Non-invasive Assessment Of Liver Fibrosis Research Articles

Noninvasive assessment of liver fibrosis in pediatric intestinal failure patients using liver stiffness measurement by Vibration-Controlled Transient Elastography

PurposeThe purpose of this study was to evaluate the diagnostic utility of noninvasive Vibration-Controlled Transient Elastography (VCTE) for assessing liver fibrosis in pediatric intestinal failure (PIF) patients. MethodsData from children with severe intestinal failure (≥90 days parenteral nutrition dependence) who underwent liver stiffness measurement (LSM), as measured by VCTE, at our institution between December 2015 and March 2018 were reviewed. LSM was compared to METAVIR fibrosis score (F0-F4) on liver biopsy performed within 1 year of VCTE. ResultsSeventy children underwent 75 LSM. Sixty-three patients (38% female) had at least one valid LSM, and 63% had a history of cholestasis (direct bilirubin ≥2 mg/dL). Median (IQR) age at first valid LSM was 4.5 years (2.6, 8.7). Sixteen patients had a liver biopsy. LSM differentiated between METAVIR F0-F1 (n = 6) and F2-F4 (n = 10) with an area under the receiver operating characteristic (AUROC) curve of 0.883 (95% CI: 0.686–0.999). The optimal cut-point derived to predict F2-F4 was an LSM ≥6 kPa (sensitivity 80%, specificity 100%). ConclusionLSM as determined by VCTE can distinguish mild (F0-F1) from moderate/severe (F2-F4) liver fibrosis in PIF. VCTE could allow for serial noninvasive monitoring of liver injury, potentially facilitating timely modifications to hepatoprotective management.Type of Study: Study of Diagnostic Test.Level of Evidence: II.

Non-invasive assessment of liver fibrosis and prognosis: an update on serum and elastography markers

ABSTRACTIntroduction: Non-invasive assessment of fibrosis is increasingly utilized in clinical practice to diagnose hepatic fibrosis. Non-invasive assessment of liver fibrosis relies on biologic and/or physical properties to assess tissue fibrosis. Serum markers estimate fibrosis by incorporating markers reflecting hepatic function (indirect markers) and/or markers measuring extracellular matrix degradation/fibrogenesis (direct markers). Radiology based techniques relay the mechanical properties and stiffness of a tissue, with increased stiffness associated with more advanced fibrosis.Areas covered: In this comprehensive review, the recent literature discussing serum markers and elastography-based techniques will be covered. These modalities are also explored in the setting of various liver diseases.Expert opinion: The etiology of liver disease and clinical context should be taken into consideration when non-invasive markers are incorporated in clinical practice. Non-invasive assessment of fibrosis has been most extensively utilized in hepatitis C, followed by hepatitis B and nonalcoholic fatty liver disease, but its role remains less developed in other etiologies of liver disease such as alcohol-associated liver disease and autoimmune liver disease. The role of non-invasive markers in predicting progression or regression of fibrosis, development of liver-related events and survival needs to be further explored.

Performance of a 2D-SWE implemented on a new system for predicting different stages of liver fibrosis using Transient Elastography as the reference method

Aim To evaluate the performance of 2D Shear-Wave Elastography from General Electric (2D-SWE.GE), implemented on the new LOGIQ P9 system, for the non-invasive assessment of liver fibrosis, and to identify liver stiffness (LS) cut-off values for predicting different stages of fibrosis, using Transient Elastography (TE) as the reference method. Material and Method Our study included 234 consecutive subjects, with or without chronic hepatopathies, in whom LS was evaluated in the same session by means of two elastographic techniques: TE (FibroScan, EchoSens) and 2D-SWE.GE (LOGIQ P9, GE Healthcare). Reliable liver stiffness measurements (LSM) were defined for TE as the median value of 10 measurements with an interquartile range/median ratio (IQR/M) Results Reliable LS measurements were obtained in 217/234 (92.7%) subjects by 2D-SWE.GE and in 222/234 (94.8%) by TE, so the final analysis included 205 subjects (p = 0.454). 36% (74/205) of subjects included in the study were healthy liver subjects. Based on TE [1] cut-off values we divided the rest of our cohort into 4 groups: F Conclusion The mean LS values for normal subjects for 2D-SWE-GE (P9) was 5.05 ± 0.83 kPa. The best 2D-SWE.GE (P9) cut-off values for predicting F ≥ 2, F ≥ 3 and F = 4 were 6.8 kPa, 7.6 kPa and 9.3 kPa.

