Elastography Point Quantification Research Articles

The Role of ElastPQ in Assessing Liver Stiffness for Non-Alcoholic Fatty Liver Disease in Patients Treated with Atypical Antipsychotic Drugs.

To evaluate the role of elastography point quantification (ElastPQ) for the quantitative assessment of stiffness in the fatty liver disease in mental disorder patients and to provide a noninvasive detection method for non-alcoholic fatty liver (NAFLD) caused by atypical antipsychotics drugs (AAPDs). A total number of 168 mental disorder patients treated with AAPDs and 58 healthy volunteers were enrolled in this study. All the subjects underwent ultrasound and ElastPQ tests. The basic data of the patients were analyzed. BMI, liver function, and the value of ElastPQ were considerably higher in the patient group than that in the healthy volunteers. The values of liver stiffness obtained by ElastPQ were increased gradually from 3.48(3.14-3.81) kPa in the normal liver to 8.15(6.44-9.88) in the severe fatty liver. The receiver operating characteristic (ROC) for the diagnosis of fatty liver with ElastPQ were 0.85, 0.79, 0.80, and 0.87 for the diagnosis of normal, mild, moderate, and severe steatosis, respectively, with a sensitive/specificity of 79%/76.4%, 85.7%/78.3%, 86.2%/73%, and 81.3%/82.1%, correspondingly. Moreover, ElastPQ in the olanzapine group was higher than those in the risperidone and aripiprazole groups (5.11(3.83-5.61) kPa vs 4.35(3.63-4.98) kPa, P < 0.05; 5.11(3.83-5.61) kPa vs 4.79(4.18-5.24) kPa, P < 0.05). After one-year treatment, the value of ElastPQ was 4.43(3.85-5.22) kPa, but it was 5.81(5.09-7.33) kPa in patients treated for more than three years. This value increased with treatment prolongation (P < 0.05). ElastPQ is a real-time, quantitative method for assessing the stiffness of NAFLD. The liver stiffness value could be varied in the different stages of fatty liver. Olanzapine has a considerable influence on liver stiffness. The long-term use of AAPDs can increase the stiffness value of fatty liver.

Shear wave elastography of the spleen using elastography point quantification: stiffness values in healthy children.

To evaluate the shear wave elastography (SWE) values of the spleen in healthy children using Elastography Point Quantification (ElastPQ). In this IRB approved prospective study, spleen stiffness was measured in 146 healthy children (2-15years) using ElastPQ. SWE values were recorded in upper pole, mid pole, and lower pole of the spleen in all the children. The mean (± SD) SWE values of the spleen in children in ≤ 5years age group, > 5-10years age group, and > 10-15years age group were 5.6 (± 4.2) kPa, 6.5 (± 3.2) kPa, and 5.9 (± 3.6) kPa, respectively. No statistically significant difference was seen in SWE values of the spleen between these three groups (p > 0.5). The mean (± SD) SWE values in ≤ 10years and > 10years age group were 6.1 (± 3.6) kPa and 5.9 (± 2.6) kPa, respectively. No statistically significant difference was seen in SWE values of the spleen between these two groups (p > 0.5). There was no significant difference in the SWE values for boys and girls. Statistically significant difference was seen between the mean SWE values in the two groups based on the median splenic length, which was 5.5 (± 3.8) kPa in the group with a length of ≤ 7.6cm and 6.7 (± 2.8) kPa in the group with a length of > 7.6cm. SWE values of the spleen in healthy children do not correlate with age, and no significant difference is there in the SWE values for boys and girls. There was a statistically significant difference in the SWE values of the spleen while comparing the groups based on the median splenic length.

Noninvasive Assessment of Liver Fibrosis with ElastPQ in Patients with Chronic Viral Hepatitis: Comparison Using Histopathological Findings.

