1
|
Kutaiba N, Chung W, Goodwin M, Testro A, Egan G, Lim R. The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review. Insights Imaging 2024; 15:146. [PMID: 38886297 DOI: 10.1186/s13244-024-01727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 05/26/2024] [Indexed: 06/20/2024] Open
Abstract
Chronic liver disease is responsible for significant morbidity and mortality worldwide. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) can fully visualise the liver and adjacent structures in the upper abdomen providing a reproducible assessment of the liver and biliary system and can detect features of portal hypertension. Subjective interpretation of CT and MRI in the assessment of liver parenchyma for early and advanced stages of fibrosis (pre-cirrhosis), as well as severity of portal hypertension, is limited. Quantitative and reproducible measurements of hepatic and splenic volumes have been shown to correlate with fibrosis staging, clinical outcomes, and mortality. In this review, we will explore the role of volumetric measurements in relation to diagnosis, assessment of severity and prediction of outcomes in chronic liver disease patients. We conclude that volumetric analysis of the liver and spleen can provide important information in such patients, has the potential to stratify patients' stage of hepatic fibrosis and disease severity, and can provide critical prognostic information. CRITICAL RELEVANCE STATEMENT: This review highlights the role of volumetric measurements of the liver and spleen using CT and MRI in relation to diagnosis, assessment of severity, and prediction of outcomes in chronic liver disease patients. KEY POINTS: Volumetry of the liver and spleen using CT and MRI correlates with hepatic fibrosis stages and cirrhosis. Volumetric measurements correlate with chronic liver disease outcomes. Fully automated methods for volumetry are required for implementation into routine clinical practice.
Collapse
Affiliation(s)
- Numan Kutaiba
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
- The University of Melbourne, Parkville, Melbourne, VIC, Australia.
| | - William Chung
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
- Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Mark Goodwin
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Adam Testro
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
- Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Clayton, VIC, 3800, Australia
| | - Ruth Lim
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
| |
Collapse
|
2
|
Moura Cunha G, Fan B, Navin PJ, Olivié D, Venkatesh SK, Ehman RL, Sirlin CB, Tang A. Interpretation, Reporting, and Clinical Applications of Liver MR Elastography. Radiology 2024; 310:e231220. [PMID: 38470236 PMCID: PMC10982829 DOI: 10.1148/radiol.231220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024]
Abstract
Chronic liver disease is highly prevalent and often leads to fibrosis or cirrhosis and complications such as liver failure and hepatocellular carcinoma. The diagnosis and staging of liver fibrosis is crucial to determine management and mitigate complications. Liver biopsy for histologic assessment has limitations such as sampling bias and high interreader variability that reduce precision, which is particularly challenging in longitudinal monitoring. MR elastography (MRE) is considered the most accurate noninvasive technique for diagnosing and staging liver fibrosis. In MRE, low-frequency vibrations are applied to the abdomen, and the propagation of shear waves through the liver is analyzed to measure liver stiffness, a biomarker for the detection and staging of liver fibrosis. As MRE has become more widely used in clinical care and research, different contexts of use have emerged. This review focuses on the latest developments in the use of MRE for the assessment of liver fibrosis; provides guidance for image acquisition and interpretation; summarizes diagnostic performance, along with thresholds for diagnosis and staging of liver fibrosis; discusses current and emerging clinical applications; and describes the latest technical developments.
