affiliation(s)
- Felix Bende
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Anesa Mulabecirovic
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Ioan Sporea
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Alina Popescu
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania.
| | - Roxana Sirli
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Odd Helge Gilja
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Mette Vesterhus
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway; Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Roald Flesland Havre
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
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Deng H, Qi X, Zhang T, Qi X, Yoshida EM, Guo X. Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis. Expert Rev Gastroenterol Hepatol 2018; 12:91-98. [PMID: 29186994 DOI: 10.1080/17474124.2018.1412257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The meta-analysis aimed to summarize the technical success rate of supersonic shear imaging (SSI) and to evaluate the diagnostic performance of liver and spleen stiffness measurement (LSM and SSM) with SSI for the detection of liver fibrosis, portal hypertension, and gastroesophageal varices in liver diseases. METHODS PubMed, EMBASE, and Cochrane Library databases were searched. Technical success rate of SSI was pooled. Area under curve (AUC), sensitivity, and specificity with corresponding 95% confidence interval (CI) were calculated. RESULTS Included studies regarding the diagnostic performance of SSI for liver fibrosis, portal hypertension, and esophageal varices numbered 28, 4, and 4 respectively. The pooled technical success rates of LSM and SSM were 95.3% and 75.5%, respectively. The AUC, sensitivity, and specificity of LSM/SSM for different stages of liver fibrosis were 0.85-0.94, 0.7-0.89, and 0.82-0.92, respectively. The AUC, sensitivity, and specificity of LSM were 0.84 (95%CI = 0.8-0.86), 0.79 (95%CI = 0.7-0.85), and 0.82 (95%CI = 0.72-0.88) for clinically significant portal hypertension, 0.85 (95%CI = 0.82-0.88), 0.8 (95%CI = 0.68-0.88), and 0.8 (95%CI = 0.6-0.92) for any varices, and 0.86 (95%CI = 0.83-0.89), 0.86 (95%CI = 0.76-0.92), and 0.61 (95%CI = 0.35-0.83) for high-risk varices, respectively. CONCLUSIONS LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices.
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Affiliation(s)
- Han Deng
- a Yuebei People's Hospital , Shaoguan , China
| | - Xingshun Qi
- b Liver Cirrhosis Study Group, Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China
- c Chinese Portal Hypertension Noninvasive Diagnosis Study (CHESS) Group , China
| | - Tiansong Zhang
- d Department of Traditional Chinese Medicine , Jing'an District Central Hospital , Shanghai , China
| | - Xiaolong Qi
- c Chinese Portal Hypertension Noninvasive Diagnosis Study (CHESS) Group , China
- e Institute of Hepatology, Nanfang Hospital, Southern Medical University , Guangdong Provincial Research Center for Liver Fibrosis , Guangzhou , China
| | - Eric M Yoshida
- f Division of Gastroenterology , Vancouver General Hospital , Vancouver , Canada
| | - Xiaozhong Guo
- b Liver Cirrhosis Study Group, Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China
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Paul SB, Das P, Mahanta M, Sreenivas V, Kedia S, Kalra N, Kaur H, Vijayvargiya M, Ghosh S, Gamanagatti SR, Gupta SD, Acharya SK. Assessment of liver fibrosis in chronic hepatitis: comparison of shear wave elastography and transient elastography. Abdom Radiol (NY) 2017. [PMID: 28643136 DOI: 10.1007/s00261-017-1213-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of shear wave elastography (SWE) and transient elastography (TE) in the evaluation of liver fibrosis in chronic hepatitis B (CHB) and C (CHC) patients taking liver biopsy as gold standard. METHODS Ethics committee approved this prospective cross-sectional study. Between October 2012 and December 2014, consecutive CHB/CHC patients fulfilling the inclusion criteria were included-age more than 18 years, informed written consent, willing and suitable for liver biopsy. SWE, TE, and biopsy were performed the same day. Liver stiffness measurement (LSM) cut-offs for various stages of fibrosis were generated for SWE and TE. AUC, sensitivity, specificity, and positive/negative predictive values were estimated individually or in combination. RESULTS CH patients (n = 240, CHB 172, CHC 68), 176 males, 64 females, mean age 32.6 ± 11.6 years were enrolled. Mean LSM of patients with no histological fibrosis (F0) was 5.0 ± 0.7 and 5.1+1.4 kPa on SWE and TE, respectively. For differentiating F2 and F3-4 fibrosis on SWE, at 7.0 kPa cut-off, the sensitivity was 81.3% and specificity 77.6%. For TE, at 8.3 kPa cut-off, sensitivity was 81.8% and specificity 83.1%. For F3 vs. F4, SWE sensitivity was 83.3% and specificity 90.7%. At 14.8 kPa cut-off, TE showed similar sensitivity (83.3%) but specificity increased to 96.5%. Significant correlation between SWE and TE was observed (r = 0.33, p < 0.001). On combining SWE and TE, a drop in sensitivity with increased specificity for all stages of liver fibrosis occured. CONCLUSION SWE is an accurate technique for evaluating liver fibrosis. SWE compares favorably with TE especially for predicting advanced fibrosis/cirrhosis. Combining SWE and TE further improves specificity.