Comparison between the performance of Two-Dimensional and Point Shear Wave elastography for the noninvasive assessment of liver cirrhosis

Background and aim The goals of this study were to compare the noninvasive diagnostic performance of two elastography techniques for the diagnosis of liver cirrhosis in a cohort of patients with known hepatitis C virus using Transient Elastography FibroScan as the method of reference since it is a validated tool for the non-invasive assessment of liver fibrosis. Material and Methods The study included 122 patients aged 38-80 (62 ± 7.9), 35% male (43/122), 65% female (79/122) with known hepatitis C virus in whom liver stiffness was evaluated during the same session by means of three elastography Methods: Point Shear Wave Elastography (pSWE) using virtual touch quantification(VTQ) technology Siemens Acuson S2000TM, Two-Dimensional Shear Wave Elastography (2D-SWE) embedded in General Electrics LOGIQ E9 ultrasound machine and Transient Elastography(TE;FibroScan, EchoSens). Reliable LS measurements were defined, for all techniques, as the median value of 10 measurements with an interquartile range/median(IQR/MED) Results Reliable liver stiffness measurements were obtained in 93% (114/122) of cases by means of TE, 88% (107/122) of cases by means of VTQ and 87% (106/122) of cases by means of 2D-SWE.GE. In the final analysis we included 93 patients which had reliable stiffness measurements with all methods.The AUROCS were calculated considering TE as the reference method. The optimal cutoff of VTQ for cirrhosis was 1.77m/s(SE:83%; SP:88%; AUC:0.89) and for 2D-SWE.GE was 10.2 kPa(SE:86%; SP:77%; AUC:0.89). No statistical differences were found between both methods(p Conclusion Both methods have similar performance for diagnosing liver cirrhosis and seem to be a promising alternative to Transient Elastography in evaluating patients with liver fibrosis.

Validation of a New Point Shear-Wave Elastography Method for Noninvasive Assessment of Liver Fibrosis: A Prospective Multicenter Study.

ObjectiveTo validate the diagnostic value of a new point shear-wave elastography method, S-shearwave elastography (S-SWE; Samsung Medison Co., Ltd.), in noninvasive assessment of liver fibrosis.Materials and MethodsIn this prospective multicenter study, liver stiffness (LS) measurements for 600 participants were obtained with both S-SWE and transient elastography (TE). The rates of unsuccessful LS measurements in S-SWE and TE were compared, and correlations between S-SWE and TE measurements were assessed. In 107 patients with histologic reference data, the optimal LS cut-off values for predicting severe fibrosis and cirrhosis on S-SWE were determined using receiver operating characteristic (ROC) curve analysis. The LS cut-off values in S-SWE were then validated in 463 patients without histologic reference data by using TE values as the reference standard, and the sensitivity and specificity of the cut-off values for predicting severe fibrosis and cirrhosis were calculated.ResultsThe frequency of unsuccessful LS measurements on TE (4.5%, 27/600) was significantly higher than that (0.7%, 4/600) on S-SWE (p < 0.001). LS measurements on S-SWE showed a significant correlation with TE values (r = 0.880, p < 0.001). In 107 patients with histological reference data, the areas under the ROC curves on S-SWE were 0.845 and 0.850, with optimal cut-offs of 7.0 kilopascals (kPa) and 9.7 kPa, for the diagnosis of severe fibrosis and cirrhosis, respectively. Using these cut-off values, S-SWE showed sensitivities of 92.9% and 97.4% and specificities of 89.5% and 83.1% in TE-based evaluations of severe fibrosis and cirrhosis, respectively.ConclusionLS measurements on S-SWE were well correlated with those on TE. In addition, S-SWE provided good diagnostic performance for staging of hepatic fibrosis, with a lower rate of unsuccessful LS measurements compared with TE.