Collapse
Affiliation(s)
- Guilherme Moura Cunha
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Boyan Fan
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Patrick J. Navin
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Damien Olivié
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Sudhakar K. Venkatesh
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Richard L. Ehman
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - An Tang
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| |
Collapse
|
3
|
Obrzut M, Atamaniuk V, Ehman RL, Yin M, Cholewa M, Gutkowski K, Domka W, Ozga D, Obrzut B. Evaluation of Spleen Stiffness in Young Healthy Volunteers Using Magnetic Resonance Elastography. Diagnostics (Basel) 2023; 13:2738. [PMID: 37685274 PMCID: PMC10486410 DOI: 10.3390/diagnostics13172738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Magnetic resonance elastography (MRE) has been established as the most accurate noninvasive technique for diagnosing liver fibrosis. Recent publications have suggested that the measurement of splenic stiffness is useful in setting where portal hypertension may be present. The goal of the current study was to compile normative data for MRE-assessed stiffness measurements of the spleen in young adults. MATERIALS AND METHODS A total of 100 healthy young Caucasian volunteers (65 females and 35 males) in the age range of 20 to 32 years were enrolled in this study. The participants reported no history of chronic spleen and liver disease, normal alcohol consumption, and a normal diet. The MRE data were acquired by using a 1.5 T whole-body scanner and a 2D GRE pulse sequence with 60 Hz excitation. Spleen stiffness was calculated as a weighted mean of stiffness values in the regions of interest manually drawn by the radiologist on three to five spleen slices. RESULTS Mean spleen stiffness was 5.09 ± 0.65 kPa for the whole group. Male volunteers had slightly higher splenic stiffness compared to females: 5.28 ± 0.78 vs. 4.98 ± 0.51 kPa, however, this difference was not statistically significant (p = 0.12). Spleen stiffness did not correlate with spleen fat content and liver stiffness but a statistically significant correlation with spleen volume was found. CONCLUSIONS The findings of this study provide normative values for 2D MRE-based measurement of spleen stiffness in young adults, a basis for assessing the value of this biomarker in young patients with portal system pathologies.
Collapse
Affiliation(s)
- Marzanna Obrzut
- Institute of Health Sciences, Medical College, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland; (M.O.)
| | - Vitaliy Atamaniuk
- Department of Biophysics, Institute of Physics, College of Natural Sciences, University of Rzeszow, Prof. Stanisława Pigonia Str. 1, 35-310 Rzeszow, Poland; (V.A.); (M.C.)
| | - Richard L. Ehman
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Marian Cholewa
- Department of Biophysics, Institute of Physics, College of Natural Sciences, University of Rzeszow, Prof. Stanisława Pigonia Str. 1, 35-310 Rzeszow, Poland; (V.A.); (M.C.)
| | - Krzysztof Gutkowski
- Institute of Medical Sciences, Medical College, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland;
| | - Wojciech Domka
- Department of Otolaryngology, Institute of Medical Sciences, Medical College, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland;
| | - Dorota Ozga
- Institute of Health Sciences, Medical College, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland; (M.O.)
| | - Bogdan Obrzut
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
| |
Collapse
|
4
|
Demirtaş D, Ünal E, İdilman İS, Akçören Z, Göktaş MA, Boyraz MS, Karahan S, Orhan D, Haliloğlu M, Karçaaltıncaba M, Özen H. Magnetic resonance elastography in evaluation of liver fibrosis in children with chronic liver disease. Insights Imaging 2023; 14:39. [PMID: 36854936 PMCID: PMC9975132 DOI: 10.1186/s13244-023-01390-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Magnetic resonance elastography (MRE) has been used to stage liver fibrosis in adults. We aimed to assess the agreement between the Ishak scoring system and magnetic resonance elastography-measured liver stiffness (MRE-LS) in children. This study included all the children who underwent abdominal MRE and liver biopsies between February 2018 and January 2021. The correlation between MRE-LS and Ishak fibrosis stage, MRE parameters, and clinical and biochemical markers affecting this relationship was investigated. RESULTS A total of 52 patients (31 male; a median age of 11.8 years) were included in the study. The MRE-LS values were significantly different between Ishak fibrosis stages (p = 0.036). With a cut-off value of 2.97 kilopascals, MRE-LS had sensitivity, specificity, PPV, NPV and accuracy values of 90.9%, 82.9%, 58.8%, 97.1%, and 84.6%, respectively, for differentiating mild/moderate fibrosis (F0, 1, 2, 3) from severe fibrosis (F ≥ 4). Although MRE-LS was moderately correlated with Ishak fibrosis score and histological activity index and weakly correlated with aspartate aminotransferase, hepatic steatosis, and R2*, only Ishak fibrosis score was a significant predictor of MRE-LS. MRE-measured spleen stiffness was weakly correlated with the Ishak fibrosis score. CONCLUSIONS MRE has high sensitivity and specificity for evaluating liver fibrosis in children. MRE may be used to evaluate liver fibrosis in pediatric patients.
