Assessment Of Chronic Liver Disease Research Articles

Assessment of Chronic Liver Disease (CLD) Based on Esophageal Varices in Children

Assessment of Chronic Liver Disease (CLD) Based on Esophageal Varices in Children

Establishing an Ultrasound Screening Protocol for Chronic Liver Disease with a Handheld Device: A Pilot Project in Southern Ethiopia.

Chronic liver disease (CLD) poses significant challenges in the developing world. The prevalence of this problem and the health burden on local health services are not well understood. The diagnosis and monitoring of CLD are difficult in these settings because of limited access to expensive imaging with limited mobility and/or liver biopsy. The aim of this project was to develop and implement an efficient evidence-based robust ultrasound protocol for the assessment of chronic liver disease using a hand-held ultrasound device that could be effectively used in the developing world. A protocol was established using scoring systems that have established accuracy for the diagnosis of hepatic fibrosis/cirrhosis and hepatic steatosis. Included in the protocol was the identification of hepatic masses, portal venous enlargement, hepatic size and splenic size. Hepatic steatosis was common, identified in 46 of 94 participants (49%). Hepatic fibrosis was observed in only 13 of 94 participants (14%). A significant limitation of the methodology was the inability to validate the results with biopsy or other forms of cross-sectional imaging. The protocol was successfully implemented in a community in a rural setting in South Ethiopia with a mean examination time of around 6 min. It is feasible to use handheld ultrasound for the screening of CLD in remote settings. This project provides an evidence-based framework for further studies in this area.

Spectroscopy-based multi-parametric quantification in subjects with liver iron overload at 1.5T and 3T.

To evaluate the precision profile (repeatability and reproducibility) of quantitative STEAM-MRS and to determine the relationships between multiple MR biomarkers of chronic liver disease in subjects with iron overload at both 1.5 Tesla (T) and 3T. MRS data were acquired in patients with known or suspected liver iron overload. Two STEAM-MRS sequences (multi-TE and multi-TE-TR) were acquired at both 1.5T and 3T (same day), including test-retest acquisition. Each acquisition enabled estimation of R1, R2, and FWHM (each separately for water and fat); and proton density fat fraction. The test-retest repeatability and reproducibility across acquisition modes (multi-TE vs. multi-TE-TR) of the estimates were evaluated using intraclass correlation coefficients, linear regression, and Bland-Altman analyses. Multi-parametric relationships between parameters at each field strength, across field strengths, and with liver iron concentration were also evaluated using linear and nonlinear regression. Fifty-six (n = 56) subjects (10 to 73 years, 37 males/19 females) were successfully recruited. Both STEAM-MRS sequences demonstrated good-to-excellent precision (intraclass correlation coefficient ≥ 0.81) for the quantification of R1water , R2water , FWHMwater , and proton density fat fraction at both 1.5T and 3T. Additionally, several moderate (R2 = 0.50 to 0.69) to high (R2 ≥ 0.70) correlations were observed between biomarkers, across field strengths, and with liver iron concentration. Over a broad range of liver iron concentration, STEAM-MRS enables rapid and precise measurement of multiple biomarkers of chronic liver disease. By evaluating the multi-parametric relationships between biomarkers, this work may advance the comprehensive MRS-based assessment of chronic liver disease and may help establish biomarkers of chronic liver disease.

Assessment of chronic liver disease by multiparametric ultrasound: results from a private practice outpatient facility.

To assess chronic liver disease (CLD) using multiparametric US in a private practice setting in a cohort of patients with increased skin-to-liver distance. 110 consecutive patients with increased skin-to-liver distance scheduled for US assessment of CLD were reviewed for study completion time, liver stiffness values (LS), attenuation imaging, and shear wave dispersion slope. The ROI was placed 2cm below the liver capsule. The study included patients with NAFLD/NASH (68), hepatitis C (30), prior Fontan surgery (1), elevated liver function tests (5), alcohol abuse (3), hepatitis B (2), and primary biliary cirrhosis (1). IQR/M values were obtained. Comparison of less experienced sonographers (LES) and more experienced sonographers (MES) were evaluated through Student's t test for independent data. Pearson coefficient r of correlation among quantitative variables was calculated. The mean time to perform the exam was 129.7 ± 62.1s. There was a statistically significant difference between LES and MES. The mean IQR/M for LS was 12.3 ± 5.5% m/s. Overall, in a cohort of difficult patients, 4.5% of LS values were not reliable. Fat quantification using attenuation imaging had a mean value of 0.60 ± 0.15dB/cm/MHz (range 0.35-0.98cm/dB/MHz) with an IQR/M of 14.7 ± 9.2%. Less reliable measurements of steatosis were obtained in 4.5% of patients. The mean shear wave dispersion slope was 12.74 ± 4.05 (m/s)/kHz (range 7.7-27.5 (m/s)/kHz) with an IQR/M of 38.7 ± 20.2% (range 3-131%). 20.9% of patients had values suggestive of compensated advanced chronic liver disease (cACLD). Multiparametric US can provide assessment of CLD in less than 3min in most patients and identify patients at risk for cACLD.

