Liver Ultrasound Elastography Research Articles

"Fontan Conduit Stent-Angioplasty and Progression of Fontan-Associated Liver Disease".

Patients with Fontan circulation insidiously develop congestive hepatopathy related to chronically reduced cardiac output and central venous hypertension, also known as Fontan-associated liver disease (FALD). Fontan pathway obstruction is increasingly detected and may accelerate FALD. The impact of conduit stent angioplasty on FALD is unknown. Retrospective, single-center review of patients with Fontan circulation who underwent conduit stent angioplasty at cardiac catheterization over 5-year period. Demographics and cardiac histories were reviewed. Labs, liver ultrasound elastography, echocardiogram, hemodynamic and angiographic data at catheterization were recorded pre- and post-stent angioplasty. Primary outcome was change in hepatic function via MELD-XI scores and liver stiffness (kPa), with secondary outcomes of ventricular function, BNP, and repeat catheterization hemodynamics. 33 patients underwent Fontan conduit stent angioplasty, 19.3 ± 7.0years from Fontan operation. Original conduit diameter was 19.1 ± 1.9mm. Prior to angioplasty, conduit size was reduced to a cross-sectional area 132 (91, 173)mm2 and increased to 314 (255, 363)mm2 post-stent. Subjects' baseline median MELD-XI of 11 (9, 12) increased to 12 (9, 13) at 19 ± 15.5months post-angioplasty (n = 22, p = 0.053). There was no significant change in liver stiffness at 12.1 ± 8.9months post-angioplasty (n = 15, p = 0.13). Median total bilirubin significantly increased (1.4 [0.9, 1.8]), from baseline 1.1 [0.7, 1.5], p = 0.04), as did median BNP (41 [0, 148] from baseline 34 [15, 79]; p = 0.02). There were no significant changes in ventricular function or repeat invasive hemodynamics (n = 8 subjects). Mid-term follow-up of Fontan subjects post-conduit stent angioplasty did not show improvements in non-invasive markers of FALD.

Exploring Opportunities to Enhance the Screening and Surveillance of Hepatocellular Carcinoma in Non-Alcoholic Fatty Liver Disease (NAFLD) through Risk Stratification Algorithms Incorporating Ultrasound Elastography.

Non-alcoholic fatty liver disease (NAFLD), with its progressive form, non-alcoholic steatohepatitis (NASH), has emerged as a significant public health concern, affecting over 30% of the global population. Hepatocellular carcinoma (HCC), a complication associated with both cirrhotic and non-cirrhotic NAFLD, has shown a significant increase in incidence. A substantial proportion of NAFLD-related HCC occurs in non-cirrhotic livers, highlighting the need for improved risk stratification and surveillance strategies. This comprehensive review explores the potential role of liver ultrasound elastography as a risk assessment tool for HCC development in NAFLD and highlights the importance of effective screening tools for early, cost-effective detection and improved management of NAFLD-related HCC. The integration of non-invasive tools and algorithms into risk stratification strategies could have the capacity to enhance NAFLD-related HCC screening and surveillance effectiveness. Alongside exploring the potential advancement of non-invasive tools and algorithms for effectively stratifying HCC risk in NAFLD, we offer essential perspectives that could enable readers to improve the personalized assessment of NAFLD-related HCC risk through a more methodical screening approach.

Liver Ultrasound Elastography in Non-Alcoholic Fatty Liver Disease: A State-of-the-Art Summary.

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease which is currently the most common hepatic disorder affecting up to 38% of the general population with differences according to age, country, ethnicity and sex. Both genetic and acquired risk factors such as a high-calorie diet or high intake of saturated fats have been associated with obesity, diabetes and, finally, NAFLD. A liver biopsy has always been considered essential for the diagnosis of NAFLD; however, due to several limitations such as the potential occurrence of major complications, sampling variability and the poor repeatability in clinical practice, it is considered an imperfect option for the evaluation of liver fibrosis over time. For these reasons, a non-invasive assessment by serum biomarkers and the quantification of liver stiffness is becoming the new frontier in the management of patients with NAFLD and liver fibrosis. We present a state-of-the-art summary addressing the methods for the non-invasive evaluation of liver fibrosis in NAFLD patients, particularly the ultrasound-based techniques (transient elastography, ARFI techniques and strain elastography) and their optimal cut-off values for the staging of liver fibrosis.