Collapse
Affiliation(s)
- Duygu Demirtaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Emre Ünal
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlkay S. İdilman
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Zuhal Akçören
- grid.14442.370000 0001 2342 7339Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Akif Göktaş
- grid.14442.370000 0001 2342 7339Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meryem Seda Boyraz
- grid.14442.370000 0001 2342 7339Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sevilay Karahan
- grid.14442.370000 0001 2342 7339Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- grid.14442.370000 0001 2342 7339Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mithat Haliloğlu
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muşturay Karçaaltıncaba
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Özen
- grid.14442.370000 0001 2342 7339Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
5
|
Fraquelli M, Vranić L, Nadarevic T, Štimac D, Manzotti C, Fichera A, Casazza G, Colli A. Liver and spleen stiffness for the diagnosis of oesophageal varices in adults with chronic liver disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD015547. [PMCID: PMC9890918 DOI: 10.1002/14651858.cd015547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by vibration‐controlled transient elastography (VCTE) in detection of any oesophageal varices in adults with chronic liver disease. We will regard a combination of tests as positive when at least one is positive. To compare the diagnostic accuracy of individual tests (liver stiffness and spleen stiffness measured by VCTE) directly and versus the combination of both tests (considering positive when at least one is positive) in detecting any oesophageal varices. To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by other elastography techniques (2D‐shear wave elastography (2D‐SWE), point shear wave elastography (pSWE), magnetic resonance elastography (MRE)) in detection of any oesophageal varices in adults with chronic liver disease. We will regard a combination of tests as positive when at least one is positive. To compare the diagnostic accuracy of liver stiffness and spleen stiffness measured by VCTE with other techniques (pSWE, 2D‐SWE, MRE) in detection of any oesophageal varices in adults with chronic liver disease.
Collapse
Affiliation(s)
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, MilanoMilanItaly
| | - Luka Vranić
- Department of GastroenterologyClinical Hospital Centre RijekaRijekaCroatia
| | - Tin Nadarevic
- Department of RadiologyClinical Hospital Centre RijekaRijekaCroatia
| | - Davor Štimac
- Department of GastroenterologyClinical Hospital Centre RijekaRijekaCroatia
| | - Cristina Manzotti
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Anna Fichera
- UOC di Gastroenterologia ed EpatologiaPoliclinico Paolo GiacconePalermoItaly
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health – Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro"Università degli Studi di MilanoMilanItaly
| | - Agostino Colli
- Department of Transfusion Medicine and HaematologyFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| |
Collapse
|
6
|
Yiyi M, Xiaoqin Q, Lei Z. Spleen Stiffness on Magnetic Resonance Elastography for the Detection of Portal Hypertension: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1925-1935. [PMID: 36743372 PMCID: PMC9884383 DOI: 10.18502/ijph.v51i9.10548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022]
Abstract
Background Chronic liver disease, complicated by portal hypertension (PH), may alter the extra-hepatic hemodynamic condition and spleen stiffness (SS). We aimed to evaluate the diagnostic accuracy of MRI-based elastographic methods (MRE) for detecting PH. Methods Seven studies were included with reference to SS with regard to the prediction of PH patients. Major outcomes considered for data extraction were diagnostic parameters for MRI for concluding mild PH, clinically significant PH and severe PH. PubMed, Scopus, Google Scholar, Cochrane and Science Direct databases were used to extract the published literature through to May, 2021Using the Rayyan Zotero and R softwares. Results Out of 587 studies extracted, 7 were selected based on inclusion and exclusion criteria. A QUADAS-2 assessment showed that all studies were clear in terms of patient selection and reference standard. A funnel plot showed that all the selected studies were outliers, indicating a low level of accuracy for the studies included. Subgroup analysis, with reference to SS as a predictor of PH, revealed raw mean difference (RMD) of 7.78% (95% CI 5.23-10.34, P<0.01). The corresponding RMD observed for <60 years and >60 yr were 34.26% (95% CI 9.33- 59.20, I2=100%, τ2=646.7688, P=0), and 46.92% (95% CI 20-59.33, I2=97%, τ2=1003.023, P=0) respectively. The specificity and sensitivity noted for MRI in determining SS were 0.721 and 0.747, respectively with an area-under the curve of 0.788. The estimated random effect models for specificity and sensitivity were 0.938 and 0.842, respectively. Conclusion The real-time MRE has acceptable specificity and sensitivity for diagnosing SS.