Chronic viral hepatitis is a major cause of chronic liver disease leading to liver fibrosis. This study aimed to assess the diagnostic performance of elastography point quantification (ElastPQ), transient elastography (TE), and aspartate aminotransferase-to-platelet count ratio index (APRI) for the staging of liver fibrosis in patients with chronic viral hepatitis using histopathological findings as a reference standard. For 122 patients with chronic viral hepatitis, diagnostic performance was evaluated using area under the receiver operating characteristic curve (AUROC) analysis and correlations were determined using Spearman’s correlation coefficient. The AUROC of ElastPQ for the diagnosis of the fibrosis stage ≥ F2 was 0.917 with a cut-off value of 3.935. There was a significant positive correlation between the different stages of histologic liver fibrosis and stiffness values obtained using ElastPQ, TE, and APRI (ρ = 0.556, ρ = 0.657, ρ = 0.375, respectively; p < 0.001). ElastPQ showed a higher diagnostic accuracy than APRI, resembling that of TE; AUROC values of ElastPQ, TE, and APRI were 0.917, 0.964, and 0.896, respectively, for a fibrosis stage ≥ F2. ElastPQ is a promising noninvasive technique with a diagnostic accuracy comparable with that of TE for the evaluation of liver fibrosis in patients with chronic viral hepatitis.

Liver Stiffness Is Markedly Decreased After Chronic Hepatitis C Treatment.

The aim of the study was to demonstrate the liver stiffness (LS) change in chronic hepatitis C (CHC) patients obtained by elastography point quantification technique in before and after antiviral treatment (AVT). This prospective study included 84 patients diagnosed with CHC who had not previously received treatment for CHC and who had an indication for using direct-acting AVT. Necessary measurements were recorded with noninvasive liver fibrosis (LF) examinations. Posttreatment control of patients was carried out (ombitasvir + paritaprevir + ritonavir) + 3 months after the start of treatment for those treated with dasabuvir and 6 months after the start of treatment for patients treated with sofosbuvir + ribavirin. Liver stiffness changed after AVT is accepted as (Δ-LS), LS before AVT-LS after AVT. Basal LS was found to decrease significantly after AVT (8.00 ± 2.56 kPa vs 6.95 ± 2.86 kPa, P < 0.05). Similar aspartate aminotransferase-to-platelet ratio index and platelet number fibrosis 4 indices were observed before and after AVT (P > 0.05). It was observed that Δ-LS value after AVT was lower in patients with Child-Pugh class A cirrhosis than patients without cirrhosis (P < 0.05). In the comparison between Δ-LS value after AVT and LF score determined by liver biopsy, it was seen that the greatest Δ-LS value was in patients with fibrosis score of 3. An independent relationship was found between Δ-LS after AVT and LF score determined by biopsy (P < 0.05). The LS value determined by the elastography point quantification technique is more effective than other noninvasive laboratory methods in demonstrating the CHC treatment response in clinical practice.

Non-invasive splenic parameters of portal hypertension: Assessment and utility

BACKGROUNDPortal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality. The present gold-standard method to risk stratify and observe cirrhosis patients with portal hypertension is hepatic venous pressure gradient measurement or esophagogastroduodenoscopy. However, these methods are invasive, carry a risk of complications and are associated with significant patient discomfort. Therefore, non-invasive splenic parameters are of clinical interest as potential useful markers in determining the presence of portal hypertension. However, diagnostic accuracy and reproducibility remains unvalidated.AIMTo assess the diagnostic accuracy of spleen stiffness, area and diameter in predicting the presence of portal hypertension.METHODSOf 50 patients with varying liver disease pathologies were prospectively recruited from the St. Mary’s Hospital Liver Unit in London; 25 with evidence of portal hypertension and 25 with no evidence of portal hypertension. Liver stiffness, spleen stiffness, spleen diameter and spleen area were measured using the Philips Affiniti 70 elastography point quantification point shear wave elastography system. The aspartate aminotransferase-to-platelet-ratio-index (APRI) score was also calculated. Performance measures, univariate and multivariate logistic regression were used to evaluate demographic, clinical and elastography variables. Interclass correlation coefficient was used to determine the reproducibility of splenic area and diameter.RESULTSOn univariate and individual performance, platelet count [area under the receiver operating characteristic (AUROC) 0.846, P value < 0.001], spleen area (AUROC 0.828, P value = 0.002) and APRI score (AUROC 0.827, P value < 0.001) were the most accurate variables in identifying the presence of portal hypertension. On multivariate logistic regression models constructed, the combination of spleen area greater than 57.90 cm2 and platelet count less than 126 × 109 had 63.2% sensitivity and 100% specificity, 100% positive predictive value and 100% negative predictive value. An alternative combination of spleen stiffness greater than 29.99 kPa and platelet count less than 126 × 109 had 88% sensitivity, 75% specificity, 78.6% positive predictive value and 85.7% negative predictive value. An interclass correlation coefficient value of 0.98 (95%CI: 0.94-0.99, P value < 0.001) and 0.96 (95%CI: 0.91-0.99, P value < 0.001) were determined for inter-operator variability for spleen area and diameter respectively.CONCLUSIONSpleen area, spleen stiffness and platelet count may be useful markers to assess the presence of portal hypertension in patients of various etiologies.