Quantitative liver surface nodularity score based on imaging for assessment of early cirrhosis in patients with chronic liver disease: A protocol for systematic review and meta-analysis.

Background:Early stage of cirrhosis is of great value in the diagnosis and management in patients with chronic liver disease (CLD). Recent studies have shown that quantitative liver surface nodularity (LSN) score based on imaging techniques can be used to predict the early cirrhosis stage noninvasively, with varied diagnostic accuracy and limited sample size. Hence, this study will evaluate the diagnostic accuracy of LSN in the prediction of early cirrhosis.Methods:We will conduct a comprehensive search in PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases to identify eligible studies. The literature screening, data extraction, data analysis, and quality assessment will then be carried out. The summary receiver-operating-characteristic (ROC) and pooled sensitivity, specificity will be calculated to summarize the diagnostic performance of LSN using a random-effect model. A meta-regression analysis will be performed to investigate the underlying cause of the heterogeneity.Results:This study will evaluate the diagnostic accuracy of LSN score in the identification of early cirrhosis, which may further determine whether this method can be used as an alternative in the assessment of CLD patients.Conclusions:This study will help to determine the diagnostic accuracy and summarize the recent evidence on this issue.Study registration:INPLASY2020100096.

Health-related quality of life in Cuban patients with chronic liver disease: A real-world experience

Introduction and objectivesPatient-reported outcomes (PROs) are important for comprehensive assessment of chronic liver disease (CLD). Latin America and the Caribbean have a high burden of CLD, but PROs are lacking. We assessed health-related quality of life (HRQL) in Cuban patients with compensated CLD. Materials and methodsA cross sectional study performed of adult patients with a diagnosis of chronic viral infection B and C (HBV, HCV), non-alcoholic fatty liver diseases (NAFLD) and autoimmune liver diseases (AILD) including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and overlap syndrome (AIH+PBC). PROs were collected using: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Work Productivity and Activity-Specific Health Problem (WPAI: SHP), and the Chronic Liver Disease Questionnaire (CLDQ)-disease-specific. Results543 patients enrolled, n=91 (HBV), n=188 (HCV), n=221 (NAFLD), n=43 (AILD). Of those with AILD, 22 had AIH, 14 PBC, and 7 overlap AIH/PBC. Mean age was 53.5 years, 64.1% female, 69.2% white, and 58.0% employed. Patients with HCV and AILD had more severe liver disease. A significant impairment in PROs was observed in HCV group whereas the AILD patients had more activity impairment. CLDQ-HRQL scores were significantly lower for patients with NAFLD and AILD compared to HBV. Male gender and exercising ≥90min/week predicted better HRQL. The strongest independent predictors of HRQL impairment were fatigue, abdominal pain, anxiety, and depression (p<0.05). ConclusionsHRQL for Cuban patients with compensated CLD differs according to the CLD etiology. Patients with HCV and AILD had the worst PRO scores most likely related to severe underlying liver disease and/or extrahepatic manifestations.

Routine Liver Elastography Could Predict Actuarial Survival after Liver Transplantation.

Transient elastography (TE) has routinely been implemented in the diagnosis and assessment of chronic liver disease. Little data are available in the post liver transplant (LTx) setting. Three months after LTx, we performed TE in 137 liver transplant recipients and investigated its predictive value upon further clinical outcome. The mean follow-up time for clinical outcome was 24 months. Mean TE value was 10.6 kPa (± 6.3 kPa; range 2.8 - 29.9 kPa). There was a significant correlation between TE and aspartate aminotransferase (AST) (p=0.004), gamma-glutamyl transferase (GGT) (p=0.031) and bilirubin (p<0.001) serum levels. In Cox univariate analysis, TE served as a predictor of actuarial survival free of liver transplantation (OR=1.111, 95%CI: 1.051-1.174; p<0.001). In multivariate analysis, TE remained an independent risk factor associated with reduced actuarial survival free of liver transplantation (OR=1.080, 95%CI: 1.001-1.166; p=0.047), along with thrombocytes (OR=0.992, 95%CI: 0.986-0.999; p=0.020) and metabolic co-disease (OR = 0.250, 95%CI: 0.070-0.895; p=0.033). Transient elastography measurement at three months after LTx seems a robust predictor of survival in liver transplant recipients.