Collapse
Affiliation(s)
- Ma Yiyi
- Department of Ultrasound, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214000, China
| | - Qian Xiaoqin
- Department of Ultrasound, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214000, China
| | - Zhang Lei
- Department of Ultrasound, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214000, China,Corresponding Author:
| |
Collapse
|
7
|
Vranić L, Nadarevic T, Štimac D, Fraquelli M, Manzotti C, Casazza G, Colli A. Liver and spleen stiffness as assessed by vibration controlled transient elastography for diagnosing clinically significant portal hypertension in comparison with other elastography-based techniques in adults with chronic liver disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd015415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luka Vranić
- Department of Gastroenterology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Tin Nadarevic
- Department of Radiology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Davor Štimac
- Department of Gastroenterology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit; Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milano; Milan Italy
| | - Cristina Manzotti
- Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Milan Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health - Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro"; Università degli Studi di Milano; Milan Italy
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| |
Collapse
|
8
|
Chen SH, Lai HC, Su WP, Kao JT, Chuang PH, Hsu WF, Wang HW, Tsai TY, Chen HY, Peng CY. Liver and Spleen Stiffness Surveillance Through Elastography During and After Direct-Acting Antiviral Therapy in Patients With Chronic Hepatitis C. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1169-1177. [PMID: 34415630 DOI: 10.1002/jum.15806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Direct-acting antiviral agents achieve a high cure rate, resulting in early hepatic necroinflammatory resolution and sustained fibrosis regression. This study aimed to obtain longitudinal, concurrent within-subject measurements of liver stiffness (LS) and spleen stiffness (SS) and their correlates over time. METHODS Participants with hepatitis C (n = 592) receiving direct-acting antiviral-based therapy were monitored through point shear-wave elastography from the treatment baseline (TW0) across follow-up visits in terms of LS and SS. RESULTS Generalized linear mixed modeling indicated that all LS values (2301 visits) were negatively correlated with the follow-up times (all P < .05) from TW0 to 24 weeks (PW24) after the end of treatment (EOT) and positively correlated with baseline LS values (P < .001). The slopes of declines (preceding minus next) differed significantly (P < .001) between TW0-TW4 (treatment week 4) (0.060 [-0.050 to 0.225] meter/second/month [m/s/mo]) and TW4-EOT (0.010 [-0.030 to 0.075] m/s/mo). All SS values (1704 visits) were negatively correlated with time only at PW24 (P < .001) and positively correlated with baseline SS values (P < .001). The slopes of the SS values differed significantly (P < .001) only between EOT-PW12 (-0.010 [-0.110 to 0.083] m/s/mo) and PW12-PW24 (0.043 [-0.063 to 0.160] m/s/mo). CONCLUSIONS The biphasic fast-to-slow decline in LS occurred early in the on-treatment phase, which is consistent with the resolution of hepatic necroinflammation. The slow-to-fast decline in SS occurred off treatment. Future studies should investigate the association with regressions in liver fibrosis and portal hypertension.
