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Comparison of the liver stiffness measurement by transient elastography with the liver biopsy

World Journal of Gastroenterology 2008年第42期14卷 6513-6517页

作者： Ioan Sporea Roxana ■irli Alexandra Deleanu Adriana Tudora Manuela Curescu Marioara Cornianu Daniela Lazǎr Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Timi■oara 300472 Romania Department of Infectious Diseases University of Medicine and Pharmacy Timi■oara 300472 Romania Department of Pathology University of Medicine and Pharmacy Timi■oara 300472 Romania

AIM: To compare the liver stiffness (LS) measurement by transient elastography (TE) to the liver biopsy (LB)-considered the "gold standard" in the evaluation of patients with chronic hepatitis C. METHODS: During a period of 12 mo, we evaluated 199 consecutive patients with chronic hepatitis due to hepatitis C virus (HCV), in which LB and LS assessments (by means of TE) were performed during the same session. RESULTS: Out of 199 patients, a valid measurement of the LS could not be obtained in 8. The mean value of LS in the cohort of 191 valid measurements was 8.45 ± 4.96 kPa, ranging from 2.3 to 38 kPa. The mean value of LS in patients with signifi cant fi brosis at biopsy (161 patients with F ≥ 2 according to Metavir) was 9.02 ± 5.15 kPa, significantly higher than in patients with no or mild fi brosis (30 patients with F < 2 Metavir): 5.39 ± 1.81 kPa (P < 0.0001). For a cut- off value of 6.8 kPa, the LS had a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6% and a specificity of 93.3% for the presence of signifi cant fi brosis (at least F2 Metavir), with a diagnostic performance of 77.3% (AUROC 0.773). Using this cut-off value, we reached the best discrimination between absence of fibrosis/ mild fibrosis (F < 2 Metavir) and the presence ofmoderate to severe fi brosis (F ≥ 2 Metavir). CONCLUSION: In patients with chronic hepatitis due to HCV, a cut-off value of 6.8 kPa measured by TE can differentiate between significant fibrosis and absent or mild fi brosis, with a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6%, a specificity of 93.3%, and a diagnostic performance of 77.3%.

关键词： liver stiffness Transient elastography liver biopsy Chronic C hepatitis FibroScan

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Serum chitinase-3-like protein 1 is a biomarker of liver fibrosis in patients with chronic hepatitis B in China

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 384-389页

作者： Xin Jin Bin Fu Zheng-Jie Wu Xiao-Qin Zheng Jian-Hua Hu Lin-Feng Jin Ling-Ling Tang State Key Laboratory for Diagnosis and Treatment of Infectious Diseases National Clinical Research Center for Infectious DiseasesCollaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China College of Medicine Shaoxing UniversityShaoxing 312000China Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical CollegeHangzhou 310022China

Background:Serum chitinase-3-like protein 1(CHI3L1)is a potential biomarker for fibrosis *** aimed to evaluate serum CHI3L1 as a noninvasive diagnostic marker for chronic hepatitis B virusrelated ***:Serum CHI3L1 levels were measured by ELISA in 134 chronic hepatitis B(CHB)*** fibrosis was defined as a liver stiffness>9.7 *** performance of CHI3L1 was assessed and compared to that of other noninvasive tests by receiver operating characteristic(ROC)***:Serum CHI3L1 levels were significantly higher in CHB patients with significant hepatic fibrosis(≥F2)than in those without significant hepatic fibrosis(liver ***,CHI3L1 is feasible in monitoring disease progression.