Value of viscosity, viscoelasticity and attenuation measurement using shear wave ultrasound elastography

Nonalcoholic Liver Disease (NAFLD) is increasing in frequency in daily practice. Evaluation of such patients needs to assess steatosis, fibrosis and inflammation.A new Ultrasound(US) system from Canon noninvasively evaluates these parameters by measuring shear waves speed (2D-SWE) - related to viscoelasticity and fibrosis; dispersion (DI) - related to viscosity and inflammation, and attenuation parameter (ATI) - related to steatosis. Aim: To evaluate the usefulness of 2D-SWE, DI and ATI measurements obtained using Aplio i800 from Canon, for the noninvasive assessment of liver fibrosis, inflammation, and steatosis using Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) as the reference method. Material and Method: 113 consecutive subjects were included in the study group, mostly NAFLD patients, in whom liver stiffness (LS) and steatosis were evaluated in the same session by means of 2 elastography techniques: TE with CAP (FibroScan, EchoSens) and 2D-SWE with ATI(Aplio I800, Canon). Reliable LS measurements were defined for TE as the median value of 10 measurements with an interquartile range/median ratio (IQR/M) To discriminate between TE fibrosis stages we used the following cut-offs [1]: F ≥ 2: 8.4 kPa and F4: 13.2 kPa and to discriminate between steatosis stages we used the following cut-offs recommended by the manufacturer: S1(mild) – 230db/m, S2(moderate) - 275db/m, S3(severe) - 300db/m. Results: Reliable LS measurements were obtained in 99.1% subjects by both 2D-SWE and TE.A very strong positive correlation was found between the LS values obtained by the 2 Methods: r = 0.88, p The best cut-off value for fibrosis, for F0/1 was ≤ 6.2 kPa (AUROC 0.82; Se = 75%; Sp = 85.5%), for F ≥ 2 it was 7.9 kPa (AUROC 0.96; Se = 90.4%; Sp = 95.6%), for F4 it was 11.7 kPa (AUROC 0.99; Se = 100%; Sp = 96%). Regarding steatosis, the best cut-off values were: for S1 = 0.64 dB/cm/mHz (AUROC 0.89; Se = 73.6%; Sp = 88.8%), for S2 = 0.79 dB/cm/mHz (AUROC 0.88; Se = 63.4%; Sp = 96.4%), for S3 = 0.86dB/cm/mHz (AUROC 0.95; Se = 45%; Sp = 100%). When we divided the cohort into healthy vs patients with chronic hepatopathies, we found out that the mean DI values in the pathology group were higher than in the healthy group(12.4 ± 2.7 vs 11.5 ± 1.9, p = 0.03) Conclusion: 2D-SWE and ATI measurements with the new system strongly correlate with TE and CAP results 110.1111/apt.14529

Non-invasive liver fibrosis assessment correlates with collagen and elastic fiber quantity in patients with hepatitis C virus infection.

Elastic fiber deposition is a cause of irreversibility of liver fibrosis. However, to date, its relevance to clinical features has not yet been clarified. This study aimed to clarify the correlation between non-invasive markers of fibrosis and fiber quantity, including elastic fiber, obtained from computational analysis. This retrospective study included 270 patients evaluated by non-invasive liver fibrosis assessment prior to liver biopsy. Of these patients, 95 underwent magnetic resonance elastography (MRE) and 244 were assessed with Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+ -M2BP). Using whole-slide imaging of Elastica van Gieson-stained liver biopsy sections, the quantity of collagen, elastin, and total fiber (elastin + collagen) was determined. The total fiber quantity showed significant linear correlation with fibrosis stage F0-F4. Collagen fiber quantity increased from stage F0 to F4, whereas elastic fiber quantity increased significantly only from stage F2 to F3. Spearman's rank correlation test revealed that non-invasive liver fibrosis assessment significantly correlates with each fiber quantity, including correlation between total fiber quantity and the Fibrosis-4 (FIB-4) index (r = 0.361, P < 0.001), WFA+ -M2BP values (r = 0.404, P < 0.001), and liver stiffness value by MRE (r = 0.615, P < 0.001). Receiver operating characteristic (ROC) curve analyses revealed that the area under ROC for predicting higher elastic fiber (>3.6%) is 0.731 by FIB-4 index, 0.716 by WFA+ -M2BP, and 0.822 by liver stiffness by MRE. Liver fibrosis correlates with fiber quantity through non-invasive assessment regardless of fiber type, including elastic fiber. Moreover, MRE is useful for predicting high amounts of elastic fiber.