74 Implementation of routine point-of-care liver ultrasound elastography as quality improvement in a multidisciplinary cystic fibrosis clinic

74 Implementation of routine point-of-care liver ultrasound elastography as quality improvement in a multidisciplinary cystic fibrosis clinic

Accuracy of Ultrasound Elastography and Fibrosis-4 Index (FIB-4) in Ruling Out Cirrhosis in Obese Non-Alcoholic Fatty Liver Disease (NAFLD) Patients.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of advanced liver disease in the USA. Liver biopsy, the gold standard diagnostic test for evaluating liver fibrosis, is associated with significant risk and expense. The accuracy of ultrasound elastography and Fibrosis-4 index (FIB-4) in the obese NAFLD population is unknown. We aimed to compare the accuracy of ultrasound elastography and FIB-4 to liver biopsy in ruling out cirrhosis in NAFLD patients at a tertiary, transplant referral center in the US.Methods: We retrospectively evaluated 93 patients with a mean age of 53 years (SD: 13 years) who underwent liver ultrasound elastography and liver biopsy, and additionally calculated their FIB-4 at the time of biopsy. We compared the liver stiffness measurement (LSM) obtained from ultrasound elastography and FIB-4 with the pathology results for ruling out cirrhosis.Results: 85% of the patients were white, 53% were female, average BMI was 34.7 (SD: 6.7), 52% had diabetes, and 53% had hypertension. For biopsy-proven cirrhosis (prevalence 15%), a cut-off value of 12.5 kilopascals (kPa) for F4 had a sensitivity of 92% and a specificity of 54%. Values below this threshold excluded cirrhosis with 98% certainty. Compared to FIB-4, ultrasound elastography showed higher accuracy in ruling out cirrhosis (92% vs. 80% sensitivity, 98% vs. 95% negative predictive value (NPV), respectively).Conclusion: To our knowledge, this is the first study in a tertiary transplant referral center in the USA to show that ultrasound elastography was superior to FIB-4 and can be used as a reliable screening test to rule out cirrhosis in obese NAFLD patients at a 12.5 kPa cut-off. Therefore, helping to avoid the risk and expense associated with liver biopsy.

Can Liver Ultrasound Elastography Predict the Risk of Hepatocellular Carcinoma Recurrence After Radiofrequency Ablation? A Systematic Review and Meta-Analysis.

The role of liver stiffness (LS) on ultrasound elastography in the prediction of hepatocellular carcinoma (HCC) recurrence after treatment with radiofrequency ablation (RFA) is still unclear. Our aim was to perform a systematic review and meta-analysis to assess whether LS can predict the recurrence of HCC after RFA. Medline via PubMed, Embase, Scopus, and Cochrane Library databases, and abstracts of international conference proceedings were searched up to June 30, 2020. Cohort studies were included if they assessed the association between LS values measured by ultrasound elastography before RFA and HCC recurrence. 9 studies including 1373 patients with HCC treated by RFA, 643 of whom developed HCC recurrence, were identified. The mean value of LS before RFA was significantly higher in patients who developed HCC recurrence than in those who did not (weighted mean difference=11.98 kPa, 95%CI: 7.60-16.35, I2=63.8%). There was a significant positive association between LS value and HCC recurrence both at univariate (unadjusted HR=1.03, 95%CI: 1.00-1.07, I2=72.7%) and multivariate analysis (adjusted HR=1.03, 95%CI: 1.02-1.04, I2=0). Patients with LS value ≥13-14 kPa or >1.5 m/s have a higher risk of both HCC recurrence (unadjusted HR=2.18, 95%CI: 1.46-3.25, I2=49.7%; adjusted HR=2.41, 95%CI: 1.53-3.79, I2=0) and overall mortality (adjusted HR=4.38; 95%CI: 2.33-8.25, I2=0) in comparison with those with LS below these cutoffs. Liver ultrasound elastography appears to be a reliable tool to predict HCC recurrence and overall survival after RFA. This technique may be useful for the management of patients with HCC treated by RFA.