Comparative Study Between the Diagnostic Performance of Point and 2-D Shear-Wave Elastography for the Non-invasive Assessment of Liver Fibrosis in Patients With Chronic Hepatitis C Using Transient Elastography as Reference

The study compared the diagnostic performance of two shear-wave elastography techniques, elastography point quantification (ElastPQ) and 2-D shear-wave elastography by General Electric (2-D-SWE.GE), for the non-invasive assessment of liver fibrosis in a cohort of patients with chronic hepatitis C virus (HCV) infection, using transient elastography (TE) as the reference method. There was no significant difference between the feasibility rates of TE, ElastPQ and 2-D-SWE.GE (p = 0.507). A good correlation was found between the liver stiffness (LS) values obtained using the two elastographic methods (r = 0.78). The mean LS values obtained using the ElastPQ technique were significantly higher than those obtained using 2-D-SWE.GE (12.1 ± 7.3 kPa vs. 10.4 ± 4.0 kPa, p < 0.0001). Pairwise comparisons of receiver operator characteristics curves between 2-D-SWE.GE and ElastPQ have shown that there are no significant differences in their performance for staging F ≥ 2 fibrosis (p = 0.89), F ≥ 3 fibrosis (p = 0.76) and F = 4 fibrosis (p = 0.86) in patients with chronic HCV infection.

Comparison of Elastography Point Quantification with Transient Elastography in Patients with Chronic Viral Hepatitis and Nonalcoholic Fatty Liver Disease: A Pilot Study

The objective of this study was to compare diagnostic accuracy of elastography point quantification (ElastPQ) with transient elastography (TE) and liver histology for measuring liver stiffness in patients with chronic viral hepatitis (CVH) and nonalcoholic fatty liver disease (NAFLD). Thirty-two patients with chronic liver disease (CVH and NAFLD) were evaluated by ElastPQ and TE within 7 days of liver biopsy. Within the CVH group, subgroup analysis was carried out in patients with end-stage renal disease (ESRD) and without ESRD. Area under the receiver operating characteristic (AUROC) curves were calculated for ElastPQ and TE. There were 15 patients with CVH and 17 patients with NAFLD. In the CVH group, there were 8 patients with ESRD and 7 patients without ESRD. Taking liver histopathology as the gold standard, liver stiffness measurement by ElastPQ (ρ=0.826;P<0.0001) and TE (ρ=0.649; P<0.0001) correlated significantly with the stage of fibrosis. AUROCs of ElastPQ and TE for the diagnosis of any fibrosis (F≥1), significant fibrosis (F≥2), and advanced fibrosis (F≥3) were 0.907, 0.959, 0.926 and 0.870, 0.770, 0.881, respectively, in both CVH and NAFLD groups. However, the accuracy of both these techniques was poor in patients with CVH and ESRD (AUROCs for ElastPQ and TE of 0.667 and 0.167 for the diagnosis of significant fibrosis, respectively, and 0.429 and 0.143 for the diagnosis of advanced fibrosis, respectively). The diagnostic accuracy of both ElastPQ and TE for detecting significant fibrosis was excellent in patients with NAFLD (AUROC of 1.000 and 0.936, respectively). ElastPQ wassuperior to TE in the diagnosis of significant fibrosis in the combined analysis (P=0.0149) and in the CVH group (P=0.0391), while both modalities were comparable in patients of the NAFLD group (P=0.2539). ElastPQ may be equally accurate as Fibroscan, and large prospective studies are required to validate the same.