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.

Noninvasive assessment and risk factors of liver fibrosis in patients with thalassemia major using shear wave elastography

ABSTRACTObjectives: This study aimed to estimate the prevalence of liver fibrosis and assess the risk factors for developing significant liver fibrosis in patients with Thalassemia Major (TM).Methods: All patients with TM over the age of 10 years were included in the study.Results: A total of 94 eligible patients underwent 2-D SWE. The median age was 26.7 years. The median of the average 5-year serum ferritin (5yrSF) and liver iron concentration (LIC) assessed by MRI T2* were 1326 µg/L and 6.7 mg/g dw, respectively. Hepatitis C and hepatitis B core antibodies were positive in 38% and 1% of the patients respectively. The proportion of patients with significant fibrosis was 60%. Male gender increased the risk of significant fibrosis (Odds ratio of 0.4; p = .0373). Additionally, the 5yrSF (p = .00661), the LIC (p = .0225) and the lowest LIC of the previous 5 years (p = .0211) were significant. In the multivariable logistic regression model, only 5yrSF (p = .0035) and gender (p = .00984) remained significant.Conclusions: The risk of liver fibrosis is associated with iron overload and gender in patients with TM.

The study of diffusion kurtosis imaging value for assessing liver fibrosis and comparison with ultrasound elastography

Objective To explore the efficacy difference of diffusion kurtosis imaging (DKI) and ultrasound elastography (UE) in the diagnosis of liver fibrosis. Methods Thirty-five patients whose serological examination showed hepatitis B or hepatitis C virus infection, disease course ≥ 1 year, and finally liver biopsy confirmed pathological fibrosis grade in Tianjin Second People's Hospital from December 2015 to April 2017 were prospectively enrolled as patient group. During the same period, twenty healthy volunteers who matched the age, sex and BMI with patient group and showed normal liver function within the last month were enrolled as control group. All of the subjects underwent DKI experiment, and subjects in patient group underwent UE experiment in addition. Liver mean apparent diffusion (MD) and mean kurtosis (MK) were obtained in all subjects and liver stiffness measurement (LSM) was obtained in patient group. The patient group was staged for hepatic fibrosis based on liver biopsy results (S0 to S4). Differences in liver MD and MK values between control and patient groups were tested using independent sample t test (normal distribution) or Mann-Whitney U test (skewed distribution). Differences in liver MD, MK, and LSM between patients with different fibrosis stages were tested using One-way ANOVA (normal distribution) or Kruskal-Wallis test (skewed distribution). The correlation between liver MD, MK and LSM values with fibrosis stages were analyzed using Pearson correlation test. The diagnostic performance in staging fibrosis was analyzed using ROC analysis. Results Liver MD in patient group was lower than that in control group, and the difference was statistically significant (P 0.05). The AUC value for the diagnosis of liver fibrosis by MD was 0.950 (95% CI: 0.855 to 0.990). Of the 35 patients, 15 were S1 (mild fibrosis), 13 were S2 (moderate fibrosis), 4 were S3, 3 were S4 (S3+S4 were severe fibrosis). The difference of MD and LSM between different stages of liver fibrosis was statistically significant (P 0.05). Liver fibrosis stages was highly correlated with MD (r=-0.757, P<0.01), and had no correlation with MK (r=-0.010, P=0.956), and moderately correlated with LSM (r=0.440, P<0.01). The AUC values of liver MD and LSM for characterization of ≥S2 stage liver fibrosis were 0.867 and 0.800, respectively, without statistically significant difference (P=0.486). The AUC values for characterization of ≥S3 stage liver fibrosis were 0.918 and 0.653, respectively, with a statistically significant difference (P=0.032). Conclusion MD derived from DKI can be used for noninvasive assessment of liver fibrosis, and it is superior to LSM in distinguishing different fibrosis stages and detecting severe fibrosis. Key words: Liver fibrosis; Diffusion kurtosis imaging; Ultrasound elastography