关键词： Chitinase-3-like protein 1 Hepatitis B virus Noninvasive liver stiffness Significant fibrosis

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Multiparametric ultrasound as a new concept of assessment of liver tissue damage

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World Journal of Gastroenterology 2024年第12期30卷 1663-1669页

作者： Angela Peltec Ioan Sporea Department of Internal Medicine Discipline of GastroenterologyState University of Medicine and Pharmacy"Nicolae Testemitanu"Chishinev 2019Moldova Department of Gastroenterology and Hepatology "Victor Babes"University of Medicine and PharmacyTimisoara 300736Romania

liver disease accounts for approximately 2 million deaths per year *** chronic liver diseases(CLDs),whether of toxic,genetic,autoimmune,or infectious origin,undergo typical histological changes in the structure of the *** changes may include the accumulation of extracellular matrix material,fats,triglycerides,or tissue *** methods for diagnosing CLD,such as conventional B-mode ultrasound(US),play a significant role in *** US,when coupled with B-mode US,can be helpful in evaluating the hemodynamics of hepatic vessels and detecting US findings associated with hepatic *** elastography can assess liver stiffness,serving as a surrogate marker for liver *** is important to note that interpreting these values should not rely solely on a histological ***-enhanced US(CEUS)provides valuable information on tissue perfusion and enables excellent differentiation between benign and malignant focal liver *** evaluation,the etiology of liver disease,and the patient current comorbidities all influence the interpretation of liver stiffness *** measurements are most clinically relevant when interpreted as a probability of compensated advanced CLD.B-mode US offers a subjective estimation of fatty infiltration and has limited sensitivity for mild *** controlled attenuation parameter requires a dedicated device,and cutoff values are not clearly ***-titative US parameters for liver fat estimation include the attenuation coefficient,backscatter coefficient,and speed of *** parameters offer the advantage of providing fat quantification alongside B-mode evaluation and other US *** US(MPUS)of the liver introduces a new concept for complete noninvasive *** encourages examiners to utilize the latest features of an US machine,including conventional B-mode,liver stiffness evaluation,fat quantification,dispersion imaging,

关键词： Multiparametric ultrasound Ultrasound-based elastography liver stiffness Noninvasive diagnostic test for chronic liver disease liver steatosis assessment Portal hypertension evaluation

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Application of ultrasonography-elastography score to suspect porto-sinusoidal vascular disease in patients with portal vein thrombosis

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 20-24页

作者： Stefania Gioia Adriano De Santis Giulia d’Amati Silvia Nardelli Alessandra Spagnoli Arianna Di Rocco Lorenzo Ridola Oliviero Riggio Department of Translational and Precision Medicine Sapienza University of RomeRomeItaly Department of Radiological Oncologicaland Pathological SciencesSapienza University of RomeRomeItaly Department of Public Health and Infectious Diseases Sapienza University of RomeRomeItaly

Background:Porto-sinusoidal vascular disease(PSVD)and portal vein thrombosis(PVT)are causes of portal hypertension characterized respectively by an intrahepatic and a pre-hepatic obstacle to the flow in the portal *** PVT may be a consequence of PSVD,in PVT patients at presentation,a pre-existing PSVD should be *** these patients the identification of an underlying PSVD would have relevant implication regarding follow-up and therapeutic management,but it could be *** this setting ultrasonography may be valuable in differential *** aim of the study was to use ultrasonography to identify parameters to discriminate between PSVD and“pure”PVT and then to suspect PVT secondary to a pre-existing ***:Fifty-three patients with histologically proven PSVD and forty-eight patients affected by chronic PVT were enrolled and submitted to abdominal ultrasonography with elastography by acoustic radiation force impulse(ARFI).Results:ARFI was higher and superior mesenteric vein(SMV)diameter was wider in PSVD patients than in PVT ***,a prognostic score was obtained as linear combinations of the two parameters with a good discrimination capacity between PSVD and PVT(the area under the curve=0.780;95%confidence interval:0.690-0.869).Conclusions:A score based on ARFI and SMV diameter may be useful to suspect an underlying PSVD in patients with PVT and to identify a subgroup of patients to be submitted to liver biopsy.