Serum lipids are associated with nonalcoholic fatty liver disease: a pilot case-control study in Mexico

BackgroundNonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease and cirrhosis. NAFLD is mediated by changes in lipid metabolism and known risk factors include obesity, metabolic syndrome, and diabetes. The aim of this study was to better understand differences in the lipid composition of individuals with NAFLD compared to controls, by performing direct infusion lipidomics on serum biospecimens from a cohort study of adults in Mexico.MethodsA nested case-control study was conducted with a sample of 98 NAFLD cases and 100 healthy controls who are participating in an on-going, longitudinal study in Mexico. NAFLD cases were clinically confirmed using elevated liver enzyme tests and liver ultrasound or liver ultrasound elastography, after excluding alcohol abuse, and 100 controls were identified as having at least two consecutive normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (< 40 U/L) results in a 6-month period, and a normal liver ultrasound elastography result in January 2018. Samples were analyzed on the Sciex Lipidyzer Platform and quantified with normalization to serum volume. As many as 1100 lipid species can be identified using the Lipidyzer targeted multiple-reaction monitoring list. The association between serum lipids and NAFLD was investigated using analysis of covariance, random forest analysis, and by generating receiver operator characteristic (ROC) curves.ResultsNAFLD cases had differences in total amounts of serum cholesterol esters, lysophosphatidylcholines, sphingomyelins, and triacylglycerols (TAGs), however, other lipid subclasses were similar to controls. Analysis of individual TAG species revealed increased incorporation of saturated fatty acyl tails in serum of NAFLD cases. After adjusting for age, sex, body mass index, and PNPLA3 genotype, a combined panel of ten lipids predicted case or control status better than an area under the ROC curve of 0.83.ConclusionsThese preliminary results indicate that the serum lipidome differs in patients with NAFLD, compared to healthy controls, and suggest that assessing the desaturation state of TAGs or a specific lipid panel may be useful clinical tools for the diagnosis of NAFLD.

The effect of water intake on ultrasound tissue characteristics and hemodynamics of adult livers.

Aim of the studyTo assess the effect of water intake on ultrasound tissue characteristics and hemodynamics of adult livers.Material and methodsIn February 2020, we prospectively performed ultrasound shear wave elastography and attenuation imaging (ATI) of the liver parenchyma, and spectral Doppler sonography of the portal vein and hepatic artery in 19 adult healthy volunteers (10 men and 9 women, mean age 27 years, mean body mass index 24.65 kg/m2). We measured liver shear wave velocity (SWV, m/s), shear wave dispersion (SWD, m/s/kHz), attenuation coefficient (dB/cm/MHz), main portal vein velocity (PVV, cm/s), hepatic artery peak systolic velocity (PSV, cm/s), and end diastolic velocity (EDV, cm/s) immediately before and at different time points (15, 30, 45, and 60 minutes) after water intake (1.0 l water and 1.5 l water for body weight < 150 lbs. and ≥ 150 lbs., respectively).ResultsThe differences in SWV, PVV, hepatic artery PSV and EDV before and after water intake were significant (p < 0.01) whereas the differences in SWD and ATI were not (p > 0.05) based on repeated measures ANOVA tests. The values of SWV, PVV, PSV, and EDV reached a peak at 30-45 minutes and returned to baseline 60 minutes after water intake. We observed positive correlations of SWV with PVV, PSV, and EDV in linear regression analyses (r2 > 0.73).ConclusionsWater intake affects the liver stiffness and hemodynamics. No water intake at least one hour prior to liver ultrasound elastography and Doppler sonography is recommended.

Total bile acid-to-cholesterol ratio as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with non-cholestatic chronic hepatitis B virus infection.

Although serum bile acids and total cholesterol (TC) are closely related to liver cirrhosis, the potential diagnostic value of total bile acid-to-cholesterol ratio (TBA/TC) for liver fibrosis is unclear. The present study aimed to evaluate the value of TBA/TC in the diagnosis of cirrhosis and the relationship between TBA/TC and significant liver fibrosis in chronic hepatitis B virus (HBV) infected patients without cholestasis.667 patients with alkaline phosphatase (ALP) ≤ 1.5 upper limit of normal (ULN) and gamma-glutamyl transferase (GGT) ≤ 3 ULN were rigorously included in this cross-sectional study. Liver biopsy was performed in 32 patients and METAVIR scoring system was used to evaluate liver fibrosis stage. Liver ultrasound elastography was performed in 138 patients, significant fibrosis was defined as fibrosis ≥ F2. Multiple logistic regression as well as receiver operating characteristic (ROC) curves analyses were performed.Compared to patients with non-cirrhosis, TBA and TBA/TC were significantly higher in cirrhosis while TC was significantly lower (all P < .001). In multivariate analysis, TBA/TC was also independently associated with cirrhosis [odds ratio (OR) = 1.102, 95% confidence interval (CI): 1.085–1.166]. The area under the curve (AUC) of TBA/TC (0.87) was almost equivalent to the aspartate aminotransferase to platelet ratio index (APRI, AUC = 0.84) and fibrosis 4 score (FIB-4, AUC = 0.80), and the optimal cut-off value for TBA/TC to diagnose cirrhosis was 2.70. Among the patients performed liver biopsy, TBA/TC were significantly higher both in significant fibrosis and cirrhosis as well as significantly correlated with fibrosis stage (all P < .001). Furthermore, In patients performed liver ultrasound elastography, TBA/TC was also independently associated with significant fibrosis (OR = 1.040, 95% CI: 1.001–1.078).Assessment of TBA/TC could serve as an additional marker of significant liver fibrosis and cirrhosis in non-cholestatic chronic HBV infection.