Non-invasive Fibrosis Testing in Patients with Chronic Hepatitis B

Summarizing the available evidence and advantages and disadvantages of the use of non-invasive tests for the management of patients with chronic hepatitis B virus (HBV) infection, including before and during antiviral therapy. Staging of liver fibrosis and early detection of compensated cirrhosis are critical in the treatment decisions and surveillance of HBV patients. Non-invasive assessment of liver fibrosis has been one of the major advances in hepatology over the past decade, relying either on the dosage of serum biomarkers or on the measurement of liver stiffness, using either ultrasound- or magnetic resonance-based elastography techniques. The most widely used and validated tests in HBV patients are APRI, FIB-4 (non-patented), and FibroTest-Fibrosure® (patented) for serum biomarkers and transient elastography. Liver stiffness also has prognostic value in the context of cirrhosis. Non-invasive tests are now recommended by national and international guidelines as first-line tools for fibrosis assessment.

Serum cytokines, adipokines and ferritin for non-invasive assessment of liver fibrosis in chronic liver disease: a systematic review.

Chronic liver disease (CLD) is a major health problem worldwide. Non-alcoholic fatty liver disease (NAFLD), chronic hepatitis C (CHC), chronic hepatitis B (CHB), and alcoholic liver disease (ALD) are the most common etiologies of CLD. Liver biopsy is the gold standard for assessment of liver fibrosis, however, it is an invasive method. This review attempts to evaluate the usefulness of serum adiponectin, serum leptin, serum ferritin, serum transforming growth factor-β1 (TGF-β1), and serum platelet derived growth factor-BB (PDGF-BB) as non-invasive markers in the diagnosis of liver fibrosis/cirrhosis. A systematic search in MEDLINE, Web of Science, Scopus, and local databases was performed to identify articles published in English or Persian as of November 2017. Studies conducted among CLD patients, with biopsy proven fibrosis/cirrhosis, and providing sufficient details of patients' clinicopathological characteristics were included. In the 95 studies included, there were a total of 15,548 CLD patients. More than 83% of studies were carried out in Asia and Europe. The relationship between liver fibrosis/cirrhosis and serum levels of ferritin, adiponectin, leptin, TGF-β1, and PDGF-BB was assessed in 42, 33, 27, nine, and three studies, respectively. Serum levels of the markers, particularly ferritin, could successfully predict liver fibrosis/cirrhosis, however, these data might not be clinically replicated and further studies are needed.

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.

Imaging of Hepatic Fibrosis

The purpose of this review is to discuss the current imaging techniques for non-invasive assessment of liver fibrosis (LF). Elastography-based techniques are the most widely used imaging methods for the evaluation of LF. Currently, MR elastography (MRE) is the most accurate non-invasive method for detection and staging of LF. Ultrasound-based vibration-controlled transient elastography (VCTE) is the most widely used as it can be easily performed at the point of care but has technical limitations especially in the obese. Innovations and technical improvements continue to evolve in elastography for improving accuracy and avoiding misinterpretation from confounding factors. Other imaging methods including diffusion-weighted imaging (DWI), hepatocellular contrast-enhanced (HCE) MRI, T1 relaxometry, T1ρ imaging, textural analysis, liver surface nodularity, susceptibility-weighted imaging, and perfusion imaging are promising but need further evaluation and clinical validation. MRE is the most accurate imaging technique for assessment of LF.