The role of elastography in the assessment of chronic liver disease in children.

Conventional ultrasonography is a method preferred for the investigation of chronic liver diseases in pediatric groups, as it is non-invasive, cheap, feasible and available. The purpose of this study is to present the role of Share-wave Elastography (SWE) in terms of diagnostic value in children diagnosed with "chronic liver disease." We studied patients who had been diagnosed with chronic liver disease between March 2012-September 2015, and who had undergone liver biopsy and had their pathology results, compared with 26 healthy subjects. Statistical analysis was performed with IBM SPSS Statistics for Windows, Version 20.0. "Pearson Correlation Analysis" was performed in order to measure the relationship between elastography values and Brunt level. This study had 107 subjects in total, consisting of 81 patients between 0-204 months of age Pearson correlation coefficient level was determined as r = 0.644. Since the correlation coefficient is positive, there is a same-directional relationship between Elastography level and Brunt degree. This means that while one of the variables is increasing, the other one will also increase. Since it is known that development of hepatic fibrosis is a dynamic process, and that many hepatic fibrosis etiologies are known to continue throughout the course of life, the application of Real time SWE method instead of repeated liver biopsies on patients is a much simpler and smart method. Increasing the clinical use of Real Time SWE method with future studies might provide an opportunity for preventing unnecessary liver biopsies since the patients are evaluated in a shorter time and in a cost-effective manner.

Preliminary clinical experience with shear wave dispersion (SWD) imaging of the liver

Quantifying the extent of liver fibrosis is important in the management of patients with chronic liver disease. Liver biopsy is the gold standard for diagnosis and grading of liver fibrosis. However, liver biopsy is costly, invasive and may have associated complications. Liver biopsy may also be limited by sampling variability due to the heterogeneous nature of liver fibrosis. Liver biopsy limitations have led to the development of non-invasive techniques for the evaluation of and monitoring of liver fibrosis. These include transient elastography (TE) (Fibroscan©), shear wave elastography (SWE) and magnetic resonance elastography (MRE). These technologies use algorithms for quantifying liver elasticity and have all shown promising results for non-invasive fibrosis staging. However, both TE and SWE have limitations including in patients with inflammation (hepatitis) and/or steatosis. Liver diseases such as non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver disease (NAFLD) and acute hepatitis have been reported to increase liver viscosity. It is proposed that these alterations in liver viscosity alter the propagation of shear waves, and that a more accurate assessment would be obtained by assessing both the elasticity and viscosity i.e. viscoelastic properties in the liver. Shear wave dispersion (SWD) is a new imaging technology software that has been developed on the Canon Aplio i-series for assessing the dispersion of the shear wave. In viscoelastic tissue, shear wave speed undergoes frequency dispersion i.e. change in the shear wave speed dependent on the shear wave frequency. The units of measurement are m/s/kHz. In perfectly elastic tissue, shear wave speed is constant regardless of the shear wave frequency. However, in viscoelastic tissue, shear wave speed varies depending on the shear wave frequency i.e. shear wave dispersion. We present the initial findings of using this new liver imaging tool in a sequential group of patients referred for liver biopsy in a tertiary level hospital. The indications were for the assessment of chronic liver disease, with exclusion of patients with suspected or confirmed malignancy. In this group, the manufacturer recommended SWD reference value was compared to liver biopsy findings to identify whether it could discriminate between patients with, and without inflammation (hepatitis).

Quantitative and noninvasive assessment of chronic liver diseases using two-dimensional shear wave elastography.

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.

Short article: Noninvasive assessment of portal hypertension and detection of esophageal varices in cirrhosis: state-of-the-art.

Portal hypertension (PHT) is a major consequence of any chronic liver disease and it is the main cause of complications in patients with cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for PHT assessment, together with its diagnosis and prognosis relevance. Even though hepatic vein pressure gradient measurement is a safe procedure, it is still considered an invasive technique and not widely available. There is thus a need for noninvasive methods that can predict the progression of PHT as well as the presence and the risk of complications related to esophageal varices. This review aimed to discuss the noninvasive markers used in the assessment of PHT and detection of high-risk esophageal varices in patients with liver cirrhosis. We focus on the main biomarkers, particularly those used in the routine assessment of chronic liver disease, and the physical methods that use tissue elastography as a diagnosis tool.