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Affiliation(s)
- Shashi B Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mousumi Mahanta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vishnubhatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nancy Kalra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Harpreet Kaur
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Maneesh Vijayvargiya
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shouriyo Ghosh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shivanand R Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Siddhartha Dutta Gupta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Subrat K Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Taibbi A, Picone D, Midiri M, La Grutta L, Bartolotta TV. Diffuse Liver Diseases: Role of imaging. Semin Ultrasound CT MR 2017; 39:193-205. [PMID: 29571555 DOI: 10.1053/j.sult.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nowadays, the most common imaging techniques allow to study focal liver lesions with high diagnostic accuracy but a relatively recent emerging field of interest is represented by diffuse liver disease. They include a variegated series of storage and metabolic pathologies (ie, iron overload disorders and steatosis) requiring a precise diagnosis not always possible at imaging due to the overlapping of findings at conventional ultrasound, CT, or MR studies. In recent years, several imaging tecniques and specific softwares have been developed, especially for ultrasound and MR imaging, in order to identify different parameters useful in the noninvasive recognition and follow-up of these diffuse processes involving the liver. The aim of this article is to describe the most common and useful imaging findings of the most common and uncommon diffuse liver diseases illustrating the newest imaging technologies and developments at our disposal with corresponding advantages, limitations, and pitfalls.
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Affiliation(s)
- Adele Taibbi
- Department of Radiology, University Hospital, Palermo, Italy.
| | - Dario Picone
- Department of Radiology, University Hospital, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University Hospital, Palermo, Italy
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Yoon HM, Cho YA, Kim JR, Lee SS, Jung AY, Lee JS, Oh SH, Kim KM. Real-time two-dimensional Shear-wave elastography for liver stiffness in children: Interobserver variation and effect of breathing technique. Eur J Radiol 2017; 97:53-58. [PMID: 29153367 DOI: 10.1016/j.ejrad.2017.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate interobserver variation and to assess the effect of the breathing technique on liver stiffness (LS) measurement using real-time two-dimensional shear-wave elastography (2D-SWE) in children. METHODS Patients who underwent real-time 2D-SWE by two operators (group 1) and patients who underwent real-time 2D-SWE by one operator using the free-breathing and breath-holding techniques (group 2) were included. In group 1, interobserver agreement was assessed using the intraclass correlation coefficient (ICC) and the 95% limits-of-agreement was analyzed to evaluate the maximum change in the LS values based on Bland-Altman analysis. In group 2, the Bland-Altman plot and the paired t-test were used to determine the effect of breathing technique on LS measurement. RESULTS The interobserver agreement of the LS measurement in group 1 (n=63) was excellent (ICC, 0.953), and the 95% limits-of-agreement was 31.8% of the mean LS values. In group 2 (n=45), the free-breathing technique revealed systematically lower LS with a mean difference of -11.1% of the mean LS values, compared to the breath-holding technique (P=0.016). CONCLUSION LS measurement assessed by real-time 2D-SWE in children showed excellent interobserver agreement. Changes in LS values less than 31.8% of the mean LS values may represent the measurement error. The free-breathing technique showed lower LS values, compared to the breath-holding technique.