Elast PQ Ultrasound - a Noninvasive, Reproducible, Easily Performed Method and a New Era in Liver Fibrosis Assessment

Liver fibrosis represents the repair mechanism in liver injury and is a feature of most chronic liver diseases. The degree of liver fibrosis in chronic viral hepatitis infection has major clinical implications and presence of advanced fibrosis or cirrhosis determines prognosis. Treatment initiation for viral hepatitis is indicated in most cases of advanced liver fibrosis and diagnosis of cirrhosis entails hepatology evaluation for specialized clinical care. Liver biopsy is an invasive technique and has been the standard of care of fibrosis assessment for years; however, it has several limitations and procedure related complications. Recently, several methods of noninvasive assessment of liver fibrosis have been developed which require either serologic testing or imaging of liver. Imaging based noninvasive techniques are reviewed here and their clinical use is described. Some of the imaging based tests are becoming widely available, and collectively they are shown to be superior to liver biopsy in important aspects. Clinical utilization of these methods requires understanding of performance and quality related parameters which can affect the results and provide wrong assessment of the extent of liver fibrosis. Familiarity with the strengths and weakness of each modality is needed to correctly interpret the results in appropriate clinical content. A new technique called Elast PQ uses ultrasound shear wave elastography to provide a noninvasive, reproducible, easily performed method of assessing liver fibrosis. It can easily combine a routine ultrasound imaging exam of the liver anatomy with targeted tissue stiffness values, assess liver fibrosis in patient with clinically suspected disease even before abnormalities are detected with ultrasound imaging, evaluate and obtain a baseline stiffness value in patients with chronic liver disease, follow up patients under treatment to monitor progression, stabilization or regression of liver disease and help avoid the need for liver biopsies when elastography results are consistent with other clinical findings. Both the prognosis and potential treatment of chronic liver diseases greatly depend on the progression of liver fibrosis, which is the ultimate outcome of chronic liver damage. Historically, liver biopsy has been instrumental in adequately assessing patients allows clinicians both to obtain diagnosis information and initiate adequate therapy. However, the technique is not exempt of deleterious effects. Multiple diagnostic tests have been developed for the staging of fibrosis using noninvasive methods, most of them in the setting of chronic hepatitis C. The goal of this paper is to review available data on the staging and assessment of liver fibrosis with two methods: serum markers &amp; transient elastography (FibroScan).Faridpur Med. Coll. J. Jan 2018;13(1): 44-46

Non-Invasive Assessment of Liver Fibrosis in a Rat Model: Comparison of Shear Wave Elastography with Serologic Tests

Background: Non-invasive evaluation of hepatic fibrosis, especially serum biomarkers and ultrasound elastography, has vigorously developed during the past decades. Objectives: The purpose of this study was to evaluate the diagnostic performance of the latest generation of ultrasound elastography- two-dimensional real-time shear wave elastography (SWE) in accessing liver fibrosis progression in comparison with serologic tests in a rat model. Materials and Methods: Liver fibrosis was induced in 108 rats (control group: 18 rats, experiment group: 90 rats) by intraperitoneal injection of thioacetamide (300mg/kg, twice a week for 12 weeks). SWE examination was done by two operators. Hyaluronic acid (HA), aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) were used for serology tests. Histological fibrosis stages (F0-F4) according to the Scheuer scoring system were referred as the gold standard. Diagnostic performance of elastography and serology methods were determined by the areas under receiver operating characteristic curve (AUROC). Results: Liver stiffness values increased with the progression of hepatic fibrosis. Liver stiffness assessed by SWE exhibited a strong positive correlation with histological fibrosis stages (r = 0.849, P < 0.001). SWE showed a better diagnostic performance than the selected serological biomarkers HA, APRI, and AAR (AUROC for SWE, HA, APRI, and AAR were 0.933, 0.707, 0.714, and 0.691 in diagnosing F ≥ F2 and 0.986, 0.807, 0.870, and 0.770 in diagnosing F = F4, respectively). Conclusion: Ultrasound elastography SWE technique is a reliable method for noninvasive evaluation of liver fibrosis in comparison with the serological biomarkers, HA, APRI, and AAR.