Improved Shear Wave Group Velocity Estimation Method Based on Spatiotemporal Peak and Thresholding Motion Search.

Quantitative ultrasound elastography is increasingly being used in the assessment of chronic liver disease. Many studies have reported ranges of liver shear wave velocity values for healthy individuals and patients with different stages of liver fibrosis. Nonetheless, ongoing efforts exist to stabilize quantitative ultrasound elastography measurements by assessing factors that influence tissue shear wave velocity values, such as food intake, body mass index, ultrasound scanners, scanning protocols, and ultrasound image quality. Time-to-peak (TTP) methods have been routinely used to measure the shear wave velocity. However, there is still a need for methods that can provide robust shear wave velocity estimation in the presence of noisy motion data. The conventional TTP algorithm is limited to searching for the maximum motion in time profiles at different spatial locations. In this paper, two modified shear wave speed estimation algorithms are proposed. The first method searches for the maximum motion in both space and time [spatiotemporal peak (STP)]; the second method applies an amplitude filter [spatiotemporal thresholding (STTH)] to select points with motion amplitude higher than a threshold for shear wave group velocity estimation. The two proposed methods (STP and STTH) showed higher precision in shear wave velocity estimates compared with TTP in phantom. Moreover, in a cohort of 14 healthy subjects, STP and STTH methods improved both the shear wave velocity measurement precision and the success rate of the measurement compared with conventional TTP.

Liver fibrosis: Review of current imaging and MRI quantification techniques.

5 J. MAGN. RESON. IMAGING 2017;45:1276-1295.

TU‐H‐CAMPUS‐IeP3‐05: Computer Aided Diagnosis Employing Automatically Segmented Color‐Specific Regions in Ultrasound Shear Wave Elastography for the Assessment of Chronic Liver Disease

Purpose:To assess the role of an automated Computer Aided Diagnosis (CAD) system in differentiation of Healthy Subjects to Chronic Liver Disease (CLD) Patients in terms of liver fibrosis (F0‐F4), using Ultrasound Shear Wave Elastography (SWE).Methods:Clinical Dataset consisted of 125 subjects, 55 Healthy (F0) whom condition was validated with Normal Biochemical Markers and clear Clinical History, and 70 with CLD (F1‐F4) whom condition was validated with Liver Biopsy. For each subject an SWE examination on their liver right lobe was performed using Supersonic Imagine's Aixplorer ultrasound system, and an SC6‐1 transducer. The examination was performed using preset default settings for Abdomen/Liver, and according to literature's suggested guidelines. An SWE image was then acquired, and a separation of the colored areas from the grayscale ones was performed. An RGB‐to‐Stiffness algorithm was consequently applied on the resulting image (Stiffness Box), using the nbuilt‐in colormap, to replace RGB values to Stiffness values. A segmentation procedure was employed using thresholds that segment the image to 5 stiffness range clusters (0–6, 6–12, 12–18, 18–24, and 24–30 kPa), and extract 7 features from each cluster (Mean, Median, Standard Deviation, Sample Kurtosis, 10th Percentile, 90th Percentile, and Cluster's Pixel Percentage on the Stiffness Box) deriving 35 features for each SWE image. The computed feature set was then fed to a designed SVM classifier. SVM‐model evaluation was performed by means of exhaustive search, and leave‐one‐out methods.Results:Maximum classification accuracy (85.6%) in distinguishing Healthy from chronic liver disease patients was obtained employing three features (Blue mean and Cyan median values, and Red maximum pixel number) with sensitivity and specificity values of 91.9% and 79.3% respectively.Conclusion:The proposed CAD system accurately differentiates Healthy to CLD patients assisting in evaluating important factors for performing SWE examination, enriching its guidelines, and aiding clinicians in a more accurate diagnosis.

Su1507 Combined Noninvasive Evaluation of Liver and Spleen Stiffness By Acoustic Radiation Force Impulse (ARFI) for Assessment of Chronic Liver Disease and Portal Hypertension

Su1507 Combined Noninvasive Evaluation of Liver and Spleen Stiffness By Acoustic Radiation Force Impulse (ARFI) for Assessment of Chronic Liver Disease and Portal Hypertension

Ultrasound Shear Wave Elastography for Liver Disease. A Critical Appraisal of the Many Actors on the Stage.

Ultrasound Shear Wave Elastography for Liver Disease. A Critical Appraisal of the Many Actors on the Stage.