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version).

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version).

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, update 2017 (long and short version)

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, update 2017 (long and short version)

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version).

We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography, focused on the assessment of diffuse liver disease. The first part (long version) of these Guidelines and Recommendations deals with the basic principles of elastography and provides an update of how the technology has changed. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided regarding optimization of scanning technique, image display, image interpretation, reporting of data and some of the known image artefacts. The second part provides clinical information about the practical use of elastography equipment and the interpretation of results in the assessment of diffuse liver disease and analyzes the main findings based on published studies, stressing the evidence from meta-analyses. The role of elastography in different etiologies of liver disease and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users.

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version).

We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography with a focus on the assessment of diffuse liver disease. The short version provides clinical information about the practical use of elastography equipment and interpretation of results in the assessment of diffuse liver disease and analyzes the main findings based on published studies, stressing the evidence from meta-analyses. The role of elastography in different etiologies of liver disease and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users.

Ultrasound elastography of the liver for assessing the risk of complications of its cirrhosis of different etiologies

To study the results of dynamic liver ultrasound elastography (LUE) in assessing the risk of complications of liver cirrhosis (LC) of different etiologies and to elaborate a monitoring program for estimation of the predictive value of elastography in patients with LC. A total of 194 patients with LC of different etiologies, including 56 patients with alcoholic cirrhosis, 48 with LC and an outcome of nonalcoholic fatty liver disease, 53 with LC and an outcome of chronic hepatitis C, 23 with LC and an outcome of chronic hepatitis B, and 14 with an outcome of coinfection with hepatitis B and D viruses, were examined. An analysis was made between the presence of a number of LC complications and the results of LUE, by constructing the receiver operating characteristic (ROC) curves to select LUE threshold values, in which there was a high risk for LC complications (esophageal varices, bleeding esophageal varices, hepatic encephalopathy, and ascites). The investigation could obtain liver elastography threshold values expressed in kilopascals (kPa), which were proposed for use as a prognostic sign of the presence of complications caused by LC and assessed liver elastography threshold values for its mortality prediction. The predictive value of positive LUE results in determining the risk of different complications was 75.7 to 92.5%; that of negative results was 70 to 92.9%. An algorithm for individualized diagnostic and treatment policy was elaborated in relation to the liver elastography results obtained during the primary examination of a patient. The dynamic LUE findings in patients with LC of different etiologies suggest that the proposed LUE threshold values are efficient and may be used in practical healthcare, which will be able to timely correct management tactics for a patient and to monitor his treatment.