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Affiliation(s)
- Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
| | - Jeong Rye Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, South Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, South Korea
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Mancini M, Salomone Megna A, Ragucci M, De Luca M, Marino Marsilia G, Nardone G, Coccoli P, Prinster A, Mannelli L, Vergara E, Monti S, Liuzzi R, Incoronato M. Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease. PLoS One 2017; 12:e0185391. [PMID: 29023554 PMCID: PMC5638246 DOI: 10.1371/journal.pone.0185391] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/12/2017] [Indexed: 02/06/2023] Open
Abstract
The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The aim of the study was to determine reproducibility of real-time shear wave elastography using a hepatic biopsy as the reference standard to identify patients with chronic liver disease. Forty patients with chronic liver disease and 12 normal subjects received shear wave elastography performed by skilled operators. Interoperator reproducibility was studied in 29 patients. Fibrosis was evaluated using the Metavir score. The median and range shear wave elastography values in chronic liver disease subjects were 6.15 kPa and 3.14-16.7 kPa and were 4.49 kPa and 2.92-7.32 kPa in normal subjects, respectively. With respect to fibrosis detected by liver biopsy, shear wave elastography did not change significantly between F0 and F1 (p = 0.334), F1 and F2 (p = 0.611), or F3 and F4 (0.327); a significant difference was observed between the F0-F2 and F3-F4 groups (p = 0.002). SWE also correlated with inflammatory activity (Rs = 0.443, p = 0.0023) and ALT levels (Rs = 0.287, p = 0.0804). Age, sex and body mass index did not affect shear wave elastography measurements. Using receiver operator characteristic curves, two threshold values for shear wave elastography were identified: 5.62 kPa for patients with fibrosis (≥F2; sensitivity 80%, specificity 69.4%, and accuracy 77%) and 7.04 kPa for patients with severe fibrosis (≥F3; sensitivity 88.9%, specificity 81%, and accuracy 89%). Overall interobserver agreement was excellent and was analysed using an interclass correlation coefficient (0.94; CI 0.87-0.97).This study shows that shear wave elastography executed by skilled operators can be performed on almost all chronic liver disease patients with high reproducibility. It is not influenced by age, sex or body mass index, identifies severely fibrotic patients and is also related to inflammatory activity.
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Affiliation(s)
- Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | | | - Monica Ragucci
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | | | | | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, Federico II University, Naples, Italy
| | - Pietro Coccoli
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, Federico II University, Naples, Italy
| | - Anna Prinster
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, United States of America
| | - Emilia Vergara
- Istituto di Ricovero e Cura a Carattere Scientifico SDN (IRCCS SDN), Naples, Italy
- Dipartimento Assistenziale Integrato di Diagnostica morfologica e funzionale, Radioterapia, Medicina Legale, A.O.U. Federico II, Naples, Italy
| | - Serena Monti
- Istituto di Ricovero e Cura a Carattere Scientifico SDN (IRCCS SDN), Naples, Italy
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
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Fang C, Konstantatou E, Romanos O, Yusuf GT, Quinlan DJ, Sidhu PS. Reproducibility of 2-Dimensional Shear Wave Elastography Assessment of the Liver: A Direct Comparison With Point Shear Wave Elastography in Healthy Volunteers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1563-1569. [PMID: 28370146 DOI: 10.7863/ultra.16.07018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/14/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Two-dimensional shear wave elastography (2D-SWE) imaging for the noninvasive assessment of tissue stiffness was assessed for reproducibility in healthy volunteers in quantifying liver elasticity, compared with an established point shear wave elastography (p-SWE) technique also known as virtual touch quantification (VTQ) (SIEMENS). METHODS Eleven healthy volunteers were examined by four experienced operators on two occasions, separated by two weeks (sessions A and B). Ten 2D-SWE using LOGIQ E9 and p-SWE measurements using VTQ (in meters per second) were consecutively taken from deep portions of liver segments 5 or 6 away from vascular structures, using standard techniques. Inter- and intra-observer agreement was assessed by intraclass coefficient (ICC). RESULTS A total of 880 2D-SWE and p-SWE velocities were recorded. Mean values from the four operators ranged between 1.188 and 1.196 m/s for 2D-SWE and 1.170 to 1.207 m/s for p-SWE. Interobserver reproducibility was good for both sessions with ICCs of 0.88 and 0.93 (2D-SWE) and 0.87 and 0.93 (p-SWE). The overall intra-operator reproducibility between sessions A and B was good for both p-SWE and 2D-SWE with ICC of 0.87 and 0.83, respectively. For inter- and intra-observer variability, the ICC was more than or equal to 0.71, indicating that the results were reliable. There was a strong and significant correlation between the 2D-SWE and p-SWE measurements (r = 0.87, P = .0006), but their velocities did not agree equally across different velocities. CONCLUSIONS Two-dimensional SWE using LOGIQ E9 is a reliable and reproducible method for measuring elasticity in healthy volunteers and has a similar degree of reliability as p-SWE using VTQ, but absolute measurements from the two techniques should not be used interchangeably.