Collapse
Affiliation(s)
- Sheng-Hung Chen
- Department of Medicine, China Medical University, Taichung, Taiwan
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Hsueh-Chou Lai
- Department of Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Pang Su
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Jung-Ta Kao
- Department of Medicine, China Medical University, Taichung, Taiwan
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Po-Heng Chuang
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Fan Hsu
- Department of Medicine, China Medical University, Taichung, Taiwan
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Wei Wang
- Department of Medicine, China Medical University, Taichung, Taiwan
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Tsung-Yu Tsai
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Yao Chen
- Department of Medicine, China Medical University, Taichung, Taiwan
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Yuan Peng
- Department of Medicine, China Medical University, Taichung, Taiwan
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
9
|
Catucci D, Obmann VC, Berzigotti A, Gräni C, Guensch DP, Fischer K, Ebner L, Heverhagen JT, Christe A, Huber AT. Noninvasive assessment of clinically significant portal hypertension using ΔT1 of the liver and spleen and ECV of the spleen on routine Gd-EOB-DTPA liver MRI. Eur J Radiol 2021; 144:109958. [PMID: 34571458 DOI: 10.1016/j.ejrad.2021.109958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/23/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyze the predictive value of ΔT1 of the liver and spleen as well as the extracellular volume fraction (ECV) of the spleen as noninvasive biomarkers for the determination of clinically significant portal hypertension (CSPH) on routine Gd-EOB-DTPA liver MRI. METHOD 195 consecutive patients with known or suspected chronic liver disease from 9/2018 to 7/2019 with Gd-EOB-DTPA liver MRI and abdominal T1 mapping were retrospectively included. Based on the presence of splenomegaly with thrombocytopenia, ascites and portosystemic collaterals, the patients were divided into noCSPH (n = 113), compensated CSPH (cCSPH, ≥1 finding without ascites; n = 55) and decompensated CSPH (dCSPH, ascites ± other findings; n = 27). T1 times were measured in the liver, spleen and abdominal aorta in the unenhanced and contrast-enhanced T1 maps. Native T1 times and ΔT1 of the liver and spleen as well as ECV of the spleen were compared between groups using the Kruskal-Wallis test with Dunn's post hoc test. Furthermore, cutoff values for group differentiation were calculated using ROC analysis with Youden's index. RESULTS ΔT1 of the liver was significantly lower in patients with cCSPH and dCSPH (p < 0.001) compared to patients with noCSPH. In the ROC analyses for differentiation between noCSPH and CSPH (cCSPH + dCSPH), a cutoff of < 0.67 for ΔT1 of the liver (AUC = 0.79) performed better than ΔT1 (AUC = 0.69) and ECV (AUC = 0.63) of the spleen with cutoffs of > 0.29 and > 41.9, respectively. CONCLUSION ΔT1 of the liver and spleen in addition to ECV of the spleen allow for determination of CSPH on routine Gd-EOB-DTPA liver MRI.
Collapse
Affiliation(s)
- Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Dominik Paul Guensch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Johannes Thomas Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| |
Collapse
|
10
|
Diagnostic value of spleen stiffness by magnetic resonance elastography for prediction of esophageal varices in cirrhotic patients. Abdom Radiol (NY) 2021; 46:526-533. [PMID: 32676734 DOI: 10.1007/s00261-020-02628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the diagnostic value of spleen stiffness (SS) via magnetic resonance elastography (MRE) in predicting esophageal varices. METHODS From January 2016 to September 2018, we retrospectively reviewed 263 patients with esophagogastroduodenoscopy (EGD) records and available spleen and liver stiffness (LS) values from MRE. Clinical information including the underlying diseases, endoscopic grade of esophageal varices (EV) and laboratory data were collected from electronic medical records. RESULTS In cirrhotic patients, MRE-SS was higher in those with EV than in those without. MRE-SS also showed significant association with EV in the multivariate analysis, whereas MRE-LS did not. The diagnostic performance of MRE-SS for EV in cirrhotic patients was demonstrated by the area under curve of 0.853 (cut-off value: 9.53 kPa, P < 0.001), 84.4% sensitivity and 73.7% specificity. CONCLUSION For prediction of EV in cirrhotic patients, MRE-SS is a useful non-invasive tool and it demonstrates better diagnostic performance than MRE-LS does.