Shear Wave Elastography in Children

Most recently the update on the 2013 published European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines and Recommendations on the clinical use of elastography have been published focusing on the assessment of diffuse liver disease (1, 2). The first part of the long version of these EFSUMB Guidelines deals with the basic principles of elastography including the reasons why ultrasound can be used to make elastograms. Transient elastography (TE) is explained as shear wave elastometry by measurement of the speed of a shear wave that has been generated using a surface impulse. Point shear wave elastography (pSWE) is explained as shear wave elastometry at a location by measurement of the speed of a shear wave generated using acoustic radiation force. Multidimensional shear-wave elastography (2D-SWE, 3D-SWE) is described as quantitative SWE imaging (and elastometry) by measuring the speed of shear waves generated using acoustic radiation force. Acoustic radiation force impulse (ARFI) imaging is discussed as well (1, 2). Guidance is provided on optimization of scanning technique, image display, image interpretation, reporting of data and some of the known image artefacts. The second and clinical part provides clinical information about the practical use of elastography equipment and interpretation of results in the assessment of different etiologies of diffuse liver disease including normal values and reliability indices (1-4). Comparative little is known about pediatric patients. Data regarding the pediatric population with biliary atresia suggest that liver (and spleen) elastography could be a valuable tool to predict outcomes before surgery, and might be used after the Kasai operation to monitor liver disease and portal hypertension [(5)]. Many other indications have been shown of value in daily practice but comparative studies are lacking. Here we present the current knowledge and our own data on the use of elastography in pediatric patients including the use of strain elastography (SE) and strain-rate imaging (quasi-static strain imaging). Future perspectives of this promising method are discussed as well. 1. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med 2017. 2. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version). Ultraschall Med 2017. 3. Dong Y, Sirli R, Ferraioli G, Sporea I, Chiorean L, Cui X, Fan M, et al. Shear wave elastography of the liver - review on normal values. Z Gastroenterol 2017;55:153-166. 4. Dietrich CF, Dong Y. Shear wave elastography with a new reliability indicator. J Ultrason 2016;16:281-287. 5. Colecchia A, Di Biase AR, Scaioli E, Predieri B, Iughetti L, Reggiani ML, Montrone L, et al. Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure. Dig Liver Dis 2011;43:659-663.

Ultrasound elastography to evaluate keloids.

Sir: Ultrasound elastographic methods have provided the means for the objective and noninvasive evaluation of the stiffness of organs, such as the liver, breast, and thyroid. For example, liver ultrasound elastography provides information regarding the stage of fibrosis and can help physicians manage patients.1 We herein report our experience using ultrasound elastography to evaluate keloids. The device used in this study was a HITACHI Hivision Avius ultrasound scanner with real-time strain elastography and the L74M linear (5–13 MHz) probe (Hitachi Medical Corporation, Tokyo, Japan). This device calculates the tissue deformation or strain induced by a stress that is applied with slight free hand compression. The extent of the strain of the tissue is related to its stiffness, that is, the value decreases as the tissue becomes harder. The strain elastography provides a qualitative measurement of stiffness that is expressed as the ratio to a control region, such as the normal dermis. A 53-year-old man sustained an immature, elevated keloid with pain and itching on his chest (Fig. 1). The strain ratio defined as the normal dermis/keloid value was 21.0 (Fig. 1B). A 31-year-old woman had a mature flattened keloid after intralesional injection of steroids on her left shoulder and the strain ratio (normal dermis/keloid) was 0.76 (Fig. 2). These results suggest that the strain of the immature elevated keloid had a small value, and the strain ratio defined as the value of the normal dermis/keloid was increased compared to that of the mature flattened keloid.Fig. 1: A, A 53-year-old man sustained an immature elevated keloid on his chest that was associated with pain and itching. The white line indicates the location examined by the linear probe used for the ultrasound elastography. B, The ultrasound elastography image. The white arrow shows the separation between the normal skin and the keloid. The hyperechoic area on the left is the normal skin, and the hypoechoic area on the right is the keloid. Each strain was measured in the range enclosed by a square in the normal dermis and in the range enclosed by a circle in the keloid. The extent of the strain of the tissue is related to its stiffness, and the value decreases as the tissue becomes harder. The strain ratio defined as the value of the normal dermis/keloid was 21.0.Fig. 2: A, A 31-year-old woman developed a mature flattened keloid on her left shoulder after treatment with intralesional steroid injections. The white line indicates the location examined with the linear probe. B, The ultrasound elastography image. The white arrow shows the separation between the normal skin and the keloid; the area on the left is the normal skin and the area on the right is the keloid. The keloid lesion had a similar echo signal to normal skin, but it appeared slightly atrophic. The strain ratio (normal dermis/keloid) was 0.76.Accurate scar assessment before and after interventional treatments demands a quantitative and noninvasive analysis of the scar properties, but at present, there is no reliable assessment tool for measuring the characteristics of cutaneous scars.2 Although ultrasonography is a technique that can be conveniently used in daily practice and had demonstrated a good basic accuracy and reliability in scar management,2–4 there are no reports that show the stiffness of scars determined using ultrasound elastography. Although we reported only 2 cases in this study, our data indicate that ultrasound elastography can be used to assess the stiffness of keloids and scars and, consequently, to monitor the effectiveness of conservative treatment of keloids objectively by comparing the stiffness values. This method warrants further development. Bessonart et al5 examined pathological scars by B-scan ultrasound and demonstrated that the pathologic scars had significantly reduced densitometric values compared with the neighboring healthy skin. In our study, the immature elevated keloid was shown as a hypoechoic area, while the mature flattened keloid had a similar echo signal to normal skin in the B-scan. We can examine B-scans using the same device used for elastography, and a combination of these data may provide useful data for evaluating keloids and scars. In conclusion, the evaluation of keloids using ultrasound elastography allows for a noninvasive examination to provide objective measurements of the stiffness of the lesions, and it seems to have the potential to be used as a tool to assess skin scars. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