Non-Alkolik Yağlı Karaciğer Hastalığında Fibrozisin Değerlendirilmesinde Karaciğer Elastografi Point Quantification Ölçümünün Rolü ve Diğer Non-İnvazif Yöntemlerle Karşılaştırılması

Non-Alkolik Yağlı Karaciğer Hastalığında Fibrozisin Değerlendirilmesinde Karaciğer Elastografi Point Quantification Ölçümünün Rolü ve Diğer Non-İnvazif Yöntemlerle Karşılaştırılması

Value of elastography point quantification in improving the diagnostic accuracy of early diabetic kidney disease.

BACKGROUNDDiabetic kidney disease (DKD) is a common complication of diabetes. The patient’s prognosis is poor once DKD progresses to advanced stage. Accurate diagnosis and timely treatment of early DKD are important for improving patient’s prognosis and reducing mortality.AIMTo explore the value of elastography point quantification (ElastPQ) in improving the accuracy of early DKD diagnosis.METHODSA total of 69 patients with type 2 diabetes were recruited from Naval Military Medical University Affiliated Gongli Hospital. Patients were divided into early DKD group and medium DKD group according to pathological results and urinary albumin excretion rate (UAER). Another 40 patients with simple diabetes were included as the diabetes group. The baseline data, laboratory diagnostic indicators, and ultrasound indicators for each patient were recorded. The differences of the indicators in the three groups were compared. Multivariate logistic regression was used to analyze the influencing factors of the development from simple diabetes into early DKD and from early DKD into medium DKD. Receiver operating characteristic analyses of potential indicators in identifying early DKD and medium DKD, and early DKD and simple diabetes were established.RESULTSMultivariate logistic regression analysis showed that UAER (P < 0.001), renocortical Young's Modulus (YM) (P < 0.001), and renal parenchymal thickness (P = 0.013) were the independent influencing factors of the development from early DKD into medium DKD. Diabetes duration (P = 0.041), UAER (P = 0.034), and renocortical YM (P = 0.017) were the independent influencing factors of the development from simple diabetes into early DKD. Receiver operating characteristic analysis indicated that UAER, renocortical YM, and renal parenchymal thickness were accurate in identifying early DKD and medium DKD [all area under curve (AUC) > 0.9]. The accuracy of UAER (AUC = 0.744), diabetes duration (AUC = 0.757), and renocortical YM (AUC = 0.782) for the diagnosis of early DKD and simple diabetes were limited. However, the combined diagnosis of UAER, diabetes duration, and renocortical YM was accurate in identifying early DKD and simple diabetes (AUC = 0.906), which was significantly higher than any of the three indicators (all P < 0.05).CONCLUSIONElastPQ is of great value in the diagnosis of early DKD. When combined with the diabetes duration and UAER, it is expected to diagnose accurately early DKD.

Prediabetes Is Associated With Increased Liver Stiffness Identified by Noninvasive Liver Fibrosis Assessment: ElastPQ Ultrasound Shear Wave Elastography Study.

Patients with type 2 diabetes mellitus (DM) have been shown to have increased liver fibrosis (LF) as determined by liver elastography. However, the data on LF incidence in patients with prediabetes are scarce. This study was undertaken to determine the incidence of LF and associated parameters in prediabetic patients. Three study groups with equal number of participants defined on the basis of glucose metabolism status were included the following: normal glucose metabolism (NGM), prediabetes, and newly diagnosed type 2 DM (55 patients in each group). Liver stiffness measurements were carried out using liver elastography point quantification, and 7 kPa or greater was considered to denote the presence of LF. Patients were subdivided into 2 groups as those with or without LF. Of the NGM, prediabetes, and type 2 DM subjects involved in the study 3.6%, 27%, and 38% were found to have LF (P < 0.001), respectively. Glycated hemoglobin (HbA1c), triglycerides, and alkaline phosphatase levels independently correlated with liver stiffness measurements (P < 0.05, for each). In addition, presence of mild or moderate-severe liver steatosis, hypertension, waist circumference, and HbA1c were independent predictors of the LF status. Presence of mild or moderate-severe liver steatosis, hypertension, waist circumference (each 1-cm increment), and HbA1c (each 1% increment) were associated with a 2.78-fold, 7.16-fold, 68%, and 36.7% increased likelihood of LF, respectively. As compared with subjects with NGM, patients with impaired glucose metabolism were more likely to have LF. As in patients with type 2 DM, a significant proportion of patients with prediabetes (27%) have LF, which is closely or independently associated with markers of metabolic syndrome.