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Affiliation(s)
- Cheng Fang
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Eleni Konstantatou
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Odyssefs Romanos
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Gibran T Yusuf
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Daniel J Quinlan
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, United Kingdom
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Perry MT, Savjani N, Bluth EI, Dornelles A, Therapondos G. Point Shear Wave Elastography in Assessment of Hepatic Fibrosis: Diagnostic Accuracy in Subjects With Native and Transplanted Livers Referred for Percutaneous Biopsy. Ultrasound Q 2017; 32:201-7. [PMID: 26808171 DOI: 10.1097/ruq.0000000000000219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of this study was to prospectively evaluate the use of point shear wave elastography for the assessment of liver fibrosis and to determine the usefulness and optimal location for obtaining elastography measurements in native and transplanted livers. Point shear wave elastography measurements were obtained from 100 consecutive patients presenting for percutaneous liver biopsy. Measurements were acquired within both the superior right hepatic lobe (segments VII/VIII) via an intercostal approach and the inferior right hepatic lobe (segments V/VI) via a subcostal approach. Analysis of variance was used to assess statistical differences between the degree of fibrosis on percutaneous liver biopsy and elastography measurements. No statistical difference was present when comparing elastography measurements in patients with hepatic steatosis compared with patients without steatosis (P = 0.2759). There was no difference in the accuracy of elastography measurements in native livers versus transplanted livers (P = 0.221). Point shear wave elastography can accurately differentiate between patients with no-to-mild hepatic fibrosis (F0-F1) and moderate-to-severe hepatic fibrosis (≥F2) with sensitivity of 72% and specificity of 69%. Point shear wave elastography can be used as a noninvasive method to assess fibrosis in patients with native or transplanted livers. In addition, measurements can be combined or taken separately from either the superior or inferior right hepatic lobe. The presence of hepatic steatosis does not affect the accuracy of point shear wave elastography. However, shear wave elastography values in patients with body mass index greater than 40 should be interpreted with caution.
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Affiliation(s)
- Michael T Perry
- *Department of Radiology, Ochsner Clinic Foundation; and †Department of Radiology, Ochsner Clinic Foundation, The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA; ‡Department of Economics, W.P. Carey School of Business, Tempe, AZ; and §Department of Gastroenterology & Hepatology, Ochsner Clinic Foundation, New Orleans, LA
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Park SH, Kim SY, Suh CH, Lee SS, Kim KW, Lee SJ, Lee MG. What we need to know when performing and interpreting US elastography. Clin Mol Hepatol 2017; 22:406-414. [PMID: 27729637 PMCID: PMC5066374 DOI: 10.3350/cmh.2016.0106] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
According to the increasing need for accurate staging of hepatic fibrosis, the ultrasound (US) elastography techniques have evolved significantly over the past two decades. Currently, US elastography is increasingly used in clinical practice. Previously published studies have demonstrated the excellent diagnostic performance of US elastography for the detection and staging of liver fibrosis. Although US elastography may seem easy to perform and interpret, there are many technical and clinical factors which can affect the results of US elastography. Therefore, clinicians who are involved with US elastography should be aware of these factors. The purpose of this article is to present a brief overview of US techniques with the relevant technology, the clinical indications, diagnostic performance, and technical and biological factors which should be considered in order to avoid misinterpretation of US elastography results.
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Affiliation(s)
- So Hyun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, Namwon Medical Center, Namwon, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sande JA, Verjee S, Vinayak S, Amersi F, Ghesani M. Ultrasound shear wave elastography and liver fibrosis: A Prospective Multicenter Study. World J Hepatol 2017; 9:38-47. [PMID: 28105257 PMCID: PMC5220270 DOI: 10.4254/wjh.v9.i1.38] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/24/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the accuracy of shear wave elastography (SWE) alone and in combination with aminotransferase platelet ratio index (APRI) score in the staging of liver fibrosis.
METHODS A multicenter prospective study was conducted to assess the accuracy of SWE (medians) and APRI to predict biopsy results. The analysis focused on distinguishing the different stages of liver disease, namely, F0 from F1-4, F0-1 from F2-4, F0-2 from F3-4 and F0-3 from F4; F0-F1 from F2-F4 being of primary interest. The area under the receiver operating characteristic (AUROC) curve was computed using logistic regression model. The role of age, gender and steatosis was also assessed.