Hepatic Venous Waveform, Splenoportal and Damping Index in Liver Cirrhosis: Correlation with Child Pugh's Score and Oesophageal Varices.

Clinical assessment of chronic liver disease is done by Modified Child Pugh's and Model for end-stage liver disease scoring system. Measurement of hepatic venous pressure gradient (HVPG) and Upper GI Endoscopy are considered the gold standards for measurement of portal hypertension in cirrhotics. There is a need for non-invasive evaluation of portal hypertension. Ultrasonography with colour and spectral Doppler evaluation may be an effective, rapid and inexpensive alternative. To evaluate hepatic venous waveform, damping index, splenoportal index in patients of cirrhosis on Colour Doppler ultrasound, also predict severity of portal hypertension and presence of oesophageal varices. Thirty patients of chronic liver disease were included in the study. Ultrasound and colour Doppler was done to look hepatic venous waveform pattern, Damping Index (DI), and Splenoportal Index (SPI). Contrast-enhanced Computed Tomography scan (CT) was done if renal function tests were normal, else endoscopy when the renal function tests were deranged to look for oesophageal varices. Twenty two (73.3%) patients had monophasic waveform. Biphasic and triphasic waveforms were seen in 4 (13.3%) cases. Twenty two patients (73.3%) had monophasic waveforms and majority of them were in class C. This distribution of hepatic vein waveform was statistically significantly with the Child Pugh's class (p<0.05). Twenty patients (66.7%) had value of Damping index more than >0.6 where majority of patients (18) belonged to class C and 2 in class B. There was a positive correlation between Child Pugh's total score and Damping index (r=0.614; p<0.05). There was weak positive correlation between splenoportal index and Child Pugh's score (r=0.269; p=0.15). Change in triphasic to monophasic waveform and DI >0.6 suggests severe liver dysfunction and is associated with severe portal hypertension. Hepatic venous waveform pressure changes, DI and SPI have no value in predicting presence of oesophageal varices.

SAT-472 - Exhaled Breath Profiling by Electronic Nose as a Novel Non-Invasive Method for Assessment of Chronic Liver Disease: Proof of Principle Study

SAT-472 - Exhaled Breath Profiling by Electronic Nose as a Novel Non-Invasive Method for Assessment of Chronic Liver Disease: Proof of Principle Study

Magnetic resonance elastography: evaluation of new inversion algorithm and quantitative analysis method.

To assess mean shear hepatic stiffness calculations using various region of interest (ROI) techniques, a new inversion algorithm, and a confidence threshold mask. Seventy-three patients (49 with abnormal liver function tests/known chronic liver disease and 24 healthy liver transplant donors) underwent liver biopsy and magnetic resonance elastography (MRE). MRE data processed with the current inversion algorithm [multiscale direct inversion (MSDI)] was assessed using 2 ROI methods (single vs. triple). The data were then reprocessed using the new inversion algorithm (multimodel direct inversion [MMDI]) Hepatic stiffness calculations were performed using a single (70%) ROI method, with/without a 95% confidence threshold mask, and compared with MSDI. For MSDI, average stiffness difference between single and triple ROI methods was not statistically significant by the 2-sample t test [0.15 kilopascals (kPa); P = .77]. For the 2 algorithms, there was little difference in average stiffness measurements of MSDI and MMDI (mean, 0.32 kPa; 9%) using a confidence mask with good agreement [intraclass correlation coefficient (ICC), 0.986 (95% CI 0.975-0.994)]. Use of the confidence mask showed excellent consistency and less variance [ICC, 0.995 (95% CI 0.993-0.998)] compared to either the inter-observer or intra-observer freehand technique. MRE analysis showed no significant difference between the 2 freehand ROI techniques. With a 9% average kPa variance, stiffness measurements for MSDI and MMDI were also not significantly different. The use of the confidence mask reduces calculated stiffness variability, which impacts the use of MRE for assessing therapy response and initial/longitudinal assessment of chronic liver disease.

Diagnostic accuracy of liver and spleen stiffness measurement for portal hypertension using bidimensional shear weave elastography

Background: Liver and spleen stiffness measurement (LSM;SSM) are used for the noninvasive assessment of chronic liver diseases and may identify clinically significant portal hypertension (CSPH). Besides transient elastography new methods are proposed, but their performance to assess PH and their reliability criteria are unknown. We aimed to assess diagnostic accuracy for CSPH and to determine a set of reliability criteria for bidimensional shear wave elastography (2D-SWE).