Magnitude dependent discordance in liver stiffness measurements using elastography point quantification with transient elastography as the reference test.

To investigate diagnostic performance of point shear wave elastography by elastography point quantification (ElastPQ) for non-invasive assessment of liver fibrosis in patients with chronic liver diseases (CLD). Liver stiffness measurement (LSM) by transient elastography (TE) and ElastPQ was performed in patients with CLD and healthy volunteers. The stage of liver fibrosis was defined by TE which served as the reference. We compared two methods by using correlation, area under the receiver operating characteristics curve (AUC) analysis, Bland and Altman plot and Passing-Bablok regression. A total of 185 subjects (20 healthy volunteers and 165 patients with CLD (128 non-alcoholic fatty liver disease), 83 (44.9%) females, median age 53years, BMI 27.3kg/m2) were evaluated. There were 24.3%, 13.5% and 11.4% patients in ≥ F2, ≥ F3 and F4 stage, respectively. The best performing cutoff LSM values by ElastPQ were 5.5kPa for F ≥ 2 (AUC = 0.96), 8.1kPa for F ≥ 3 (AUC = 0.98) and 9.9kPa for F4 (AUC = 0.98). Mean (SD) difference between TE and ElastPQ measurements was 0.98 (3.27) kPa (95% CI 0.51-1.45, range 4.99-21.60kPa). Two methods correlated significantly (r = 0.86; p < 0.001), yet Bland and Altman plot demonstrated difference between measurements, especially with TE values > 10kPa. Passing and Bablok regression analysis yielded significant constant and proportional difference between ElastPQ and TE. ElastPQ is reliable method for assessment of liver fibrosis but LSM values are not interchangeable with TE, especially above 10kPa. Diagnostic performance of ElastPQ for sub-classification of patients with compensated advanced chronic liver disease should therefore be furtherly investigated. • ElastPQ appears to be reliable method for assessment of liver fibrosis, with data presented here mostly applicable to NAFLD. • LSM values produced by TE and ElastPQ are NOT interchangeable-in values < 10kPa, they are similar, but in values > 10kPa, they appear to be increasingly and significantly different. • Diagnostic performance of ElastPQ for sub-classification of patients with compensated advanced chronic liver disease should be furtherly investigated.

Point Shear Wave Elastography for Non-invasive Assessment of Liver Fibrosis in Patients with Viral Hepatitis

Elastography point quantification (ElastPQ) is a new ultrasound-based shear wave elastography method for non-invasive assessment of liver fibrosis. We evaluated the diagnostic accuracy of ElastPQ in patients with chronic viral hepatitis. Fibrosis stage (F) was determined by transient elastography (F0/F1: <7.1 kPa, F2: 7.1–9.4 kPa, F3: 9.5–12.4 kPa, F4: ≥12.5 kPa). Area under the receiver operator characteristics curve (AUROC) analysis was performed to assess ElastPQ cutoffs for significant fibrosis (≥F2) and cirrhosis (F4). Paired transient elastography and ElastPQ measurements were obtained from 217 patients (mean age ± SEM: 49 ± 0.79 years, 68.2% male, F0/F1: n = 98 [45.0%], F2: 47 [21.6%], F3: 22 [10.1%], F4: 50 [22.9%]). AUROC for ≥F2 was 0.843 (95% confidence interval: 0.791–0.895), and for F4, 0.933 (95% confidence interval: 0.894–0.972). The optimal ElastPQ cutoff for F2 was 6.68 kPa (sensitivity: 80.7%, specificity: 70.4%, positive predictive value: 78.5%, negative predictive value: 72.3%), and for F4 11.28 kPa (sensitivity: 86.0%, specificity: 85.6%, positive predictive value: 60.52%, negative predictive value: 97.16%). In conclusion, ElastPQ represents an accurate tool for non-invasive staging of liver fibrosis in patients with viral hepatitis.