Diagnostic value of two liver imaging techniques combined with serological models for hepatitis B virus-related liver fibrosis

Objective To compare the diagnostic efficacy of transient elastography (TE) FibroScan and acoustic radiation force impulse imaging (ARFI) combined with serological models including aspartate aminotransferase-to-platelet ratio (APRI) and fibrosis-4 (FIB-4) in hepatitis B virus-related fibrosis. Methods Sixty-seven patients with chronic HBV infection from October 2014 to May 2017 in Department of Infectious Diseases, Putuo Hospital were enrolled. Both FibroScan and ARFI were conducted in all patients together with serological tests. According to the golden standard of pathology results, the diagnosis values of FibroScan, ARFI combined with APRI or FIB-4 were compared as noninvasive assessment for liver fibrosis. Data with homogeneity of variance were tested by t test, and data with heterogeneity of variance were tested by Mann-Whitney U test. Results Based on the pathology results, the receiver operating characteristic (ROC) areas under the curve (AUC) of APRI, FIB-4, FibroScan and ARFI in diagnosis of hepatic fibrosis ≥S2 were 0.752, 0.612, 0.885, and 0.850, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S3 were 0.746, 0.733, 0.851, and 0.863, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S4 were 0.782, 0.705, 0.962 and 0.981, respectively. Combined liver imaging technique and serological tests, such as APRI with FibroScan, APRI with ARFI, FIB-4 with FibroScan or FIB-4 with ARFI, the AUC of ROC curve in the 4 groups in diagnosis of hepatic fibrosis ≥S2 were 0.887, 0.861, 0.893, and 0.853, respectively; in the diagnosis of hepatic fibrosis ≥S3 were 0.873, 0.871, 0.900, and 0.875, respectively; and in diagnosis of hepatic fibrosis ≥S4 were 0.952, 0.981, 0.969, and 0.981, respectively. FibroScan and ARFI were positively correlated with liver inflammation (r=0.467, P=0.000; r=0.371, P=0.002) and jaundice (r=0.424, P=0.000; r=0.0.312, P=0.01), while negatively correlated with platelet (r=-0.331, P=0.006; r=-0.312, P=0.01). The AUC of ROC curve of FibroScan, ARFI and their combination with serological model were significantly increased compared with the single serological model (all P<0.05). Conclusions Serological models such as APRI and FIB-4 as well as liver imaging techniques such as FibroScan and ARFI are all valuable in assessment of hepatic fibrosis, while FibroScan and ARFI have better diagnostic value. ARFI is convenient to application for its integration with the ordinary ultrasound system. The sensitivity and specificity for diagnosis of hepatic fibrosis could be improved by combining serological model with FibroScan or ARFI. Combination of APRI and ARFI show the highest accuracy in diagnosis of hepatic fibrosis. Combination of serological models and transient elastic liver imaging is recommended for assessment and follow-up of HBV-related fibrosis. Key words: FibroScan; Acoustic radiation force impulse imaging; APRI; FIB-4; Liver fibrosis

Criteria to Determine Reliability of Noninvasive Assessment of Liver Fibrosis With Virtual Touch Quantification