关键词： Non-cirrhotic portal hypertension Porto-sinusoidal vascular disease Chronic portal vein thrombosis liver stiffness Portal hypertension Acoustic radiation force impulse

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Non-invasive diagnosis of alcoholic liver disease

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World Journal of Gastroenterology 2014年第40期20卷 14626-14641页

作者： Sebastian Mueller Helmut Karl Seitz Vanessa Rausch Department of Internal Medicine Salem Medical Center University of Heidelberg 69121 Heidelberg Germany Center for Alcohol Research University of Heidelberg 69121 Heidelberg Germany

Alcoholic liver disease(ALD)is the most common liver disease in the Western *** many reasons,it isunderestimated and *** early diagnosis is absolutely essential since it(1)helps to identify patients at genetic risk for ALD;(2)can trigger efficient abstinence namely in non-addicted patients;and(3)initiate screening programs to prevent life-threateningcomplications such as bleeding from varices,spontaneous bacterial peritonitis or hepatocellular *** two major end points of ALD are alcoholic liver cirrhosis and the rare and clinically-defined alcoholic hepatitis(AH).The prediction and early diagnosis of both entities is still insufficiently solved and usually relies on acombination of laboratory,clinical and imaging *** is not widely conceived that conventional screeningtools for ALD such as ultrasound imaging or routine laboratory testing can easily overlook ca.40%of manifest alcoholic liver ***-invasive methods such as transient elastography(Fibroscan),acoustic radiation force impulse imaging or shear wave elastography have significantly improved the early diagnosis of *** algorithms allow either the exclusion or the exact definition of advanced fibrosis stages in ca.95%of *** correct interpretation of liver stiffness requires a timely abdominal ultrasound and actual transaminase *** non-invasive methods such as controlled attenuation parameter,serum levels of M30 or M65,susceptometry or breath tests are under current evaluation to assess the degree of steatosis,apoptosis and iron overload in these *** biopsy still remains an important option to rule out comorbidities and to confirm the prognosis namely for patients with AH.

关键词： Alcoholic hepatitis Alcoholic steatohepatitis Alcoholic liver disease Non-invasive liver stiffness Serum marker Steatosis

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Does pressure cause liver cirrhosis? The sinusoidal pressure hypothesis

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World Journal of Gastroenterology 2016年第48期22卷 10482-10501页

作者： Sebastian Mueller Department of Medicine and Center for Alcohol Research Salem Medical CenterUniversity of Heidelberg

Independent of their etiology, all chronic liver diseases ultimately lead to liver cirrhosis, which is a majorhealth problem worldwide. The underlying molecular mechanisms are still poorly understood and no efficient treatment strategies are available. This paper introduces the sinusoidal pressure hypothesis(SPH), which identifies an elevated sinusoidal pressure(SP) as cause of fibrosis. SPH has been mainly derived from recent studies on liver stiffness. So far, pressure changes have been exclusively seen as a consequ-ence of cirrhosis. According to the SPH, however, an elevated SP is the major upstream event that initiates fibrosis via biomechanic signaling by stretching of perisinusoidal cells such as hepatic stellate cells or fibroblasts(SPH part?Ⅰ: initiation). Fibrosis progression is determined by the degree and time of elevated SP. The SPH predicts that the degree of extracellular matrix eventually matches SP with critical thresholds > 12 mmH g and > 4 wk. Elevated arterial flow and final arterialization of the cirrhotic liver represents the self-perpetuating key event exposing the low-pressure-organ to pathologically high pressures(SPH part?Ⅱ: perpetuation). It also defines the "point of no return" where fibrosis progression becomes irreversible. The SPH is able to explain the macroscopic changes of cirrhotic livers and the uniform fibrotic response to various etiologies. It also opens up new views on the role of fat and disease mechanisms in other organs. The novel concept will hopefully stimulate the search for new treatment strategies.

关键词： liver stiffness Stretch force Sinusoidal pressure hypothesis liver cirrhosis Hepatic arterial buffer response biomechanics Arterialization Hepatic stellate cells Fibroblasts cellular and intercellular mechano-signaling

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Magnetic resonance elastography is accurate in detecting advanced fibrosis in autoimmune hepatitis

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World Journal of Gastroenterology 2017年第5期23卷 859-868页