Assessment of Liver Fibrosis With Elastography Point Quantification vs Other Noninvasive Methods

Elastography point quantification (ElastPQ) is a non-invasive method for assessing liver fibrosis based on liver stiffness. We evaluated the accuracy of ElastPQ for the staging of liver fibrosis in patients with chronic liver disease (CLD) compared with aspartate transaminase to platelet ratio index, fibrosis-4 index, and transient elastography (TE), using liver biopsy as reference standard. We performed a retrospective study of 406 patients with CLD of any etiology who underwent liver biopsy analysis from September 2012 through June 2017 at a clinic in Bologna, Italy. We obtained liver stiffness measurements, made by ElastPQ and TE, for 361 patients. Liver fibrosis stage was assessed by the METAVIR scoring system. Areas under the receiver operating characteristic curve (AUROC) were used to assess the diagnostic performance of ElastPQ. ElastPQ values correlated with histologic detection of fibrosis (r= 0.718; P < .001). The AUROC values were 0.856 for detection of significant fibrosis (F≥2), 0.951 for advanced fibrosis (F≥3), and 0.965 for cirrhosis. The best cut-off values identified for classifying patients with F≥2, F≥3, or cirrhosis were 6.0 kPa, 6.2 kPa, and 9.5 kPa, respectively: these were lower than those for TE. Comparison of ElastPQ with TE data resulted in superimposable diagnostic accuracy of both methods for each stage of liver fibrosis. Both elastography techniques performed better than aspartate transaminase to platelet ratio index or fibrosis-4 index scores (P < .05 for all AUROC comparisons). ElastPQ has good to excellent performance for the non-invasive staging of liver fibrosis in patients with CLD. ElastPQ identified patients with fibrosis or cirrhosis with levels of accuracy that were not inferior to those of TE, and outperformed serum fibrosis indexes in identifying each stage of liver fibrosis.

Non-invasive Assessment of Liver Fibrosis with ElastPQ: Comparison with Transient Elastography and Serologic Fibrosis Marker Tests, and Correlation with Liver Pathology Results

We investigated the feasibility of using ultrasound shear wave elastography point quantification (ElastPQ) for liver fibrosis staging and compared it with other non-invasive tools with respect to efficacy in liver stiffness measurement. A total of 106 patients who underwent liver stiffness measurements, using ElastPQ and biochemical investigations, before parenchymal liver biopsy or surgery were included. Among these, 51 also underwent transient elastography (TE). Correlations of ElastPQ, TE and aspartate aminotransferase-to-platelet ratio index (APRI) with histopathological findings (as the reference standard) were determined using Spearman's correlation coefficient. The diagnostic performance of ElastPQ, TE and APRI was evaluated using receiver operating characteristic (ROC) curve analysis. ElastPQ had good diagnostic accuracy in identifying each liver fibrosis stage, with an area under the ROC curve (AUC) of 0.810 to 0.864. Stiffness values obtained using ElastPQ, TE and APRI were significantly positively correlated (r = 0.686, r = 0.732 and r = 0.454, respectively) with histologic fibrosis staging (p < 0.001). According to the AUC for the diagnosis of significant fibrosis (≥F2) and cirrhosis (=F4), ElastPQ had better diagnostic accuracy (AUC = 0.929 and 0.834, respectively) than APRI (AUC = 0.656 and 0.618, respectively) (p < 0.05), and was similar to TE (AUC = 0.915 and 0.879, respectively). ElastPQ is a promising ultrasound-based imaging technique for evaluation of liver fibrosis, with a diagnostic accuracy comparable to that of TE.