The role of ultrasound elastographic techniques in chronic liver disease: Current status and future perspectives

This review illustrates the state of the art clinical applications and the future perspectives of ultrasound elastographic methods for the evaluation of chronic liver diseases, including the most widely used and validated technique, transient elastography, followed by shear wave elastography and strain imaging elastography. Liver ultrasound elastography allows the non-invasive evaluation of liver stiffness, providing information regarding the stage of fibrosis, comparable to liver biopsy which is still considered the gold standard; in this way, it can help physicians in managing patients, including the decision as to when to start antiviral treatment.The characterization of focal liver lesions and the prognostic role of the elastographic technique in the prediction of complications of cirrhosis are still under investigation.

Chaperone therapy for neuronopathic Gaucher disease

Liver ultrasound elastography (LUE) is considered being one of the promising methods of non-invasive diagnostics of hepatic fibrosis (HF) stages in mucopolysaccharidoses (MPS), however data of using it in children in national and foreign literature are lacking. Objective:Detection of hepatic fibrosis severity stage in chidrenwith MPS with LUE. Materials and methods. We examined 20 children with MPS at the age from 1,5 to 17 (median age 8.0±4.8 years), of them 3 children with the I type, 11 —with the II, 4—with the III, and 2—with the VI type. All childrenwere performed LUE on “Fibroscan” (EchoSens, France). Results and their discussion: In 10 (50%) of 20 children median elasticity exceedance from 5.7 to 13.1 kPa was noted. Of them in 4 patients indices corresponded to minimal HF (F1), in 2 — to moderate fibrosis (F2), in 3 — to severe fibrosis (F3), and in 1 — to cirrhosis (F4). Besides, in 5 (50,0%) of 10 children having normal elasticity median (F0), up to LUE indexes, elevated indexes in separate measurements (from 6.1 to 23.4 kPa) were recorded, allowing us to identify them as the risk group because of diffuse sclerotic changes in the liver. Conclusion: According to LUE data results, 50% of children have fibrotic changes in the liver, of them in 40% of cases severe HF and cirrhosis is noted; and next 50% are in the risk group because of HF developing. LUE is informative non-invasive diagnostic method of HF severity stage in children with MPS.

Liver ultrasound elastography using in children with mucopolysaccharidoses

Liver ultrasound elastography (LUE) is considered being one of the promising methods of non-invasive diagnostics of hepatic fibrosis (HF) stages in mucopolysaccharidoses (MPS), however data of using it in children in national and foreign literature are lacking. Objective:Detection of hepatic fibrosis severity stage in chidrenwith MPS with LUE. Materials and methods. We examined 20 children with MPS at the age from 1,5 to 17 (median age 8.0±4.8 years), of them 3 children with the I type, 11 —with the II, 4—with the III, and 2—with the VI type. All childrenwere performed LUE on “Fibroscan” (EchoSens, France). Results and their discussion: In 10 (50%) of 20 children median elasticity exceedance from 5.7 to 13.1 kPa was noted. Of them in 4 patients indices corresponded to minimal HF (F1), in 2 — to moderate fibrosis (F2), in 3 — to severe fibrosis (F3), and in 1 — to cirrhosis (F4). Besides, in 5 (50,0%) of 10 children having normal elasticity median (F0), up to LUE indexes, elevated indexes in separate measurements (from 6.1 to 23.4 kPa) were recorded, allowing us to identify them as the risk group because of diffuse sclerotic changes in the liver. Conclusion: According to LUE data results, 50% of children have fibrotic changes in the liver, of them in 40% of cases severe HF and cirrhosis is noted; and next 50% are in the risk group because of HF developing. LUE is informative non-invasive diagnostic method of HF severity stage in children with MPS.

29 Diagnostic capabilities of liver ultrasound elastography in the care of children with cystic fibrosis

29 Diagnostic capabilities of liver ultrasound elastography in the care of children with cystic fibrosis