作者： Jin Wang Neera Malik Meng Yin Thomas C Smyrk Albert J Czaja Richard L Ehman Sudhakar K Venkatesh Department of Radiology Mayo Clinic College of MedicineMayo Clinic Department of Radiology the Third Affiliated HospitalSun Yat-Sen University Laboratory Medicine and Pathology Mayo Clinic College of MedicineMayo Clinic Department of Gastroenterology and Hepatology Mayo Clinic College of MedicineMayo Clinic

AIM To assess the value of magnetic resonance elastography (MRE) in detecting advanced fibrosis/cirrhosis in autoimmune hepatitis (AIH). METHODS In this retrospective study, 36 patients (19 treated and 17 untreated) with histologically confirmed AIH and liver biopsy performed within 3 mo of MRE were identified at a tertiary care referral center. liver stiffness (LS) with MRE was calculated by a radiologist, and inflammation grade and fibrosis stage in liver biopsy was assessed by a pathologist in a blinded fashion. Two radiologists evaluated morphological features of cirrhosis on conventional magnetic resonance imaging (MRI). Accuracy of MRE was compared to laboratory markers and MRI for detection of advanced fibrosis/cirrhosis. RESULTS liver fibrosis stages of 0, 1, 2, 3 and 4 were present in 4, 6, 7, 6 and 13 patients respectively. There were no significant differences in distribution of fibrosis stage and inflammation grade between treated and untreated patient groups. LS with MRE demonstrated stronger correlation with liver fibrosis stage in comparison to laboratory markers for chronic liver disease (r = 0.88 vs -0.48-0.70). A trend of decreased mean LS in treated patients compared to untreated patients was observed (3.7 kPa vs 3.84 kPa) but was not statistically significant. MRE had an accuracy/sensitivity/specificity/positive predictive value/negative predictive value of 0.97/90%/100%/100%/90% and 0.98/92.3%/96%/92.3%/96% for detection of advanced fibrosis and cirrhosis, respectively. The performance of MRE was significantly better than laboratory tests for detection of advanced fibrosis (0.97 vs 0.53-0.80, p < 0.01), and cirrhosis (0.98 vs 0.58-0.80, p < 0.01) and better than conventional MRI for diagnosis of cirrhosis (0.98 vs 0.78, p = 0.002). CONCLUSION MRE is a promising modality for detection of advanced fibrosis and cirrhosis in patients with AIH with superior diagnostic accuracy compared to laboratory assessment and MRI.

关键词： autoimmune hepatitis advanced fibrosis magnetic resonance elastography liver stiffness cirrhosis

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Current strategies for predicting post-hepatectomy liver failure and a new ultrasound-based nomogram

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World Journal of Gastroenterology 2024年第39期30卷 4254-4259页

作者： Xing-Xue Gao Jun-Feng Li Department of Infectious Disease Lanzhou University First Clinical Medical CollegeLanzhou 730000Gansu ProvinceChina Department of Infectious Diseases&Infectious Disease Research Laboratory Lanzhou University First HospitalLanzhou 730000Gansu ProvinceChina

liver cancer is associated with a few factors,such as viruses and alcohol con-sumption,and hepatectomy is an important treatment for patients with liver ***,post-hepatectomy liver failure(PHLF)is the most serious complication and has a high mortality *** prediction of PHLF allows for the adjustment of clinical treatment strategies and is critical to the long-term prognosis of *** factors have been associated with the development of PHLF,so there is an increasing interest in the development of predictive models for PHLF,such as nomograms that integrate intra-operative factors,imaging and biochemical characteristics of the ***,as a simple and important examination method,plays an important role in predicting PHLF,especially the Nomogram established based on ultrasound measurements of liver stiffness and spleen area provides a more convenient way to predict the occurrence of PHLF.

关键词： Ultrasound liver stiffness Spleen area Hepatocellular carcinoma Post-hepatectomy liver failure

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Transient elastography compared to liver biopsy and morphometry for predicting fibrosis in pediatric chronic liver disease: Does etiology matter?