The Relationship between Kidney Shear Wave Speed Measured Using the Elastpq Technique and Different Biomarkers of Chronic Kidney Disease

The present study aims to find a relationship between kidney shear wave speed (KSWS) measured using Elastography Point Quantification (ElastPQ) and different biomarkers of chronic kidney disease (CKD): a tubular injury marker- kidney injury molecule-1 (KIM-1), a marker of interstitial inflammation- urinary monocyte chemoattractive protein 1 (MCP1), markers of fibrogenesis- connective tissue growth factor (CTGF), and soluble Klotho, that inhibits fibrogenesis, as a pleiotropic effect. Our study included 38 patients (mean age 56.5+/-16.12 years; 19 female, 19 male) with diabetic kidney disease. In all patients KSWS was measured using ElastPQ (Philips Affinity) and median values of 5 valid KSWS measurements were calculated and expressed in meters/second (m/s). In all patients we assessed renal function- glomerular filtration rate (eGFR), and using an ELISA method, serum levels of: KIM-1, CTGF, klotho, and urinary levels of MCP1. We obtained a mean KSWS of 0.98+/-0.40 m/s (right kidney) and 0.90+/-0.37 m/s (left kidney). KSWS was significantly lower in male vs. female subjects (0.77 vs. 1.02 m/s, p=0.05), and in patients with eGFR < 60ml/min (0.8 vs. 1.1 m/s, p=0.05). KSWS showed also a decrease with age (r=-0.53, p=0.0009). We found a statistically significant correlation of KSWS with urinary MCP1 (r=0.34, p=0.05), and with the level of sKlotho (r=0.56, p=0.03), but no correlation with CTGF and KIM-1. Our study shows that KSWS is decreased in advanced stages of CKD, and this decreased levels are associated to reduced interstitial infiltration (urinary MCP1) and probably to increased interstitial fibrosis (low soluble Klotho).

Quantitative assessment of liver fibrosis in chronic viral hepatitis C patients using shear wave elastography with elastography point quantification feature

IntroductionHepatic fibrosis is the underlying pathological condition in chronic hepatitis C virus (HCV) infection. Shear wave elastography (SWE) with elastography point quantification (ElastPQ) feature is a recently developed method for measuring tissue elasticity. Aim of this studyTo evaluate the diagnostic value of SWE with ElastPQ feature for the quantitative assessment of liver fibrosis in patients with chronic HCV infection. Patients and methodsThis prospective study included 60 patients with chronic HCV infection and 50 healthy controls. All participants underwent imaging with ElastPQ technique for evaluation of the liver stiffness (LS). All patients underwent ultrasound guided liver biopsy. The METAVIR scores of fibrosis were illustrated. ResultsThe study participants included 50 controls (mean LS 3.12±0.40kPa), 5 patients with F0 score (mean LS 3.77±1.44kPa); 10 patients with F1 score (mean LS 7.50±0.68kPa), 23 patients with F2 score (mean LS 8.45±0.62kPa), 17 patients with F3 score (mean LS 9.64±1.20kPa) and 5 patients with F4 score (mean LS 12.61±1.41kPa). There was a highly significant correlation between the METAVIR scores of liver fibrosis and LS measurements assessed by ElastPQ SWE (p>0.0001). ConclusionThe ElastPQ SWE technique appears as a reliable non-invasive tool that can provide an optimal way to monitor liver tissue stiffness in patients with chronic HCV infection with high accuracy (97.6%) in recognition of the earlier fibrosis stage (F2).

Liver Stiffness and Serum Alpha-Fetoprotein in Discriminating Small Hepatocellular Carcinoma from Cirrhotic Nodule.