Collapse
|
11
|
Obmann VC, Berzigotti A, Catucci D, Ebner L, Gräni C, Heverhagen JT, Christe A, Huber AT. T1 mapping of the liver and the spleen in patients with liver fibrosis-does normalization to the blood pool increase the predictive value? Eur Radiol 2020; 31:4308-4318. [PMID: 33313965 PMCID: PMC8128789 DOI: 10.1007/s00330-020-07447-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Purpose To analyze whether the T1 relaxation time of the liver is a good predictor of significant liver fibrosis and whether normalization to the blood pool improves the predictive value. Methods This prospective study was conducted between 03/2016 and 02/2018. One hundred seventy-three patients underwent multiparametric liver MRI at 3 T. The T1 relaxation time was measured in the liver and the spleen, in the aorta, the portal vein, and the inferior vena cava (IVC). T1 relaxation times with and without normalization to the blood pool were compared between patients with (n = 26) and without (n = 141) significant liver fibrosis, based on a cutoff value of 3.5 kPa in MRE as the noninvasive reference standard. For statistics, Student’s t test, receiver operating characteristic (ROC) curve analysis, and Pearson’s correlation were used. Results The T1 relaxation time of the liver was significantly longer in patients with liver fibrosis, both with and without blood pool normalization (p < 0.001). T1 relaxation time of the liver allowed prediction of significant liver fibrosis (AUC = 0.88), while normalization to the IVC resulted in a slightly lower performance (AUC = 0.82). The lowest performance was achieved when the T1 relaxation times of the liver were normalized to the aorta (AUC = 0.66) and to the portal vein (AUC = 0.62). The T1 relaxation time of the spleen detected significant liver fibrosis with an AUC of 0.68, and 0.51–0.64 with normalization to the blood pool. Conclusion The T1 relaxation time of the liver is a good predictor of significant liver fibrosis. However, normalization of the blood pool did not improve the predictive value. Key Points • The T1 relaxation time of the liver is a good predictor of significant liver fibrosis. • Normalization to the blood pool did not improve the predictive value of T1 mapping. • If the blood pool normalization was weighted 30% to the aorta and 70% to the portal vein, the performance was better than normalization to the aorta alone but still lower than normalization to the IVC.
Collapse
Affiliation(s)
- Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Thomas Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| |
Collapse
|
12
|
Zheng Y, Xia S, Ren X, Zhan W, Zheng Z, Chen Z. A study of spleen shear-wave elastography in indirect prediction of liver fibrosis in patients with chronic hepatitis B. Clin Hemorheol Microcirc 2020; 76:63-72. [PMID: 32538828 DOI: 10.3233/ch-200869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the value of spleen shear-wave elastography (sound touch elastography [STE], sound touch quantification [STQ]) in indirect prediction of liver fibrosis in patients with chronic hepatitis B (CHB). METHODS The Young's modulus (kPa) of spleen STE, STQ and liver FibroScan were measured in 112 patients with CHB. The final diagnosis was according to histological results from liver biopsy based on Scheure G/S scoring system and liver FibroScan was considered as a reference index of prediction efficiency. Grouped by the stage of liver fibrosis, data were analyzed by Spearman correlation analysis, Mann-Whitney test and receiver operating characteristic curve (ROC). RESULTS Spleen STE was positively correlated with the degree of liver fibrosis, but spleen STQ was not. STEmean and STEmax of spleen were statistically different between the groups categorized by S = 2, S = 3 and S = 4 (all p < 0.05), respectively. Spleen STEmean had the best predicting performance on staging liver fibrosis. The areas under the ROC (AUC) for spleen STEmean were 0.66 (95% confidence interval [CI], 0.56-0.76) for stage S = 2 or higher, 0.72 (95% CI, 0.60-0.83) for S = 3 or higher, 0.83 (95% CI, 0.74-0.92) for S = 4 (all P < 0.01). The differences between the AUC for spleen STEmean and liver FibroScan in liver fibrosis staging were not statistically significant when the groups categorized by S = 2 and S = 4 (P = 0.146 and P = 0.052). But when categorized by S = 3, the evaluating performance of liver FibroScan was better (P = 0.004). CONCLUSION STEmean of spleen is applicable in indirect predicting fibrosis stage in patients with CHB.