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World Journal of Gastroenterology 2016年第16期22卷 4238-4249页

作者： Behairy El-Sayed Behairy Mostafa Mohamed Sira Khaled Refat Zalata El-Sayed Ebrahem Salama Mohamed Ahmed Abd-Allah Department of Pediatric Hepatology National Liver Institute Menofiya University Department of Pathology Faculty of Medicine Mansura University

AIM: To evaluate transient elastography (TE) as a noninvasive tool in staging liver fibrosis compared with liver biopsy and morphometry in children with different chronic liver ***: A total of 90 children [50 with chronic hepatitis C virus (HCV), 20 with autoimmune hepatitis (AIH) and 20 with Wilson disease] were included in the study and underwent liver stiffness measurement (LSM) using TE. liver biopsies were evaluated for fibrosis, qualitatively, by Ishak score and quantitatively by fibrosis area fraction (FAF) using digital image analysis (morphometry). LSM was correlated with fibrosis and other studied variables using spearman correlation. A stepwise multiple regression analysis was also performed to examine independent factors associated with LSM. Different cut-off values of LSM were calculated for predicting individual fibrosis stages using receiver-operating characteristic curve. Cut-off values with optimal clinical performance (optimal sensitivity and specificity simultaneously) were ***: The majority of HCV group had minimal activity (80%) and no/mild fibrosis (72%). On the other hand, the majority of AIH group had mild to moderate activity (70%) and moderate to severe fibrosis (95%) and all Wilson disease group had mild to moderate activity (100%) and moderate to severe fibrosis (100%). LSM correlated significantly with both FAF and Ishak scores and the correlation appeared better with the latter (r = 0.839 vs 0.879, P < 0.0001 for both). LSM discriminated individual stages of fibrosis with high performance. Sensitivity ranged from 81.4% to 100% and specificity ranged from 75.0% to 97.2%. When we compared LSM values for the same stage of fibrosis, they varied according to the different etiologies. Higher values were in AIH (16.15 ± 7.23 kPa) compared to Wilson disease (8.30 ± 0.84 kPa) and HCV groups (7.43 ± 1.73 kPa). Multiple regression analysis revealed that Ishak fibrosis stage was the only ind

关键词： Autoimmune hepatitis Chronic hepatitis C liver fibrosis liver stiffness Morphometry Pediatrics Transient elastography Wilson disease

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Non-invasive assessment of liver fibrosis using twodimensional shear wave elastography in patients with autoimmune liver diseases

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World Journal of Gastroenterology 2017年第26期23卷 4839-4846页

作者： Jie Zeng Ze-Ping Huang Jian Zheng Tao Wu Rong-Qin Zheng Department of Medical Ultrasonics Third Affiliated Hospital of Sun Yat-Sen University Guangdong Key Laboratory of Liver Disease Research Sun Yat-Sen University Department of Medical Ultrasonics Third Hospital of Longgang

AIM To determine the diagnostic accuracy of two-dimensional shear wave elastography(2D-SWE) for the noninvasive assessment of liver fibrosis in patients with autoimmune liver diseases(AILD) using liver biopsy as the reference *** Patients with AILD who underwent liver biopsy and 2D-SWE were consecutively enrolled. Receiver operating characteristic(ROC) curves were constructed to assess the overall accuracy and to identify optimal cut-off *** The characteristics of the diagnostic performance were determined for 114 patients with AILD. The areas under the ROC curves for significant fibrosis, severe fibrosis, and cirrhosis were 0.85, 0.85, and 0.86, respectively, and the optimal cut-off values associated with significant fibrosis(≥ F2), severe fibrosis(≥ F3), and cirrhosis(F4) were 9.7 k Pa, 13.2 k Pa and 16.3 k Pa, respectively. 2D-SWE showed sensitivity values of 81.7% for significant fibrosis, 83.0% for severe fibrosis,and 87.0% for cirrhosis, and the respective specificity values were 81.3%, 74.6%, and 80.2%. The overall concordance rate of the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages was 53.5%.CONCLUSION2D-SWE showed promising diagnostic performance for assessing liver fibrosis stages and exhibited high cut-off values in patients with AILD. Low overall concordance rate was observed in the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages.

关键词： Autoimmune liver disease liver fibrosis Two-dimensional shear wave elastography Ultrasound liver stiffness

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