RESULTS SWE alone accurately distinguished F0-1 from F2-4 with a high probability. The AUROC using SWE alone was 0.91 compared to 0.78 for using the APRI score alone. The APRI score, when used in conjunction with SWE, did not make a significant contribution to the AUROC. SWE and steatosis were the only significant predictors that differentiated F0-1 from F2-4 with an AUROC of 0.944.
CONCLUSION Our study validates the use of SWE in the diagnosis and staging of liver fibrosis. Furthermore, the probability of a correct diagnosis is significantly enhanced with the addition of steatosis as a prognostic factor.
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Shear Wave Elastography of Focal Liver Lesion: Intraobserver Reproducibility and Elasticity Characterization. Ultrasound Q 2016; 31:262-71. [PMID: 26086459 DOI: 10.1097/ruq.0000000000000175] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of the study was to evaluate the intraobserver reproducibility and to determine the elasticity characteristics of focal liver lesions (FLLs) by shear wave elastography (SWE). METHODS One hundred thirty-six FLLs in 118 patients were examined with SWE for quantitative and qualitative assessment of stiffness. Three SWE images were obtained for each lesion and liver parenchyma by 1 radiologist. Intraobserver reproducibility was assessed by intraclass correlation coefficients (ICCs). Patient and lesion factors that can affect the reproducibility were evaluated. For characterization of the lesion elasticity, the difference in stiffness between the groups of lesions was evaluated. RESULTS The mean (SD) diameter and depth of the lesions were 3.98 (2.07) and 4.4 (1.59) cm, respectively. The ICC of intraobserver reproducibility was 0.763. Deep-seated lesions (≥6 cm; ICC, 0.621) showed significantly lower intraobserver reproducibility compared with superficial lesions (ICC, 0.793; P = 0.047). Stiffness values of malignant lesions (n = 85, 60.41 [47.81] kPa) were significantly higher than those of benign lesions (n = 51, 22.05 [17.24] kPa, P < 0.0001). Mean (SD) stiffness of hepatocellular carcinoma (45.72 [35.65] kPa) was significantly lower than that of metastasis (67.43 [43.39] kPa) and was significantly higher than benign FLLs (22.05 [17.24] kPa). However, mean (SD) lesion-parenchyma ratio of hepatocellular carcinoma (3.76 [4]) was not significantly different from that of benign FLLs (3.7 [3.77]). CONCLUSIONS Overall, intraobserver reproducibility of SWE in evaluation of FLLs was excellent, but it can be affected by lesion depth. In addition, SWE is helpful in elasticity characterization of FLLs.
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Zhang HC, Hu RF, Zhu T, Tong L, Zhang QQ. Primary biliary cirrhosis degree assessment by acoustic radiation force impulse imaging and hepatic fibrosis indicators. World J Gastroenterol 2016; 22:5276-5284. [PMID: 27298571 PMCID: PMC4893475 DOI: 10.3748/wjg.v22.i22.5276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/02/2016] [Accepted: 03/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the assessment of primary biliary cirrhosis degree by acoustic radiation force impulse imaging (ARFI) and hepatic fibrosis indicators.
METHODS: One hundred and twenty patients who developed liver cirrhosis secondary to primary biliary cirrhosis were selected as the observation group, with the degree of patient liver cirrhosis graded by Child-Pugh (CP) score. Sixty healthy individuals were selected as the control group. The four indicators of hepatic fibrosis were detected in all research objects, including hyaluronic acid (HA), laminin (LN), type III collagen (PC III), and type IV collagen (IV-C). The liver parenchyma hardness value (LS) was then measured by ARFI technique. LS and the four indicators of liver fibrosis (HA, LN, PC III, and IV-C) were observed in different grade CP scores. The diagnostic value of LS and the four indicators of liver fibrosis in determining liver cirrhosis degree with PBC, whether used alone or in combination, were analyzed by receiver operating characteristic (ROC) curve.
RESULTS: LS and the four indicators of liver fibrosis within the three classes (A, B, and C) of CP scores in the observation group were higher than in the control group, with C class > B class > A class; the differences were statistically significant (P < 0.01). Although AUC values of LS within the three classes of CP scores were higher than in the four indicators of liver fibrosis, sensitivity and specificity were unstable. The ROC curves of LS combined with the four indicators of liver fibrosis revealed that: AUC and sensitivity in all indicators combined in the A class of CP score were higher than in LS alone, albeit with slightly decreased specificity; AUC and specificity in all indicators combined in the B class of CP score were higher than in LS alone, with unchanged sensitivity; AUC values (0.967), sensitivity (97.4%), and specificity (90%) of all indicators combined in the C class of CP score were higher than in LS alone (0.936, 92.1%, 83.3%).