Collapse
Affiliation(s)
- Yi Zheng
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Shujun Xia
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xinping Ren
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.,Department of Ultrasound, Wuxi Branch of Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Wuxi, Jiangsu, China
| | - Weiwei Zhan
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Zhan Zheng
- School of Systems Engineering, National University of Defense Technology, Changsha, Hunan, China
| | - Zhijie Chen
- Shenzhen Mindary Biomedical Electronics Co., Ltd. Shenzhen, Guang Dong, China
| |
Collapse
|
13
|
Wang XP, Wang Y, Ma H, Wang H, Yang DW, Zhao XY, Jin EH, Yang ZH. Assessment of liver fibrosis with liver and spleen magnetic resonance elastography, serum markers in chronic liver disease. Quant Imaging Med Surg 2020; 10:1208-1222. [PMID: 32550131 DOI: 10.21037/qims-19-849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The accurate assessment of liver fibrosis is essential for patients with chronic liver disease. A liver biopsy is an invasive procedure that has many potential defects and complications. Therefore, noninvasive assessment techniques are of considerable value for clinical diagnosis. Liver and spleen magnetic resonance elastography (MRE) and serum markers have been proposed for quantitative and noninvasive assessment of liver fibrosis. This study aims to compare the diagnostic performance of liver and spleen stiffness measured by MRE, fibrosis index based on the 4 factors (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and their combined models for staging hepatic fibrosis. Methods One hundred and twenty patients with chronic liver disease underwent MRE scans. Liver and spleen stiffness were measured by the MRE stiffness maps. Serum markers were collected to calculate FIB-4 and APRI. Liver biopsies were used to identify pathologic grading. Spearman's rank correlation analysis evaluated the correlation between the parameters and fibrosis stages. Receiver operating characteristic (ROC) analysis evaluated the performance of the four individual parameters, a liver and spleen stiffness combined model, and an all-parameters combined model in assessing liver fibrosis. Results Liver stiffness, spleen stiffness, FIB-4, and APRI were all correlated with fibrosis stage (r=0.87, 0.64, 0.65, and 0.51, respectively, all P<0.001). Among the 4 individual diagnostic markers, liver stiffness showed the highest values in staging F1-4, F2-4, F3-4 and F4 (AUC =0.89, 0. 97, 0.95, and 0.95, all P<0.001). The AUCs of the liver and spleen stiffness combined model in the F1-4, F2-4, F3-4, and F4 staging groups were 0.89, 0.97, 0.95, and 0.96, respectively (all P<0.001). The corresponding AUCs of the all-parameters combined model were 0.90, 0.97, 0.95, and 0.96 (all P<0.001). The AUCs of the liver and spleen stiffness combined model were significantly higher than those of APRI, FIB-4 in the F2-4, F3-4, and F4 staging groups (all P<0.05). Both combined models were not significantly different from liver stiffness in staging liver fibrosis (all P>0.05). Conclusions Liver stiffness measured with MRE had better diagnostic performance than spleen stiffness, APRI, and FIB-4 for fibrosis staging. The combined models did not significantly improve the diagnostic value compared with liver stiffness in staging fibrosis.
Collapse
Affiliation(s)
- Xiao-Pei Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yu Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hong Ma
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Han Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Da-Wei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xin-Yan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Er-Hu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zheng-Han Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| |
Collapse
|