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Role of spleen elastography in patients with chronic liver diseases

World Journal of Gastroenterology 2016年第35期22卷 7857-7867页

作者： Mariangela Giunta Dario Conte mirella fraquelli Gastro-enterology and Endoscopy Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico 20122 Milan Italy Department of Pathophysiology and Organ Transplantation Università degli Studi di Milano

The development of liver cirrhosis and portal hypertension(PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases(CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations.

关键词： Cirrhosis spleen stiffness elastography Portal hypertension Transient elastography

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Ultrasound elastographic techniques in focal liver lesions

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World Journal of Gastroenterology 2016年第9期22卷 2647-2656页

作者： Clara Benedetta Conti Federica Cavalcoli mirella fraquelli Dario Conte Sara Massironi Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Department of Pathophysiology and Organ Transplantation Università degli Studi di Milano

Elastographic techniques are new ultrasound-based imaging techniques developed to estimate tissue deformability/stiffness. Several ultrasound elastographic approaches have been developed, such as static elastography, transient elastography and acoustic radiation force imaging methods, which include point shear wave and shear wave imaging elastography. The application of these methods in clinical practice aims at estimating the mechanical tissues properties. One of the main settings for the application of these tools has been liver stiffness assessment in chronic liver disease, which has been studied mainly using transient elastography. Another field of application for these techniques is the assessment of focal lesions, detected by ultrasound in organs such as pancreas, prostate, breast, thyroid, lymph nodes. Considering the frequency and importance of the detection of focal liver lesions through routine ultrasound, some studies have also aimed to assess the role that elestography can play in studying the stiffness of different types of liver lesions, in order to predict their nature and thus offer valuable non-invasive methods for the diagnosis of liver masses.

关键词： Focal liver lesions Acoustic radiation force imaging Transient elastography Elastographic techniques Shear wave imaging

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Non-invasive evaluation of intestinal disorders: The role of elastographic techniques

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World Journal of Gastroenterology 2017年第16期23卷 2832-2840页

作者： Federica Branchi Flavio Caprioli Stefania Orlando Dario Conte mirella fraquelli Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico20122 MilanItaly Department of Pathophysiology and Transplantation Universitàdegli Studi di Milano20122 MilanItaly

Over the recent years the non-invasive techniques for the evaluation of the small bowel have been playing a major role in the management of chronic intestinal diseases, such as inflammatory bowel diseases(IBD). The diagnostic performances of magnetic resonance imaging, computed tomography and ultrasound in the field of small bowel disorders, have been assessed and established for more than two decades. Newer sonographic techniques, such as strain elastography and shear wave elastography, have been put forward for the assessment of disease activity and characterization of IBD-related damage in the setting of Crohn's disease and other gastrointestinal disorders. The data from the preliminary research and clinical studies have shown promising results as regards the ability of elastographic techniques to differentiate inflammatory from fibrotic tissue. The distinction between IBD activity(inflammation) and IBD-related damage(fibrosis) is currently considered crucial for the assessment and management of patients. Moreover, all the elastographic techniques are currently being considered in the setting of other intestinal disorders(e.g., rectal tumors, appendicitis). The aim of this paper is to offer both a comprehensive narrative review of the non-invasive techniques available for the assessment of small-bowel disorders, with particular emphasis on inflammatory bowel diseases, and a summary of the current evidence on the use of elastographic techniques in this setting.

关键词： elastography Fibrosis Inflammatory bowel disease Bowel wall Stricture

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Non-invasive assessment of liver fibrosis in chronic hepatitis B

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World Journal of Gastroenterology 2014年第40期20卷 14568-14580页

作者： Federica Branchi Clara Benedetta Conti Alessandra Baccarin Pietro Lampertico Dario Conte mirella fraquelli Second Division of Gastroenterology IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico Università degli Studi di Milano 20122 Milan Italy First Division of Gastroenterology IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico Università degli Studi di Milano 20122 Milan Italy

The goal of this review is to provide a comprehensive picture of the role,clinical applications and future perspectives of the most widely used non-invasive techniques for the evaluation of hepatitis B virus(HBV)*** the past decade many non-invasive methods have been developed to reduce the need for liver biopsy in staging fibrosis and to overcome whenever possible its limitations,mainly:invasiveness,costs,low reproducibility,poor acceptance by *** techniques conceived to assess liver stiffness,in particular transient elastography,and the most commonly used biological markers will be assessed against their respective role and limitations in staging hepatic *** evidence highlights that both liver stiffness and some bio-chemical markers correlatewith survival and major clinical end-points such as liver decompensation,development of hepatocellular carcinoma and portal *** the non-invasive techniques here discussed can play a major role in the management of patients with chronic HBV-related *** their prognostic value,transient elastography and some bio-chemical markers can be used to better categorize patients with advanced fibrosis and cirrhosis and assign them to different classes of risk for clinically relevant *** recent data indicates that the combined measurements of liver and spleen stiffness enable the reliable prediction of portal hypertension and esophageal varices development.

关键词： Liver fibrosis Cirrhosis Hepatitis B virus Transient elastography Non invasive markers

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Accuracy of a predictive model for severe hepatic fibrosis or cirrhosis in chronic hepatitis C

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World Journal of Gastroenterology 2005年第46期11卷 7318-7322页

作者： Agostino Colli Alice Colucci Silvia Paggi mirella fraquelli Sara Massironi Marco Andreoletti Vittorio Michela Dario Conte Department of Internal MedicineOspedale "A.Manzoni" 23900 LeccoItaly Postgraduate School of GastroenterologyIRCCS Ospedale Maggiore 20122 MilanItaly

AIM: To assess the accuracy of a model in diagnosing severe fibrosis/cirrhosis in chronic hepatitis C virus (HCV)***: The model, based on the sequential combination of the Bonacini score (BS: ALT/AST ratio,platelet count and INR) and ultrasonography liver surface characteristics, was applied to 176 patients with chronic HCV infection. Assuming a pre-test probability of 35%,the model defined four levels of post-test probability of severe fibrosis/cirrhosis: 90% (almost absolute).The predicted probabilities were compared with the observed patients' distribution according to the histology (METAVIR).RESULTS: Severe fibrosis/cirrhosis was found in 67 patients (38%). The model discriminated patients in three comparable groups: 34% with a very high (>90%)or low (75%) or low (<10%) probability of cirrhosis, leaving only 33% of the patients still requiring liver biopsy.

关键词： Liver fibrosis Ultrasonography Bonacini score Liver biopsy Hepatitis C

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