CONCLUSION: The diagnostic value of PBC cirrhosis degree in liver cirrhosis degree assessment by ARFI combined with the four indicators of serum liver fibrosis is of satisfactory effectiveness and has important clinical application value.
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Jiang T, Tian G, Zhao Q, Kong D, Cheng C, Zhong L, Li L. Diagnostic Accuracy of 2D-Shear Wave Elastography for Liver Fibrosis Severity: A Meta-Analysis. PLoS One 2016; 11:e0157219. [PMID: 27300569 PMCID: PMC4907490 DOI: 10.1371/journal.pone.0157219] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/26/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the accuracy of shear wave elastography (SWE) in the quantitative diagnosis of liver fibrosis severity. Methods The published literatures were systematically retrieved from PubMed, Embase, Web of science and Scopus up to May 13th, 2016. Included studies reported the pooled sensitivity, specificity, positive and negative predictive values, as well as the diagnostic odds ratio of SWE in populations with liver fibrosis. A bivariate mixed-effects regression model was used, which was estimated by the I2 statistics. The quality of articles was evaluated by quality assessment of diagnostic accuracy studies (QUADAS). Results Thirteen articles including 2303 patients were qualified for the study. The pooled sensitivity and specificity of SWE for the diagnosis of liver fibrosis are as follows: ≥F1 0.76 (p<0.001, 95% CI, 0.71–0.81, I2 = 75.33%), 0.92 (p<0.001, 95% CI, 0.80–0.97, I2 = 79.36%); ≥F2 0.84 (p = 0.35, 95% CI, 0.81–0.86, I2 = 9.55%), 0.83 (p<0.001, 95% CI, 0.77–0.88, I2 = 86.56%); ≥F3 0.89 (p = 0.56, 95% CI, 0.86–0.92, I2 = 0%), 0.86 (p<0.001, 95% CI, 0.82–0.90, I2 = 75.73%); F4 0.89 (p = 0.24, 95% CI, 0.84–0.92, I2 = 20.56%), 0.88 (p<0.001, 95% CI, 0.84–0.92, I2 = 82.75%), respectively. Sensitivity analysis showed no significant changes if any one of the studies was excluded. Publication bias was not detected in this meta-analysis. Conclusions Our study suggests that SWE is a helpful method to appraise liver fibrosis severity. Future studies that validate these findings would be appropriate.
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Affiliation(s)
- Tian’an Jiang
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qiyu Zhao
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Dexing Kong
- Department of Mathematics, Zhejiang University, Hangzhou 310027, China
| | - Chao Cheng
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Liyun Zhong
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- * E-mail:
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50
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Gersak MM, Badea R, Lenghel LM, Vasilescu D, Botar-Jid C, Dudea SM. Influence of Food Intake on 2-D Shear Wave Elastography Assessment of Liver Stiffness in Healthy Subjects. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1295-1302. [PMID: 26947447 DOI: 10.1016/j.ultrasmedbio.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 06/05/2023]
Abstract
Transient elastography and Acoustic Radiation Force Impulse imaging are useful non-invasive methods for liver stiffness estimation, although both are influenced by food intake. The aim of the work described here was to identify liver stiffness variation after a standardized meal using 2-D shear wave elastography. Liver stiffness was estimated in 31 apparently healthy subjects, under fasting conditions and after a standardized meal (20, 40, 60, 80, 100 and 120 min after food intake). In most of the cases, liver stiffness values increased between 20 and 40 min after the meal (p < 0.05) and then significantly decreased between 60 and 80 min (p < 0.05). At 120 min after food intake, liver stiffness values were significantly lower compared with liver stiffness values under fasting conditions (p < 0.05). Gender, but not body mass index, had an important role in liver stiffness variation after food intake (p < 0.01). In conclusion, to avoid the influence of food intake on liver stiffness estimation, 2-D shear wave elastography should be performed only under fasting conditions.
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Affiliation(s)
- Mariana M Gersak
- Department of Radiology, Emergency University County Hospital Cluj, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Imaging and Radiology, Ultrasound Imaging Laboratory, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lavinia M Lenghel
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Dan Vasilescu
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carolina Botar-Jid
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorin M Dudea
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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