Virtual Touch Quantification (VTQ) evaluates liver fibrosis in patients with chronic liver diseases by measuring shear wave speed in the liver. We aimed to determine the reliability criteria of VTQ examination. We performed a prospective study of 1094 patients with chronic liver disease from November 2009 through October 2016 at Angers University Hospital, and between April 2010 and May 2015 at Bordeaux University Hospital, in France. All patients underwent liver biopsy analysis (reference standard), and VTQ examination was made by experienced operators on the same day, or no more than 3 months before or afterward. Advanced liver fibrosis was defined as fibrosis stage F ≥ 3 according to the scoring system of the Nonalcoholic Steatohepatitis Clinical Research Network, or fibrosis stage F ≥ 2 according to the Metavir scoring system. The diagnostic accuracy of VTQ in detection of advanced fibrosis or cirrhosis was assessed using the area under the receiver operating characteristic (AUROC) and the rate of correctly classified patients. Reliability criteria were defined from the intrinsic characteristics of VTQ examination, which were shown to influence the diagnostic accuracy. VTQ identified patients with advanced fibrosis with an AUROC of 0.773 ± 0.014 and correctly classified 72.0% of patients using a diagnostic cut-off value of 1.37 m/s. VTQ identified patients with cirrhosis with an AUROC value of 0.839 ± 0.014 and correctly classified 78.4% of patients using a cut-off value of 1.87 m/s. The reliability of VTQ decreased with an increasing ratio of interquartile range/median (IQR/M) in patients with intermediate-high VTQ results. We defined 3 reliability categories for VTQ: unreliable (IQR/M ≥0.35 with VTQ result ≥1.37 m/s), reliable (IQR/M ≥0.35 with VTQ result <1.37 m/s or IQR/M 0.15-0.34), and very reliable (IQR/M <0.15). For advanced fibrosis, VTQ correctly classified 57.8% of patients in the unreliable group, 73.7% of patients in the reliable group, and 80.9% of patients in the very reliable group (P < .001); for cirrhosis, these values were 50.0%, 83.4%, and 92.6%, respectively (P < .001). Of the VTQ examinations made, 21.4% were unreliable, 55.0% were reliable, and 23.6% were very reliable. The skin-liver capsule distance was independently associated with an unreliable VTQ examination, which occurred in 52.7% of patients with a distance of 30 mm or more. In a study to determine the reliability of VTQ findings, compared with results from biopsy analysis, we assigned VTQ examinations to 3 categories (unreliable, reliable, and very reliable). VTQ examinations with IQR/M ≥0.35 and ≥1.37 m/s had very low diagnostic accuracy. Our reliability criteria for liver fibrosis assessment with VTQ will help physicians to accurately evaluate the severity of chronic liver diseases and monitor their progression.

Sa1490 - Factors Affecting Non-Invasive Assessment of Liver Fibrosis in Chronic Hepatitis B: Results from a Large Single Centre Urban UK Cohort Using Acoustic Radiation Force Impulse (ARFI) Elastography with Simultanous Biopsy

Sa1490 - Factors Affecting Non-Invasive Assessment of Liver Fibrosis in Chronic Hepatitis B: Results from a Large Single Centre Urban UK Cohort Using Acoustic Radiation Force Impulse (ARFI) Elastography with Simultanous Biopsy

Non-invasive assessments for liver fibrosis: The crystal ball we long for.

Non-invasive assessment of liver fibrosis has been one of the most rapidly advancing fields in hepatology in the last decade. Progressive liver fibrosis results in cirrhosis, hepatocellular carcinoma (HCC), and various liver-related complications in essentially all chronic liver diseases. Assessment of liver fibrosis allows clinicians to determine the prognosis, need of treatment, disease progression, and response to treatment in patients with chronic liver disease. Liver biopsy has been the gold standard in last few decades and most adopted diagnostic tool in clinical trials. Nonetheless, it is impractical to apply the test in a large number of patients or to do it serially. Hence, various non-invasive assessments have been developed and adopted in some international management guidelines. Liver stiffness measurement (LSM) with transient elastography is one of the most widely validated non-invasive assessments for liver fibrosis. It is an accurate and reproducible method to predict advanced fibrosis in chronic hepatitis B. Using transient elastography, it is possible to perform repeated liver fibrosis assessments on a large number of asymptomatic patients. The key challenge of his tool is the confounding effect of alanine aminotransferase (ALT) level, such that decrease in LSM may only reflect ALT normalization, hence not accurate enough to indicate regression of liver fibrosis. This may be partially handled by combining LSM with a serum-based formula, which is independent of ALT such as the Forns index and enhanced liver fibrosis test. An LSM-based HCC risk score is useful to prioritize patients for HCC surveillance.