This study aimed to investigate the clinical significance of liver stiffness and serum alpha-fetoprotein (AFP) in differentiating small hepatocellular carcinoma (HCC) from cirrhotic nodule. A total of 95 chronic hepatitis B patients who were diagnosed with small HCC (n = 53) or cirrhotic nodule (n = 42) underwent ultrasound elastography point quantification (ElastPQ) examinations on lesion and background liver. Three stiffness parameters, lesion stiffness value (SV), absolute stiffness difference (ASD) of lesion and background liver, stiffness ratio (lesion/background liver) (SR), and serum AFP were retrospectively analyzed. Then, the capabilities of lesion SV, ASD, SR, AFP, and the combination of each individual stiffness parameter with AFP were evaluated in differentiating small HCC from cirrhotic nodule. Significantly higher lesion SV, ASD, SR, and serum AFP were observed in small HCC compared with cirrhotic nodule patients (all P ≤ 0.0001). By comparing the stiffness parameters on the patients with AFP greater than 20 ng/mL and AFP of 20 ng/mL or smaller, a higher lesion SV and comparable ASD and SR were found in the small HCC patients. The diagnostic accuracy of lesion SV, ASD, SR, and AFP in the discrimination of small HCC and cirrhotic nodule was 0.731, 0.825, 0.820, and 0.789, respectively. Moreover, the improved sensitivity was observed in the combination of liver stiffness with AFP (83%, 100%, and 92% for lesion SV/AFP, ASD/AFP, and SR/AFP, respectively). This study illustrated that the combination of liver stiffness and serum AFP has considerable clinical value in detecting suspicious small HCC from cirrhotic nodule.

Research on pediatric glomerular disease and normal kidney with shear wave based elastography point quantification

To evaluate the renal cortex stiffness in children with glomerular disease by shear wave based elastography point quantification (ElastPQ), and to investigate the association between shear wave velocity (SWV) in the renal cortex and age in normal children, and the inter-gender differences. One hundred and five children who were pathologically confirmed with glomerular diseases were selected as the disease group. Meanwhile, 120 healthy children were selected as the control group. Effective values were measured 5 times at the same kidney sites on each side. Comparisons of SWV measurements between left and right kidneys in the disease and control groups all showed significant differences (left kidney t=6.896, P=0.004; right kidney t=7.415, P=0.001). In the control group, left and right kidney SWV measurements were all positively correlated with age (left kidney r=0.792, P=0.003; right kidney r=0.794, P=0.004). Moreover, inter-gender difference was present in the right kidney measurements. ElastPQ technology has certain advantages in predicting pediatric glomerular disease compared to conventional ultrasound. ElastPQ technology contributes to the early diagnosis of the disease.

The assessment of the kidney using a new elastographic method – 2D-shear wave elastography GE (2D-SWE.GE)

Purpose: Different types of point shear wave elastography (Siemens-Virtual touch quantification, Phillips- Elastography point quantification) have been previously used to assess the kidneys. In the present study we aim to use for the first time a new method: 2D-SWE.GE (LogiqE9, GE Healthcare, Chalfont St Giles-UK), in order to analyze how many measurements are needed and what factors influence kidney shear wave speed (KSWS) in normal subjects.

Accuracy of elastography point quantification and steatosis influence on assessing liver fibrosis in patients with chronic hepatitis C.

Elastography point quantification is a novel non-invasive method for the assessment of liver fibrosis by measuring liver stiffness. The aim of this study was to evaluate the accuracy of elastography point quantification for the diagnosis of liver fibrosis and to assess impact of steatosis on liver stiffness measurement, in a cohort of patients with chronic hepatitis C. In this single-centre cross-sectional study, 211 consecutive patients with chronic hepatitis C, scheduled for liver biopsy, were examined with the elastography point quantification technology. On the same day, all patients underwent clinical examination, laboratory tests and abdominal ultrasound. The best cut-offs of liver stiffness measurement were 6.16kPa for the diagnosis of significant fibrosis (≥S3) and 6.79kPa for advanced fibrosis (≥S4). Areas under the receiver operating characteristic curve were 0.831 (CI: 0.773-0.880) for significant fibrosis, and 0.954 (CI: 0.916-0.978) for advanced fibrosis. Among patients within the same fibrosis stages (S0-S2 and S3-S6; S0-S3 and S4-S6), mean liver stiffness measurement values were similar in patients with steatosis (≥10% at liver biopsy or detected by ultrasound) compared to those without. Discordance between elastography point quantification and histology were affected by the presence of BMI>30kg/m2 (P=.047, CI: 0.136-0.988 and P=.020, CI: 0.083-0.812 respectively). In patients with chronic hepatitis C, elastography point quantification is an accurate non-invasive method for the diagnosis of significant and advanced fibrosis. The presence of obesity is a risk factor for misclassification of significant and advanced liver fibrosis.