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GE LAN, SHI BAOMIN, SONG YE, LI YUAN, WANG SHUO, WANG XIUYAN. Clinical value of real-time elastography quantitative parameters in evaluating the stage of liver fibrosis and cirrhosis. Exp Ther Med 2015; 10:983-990. [PMID: 26622426 PMCID: PMC4533211 DOI: 10.3892/etm.2015.2628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to assess the value of real-time elastography (RTE) quantitative parameters, namely the liver fibrosis (LF) index and the ratio of blue area (%AREA), in evaluating the stage of liver fibrosis. RTE quantitative analysis software was used to examine 120 patients with chronic hepatitis in order to obtain the values for 12 quantitative parameters from the elastic images. The diagnostic performance of two such parameters, the LF index and %AREA, were assessed with a receiver operating characteristic (ROC) curve to determine the optimal diagnostic cut-off values for liver cirrhosis and fibrosis. A good correlation was observed between the LF index and %AREA with the fibrosis stage. The areas under the ROC curve for the LF index were 0.985 for the diagnosis of liver cirrhosis and 0.790 for liver fibrosis. With regard to %AREA, the areas under the ROC curve for the diagnosis of liver cirrhosis and fibrosis were 0.963 and 0.770, respectively. An LF index of >3.25 and a %AREA of >28.83 for the diagnosis of cirrhosis stage resulted in sensitivity values of 100 and 100%, specificity values of 88.9 and 85.9% and accuracy values of 90.8 and 88.3%, respectively. The LF index and %AREA parameters exhibited higher reliability in the diagnosis of liver cirrhosis compared with the diagnosis of the liver fibrosis stage. However, the two parameters possessed a similar efficacy in the diagnosis of liver cirrhosis and the stage of liver fibrosis. Therefore, the quantitative RTE parameters of the LF index and %AREA may be clinically applicable as reliable indices for the early diagnosis of liver cirrhosis, without the requirement of an invasive procedure.
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Affiliation(s)
- LAN GE
- Department of Ultrasound, Tongji Hospital, Tongji University, Shanghai 200065, P.R. China
| | - BAOMIN SHI
- Department of Ultrasound, Tongji Hospital, Tongji University, Shanghai 200065, P.R. China
| | - YE SONG
- Department of Ultrasound, Tongji Hospital, Tongji University, Shanghai 200065, P.R. China
| | - YUAN LI
- Department of Ultrasound, Tongji Hospital, Tongji University, Shanghai 200065, P.R. China
| | - SHUO WANG
- Department of Ultrasound, Tongji Hospital, Tongji University, Shanghai 200065, P.R. China
| | - XIUYAN WANG
- Department of Ultrasound, Tongji Hospital, Tongji University, Shanghai 200065, P.R. China
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Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, Cosgrove D, Dietrich CF, Amy D, Bamber JC, Barr R, Chou YH, Ding H, Farrokh A, Friedrich-Rust M, Hall TJ, Nakashima K, Nightingale KR, Palmeri ML, Schafer F, Shiina T, Suzuki S, Kudo M. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1161-79. [PMID: 25800942 DOI: 10.1016/j.ultrasmedbio.2015.03.007] [Citation(s) in RCA: 475] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced these guidelines for the use of elastography techniques in liver disease. For each available technique, the reproducibility, results, and limitations are analyzed, and recommendations are given. Finally, recommendations based on the international literature and the findings of the WFUMB expert group are established as answers to common questions. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico S. Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Carlo Filice
- Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico S. Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Clichy, Assistance Publique-Hôpitaux de Paris, INSERM U 773 CRB3, Université Denis Diderot Paris-VII, Paris, France
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timişoara, Romania
| | - Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - David Cosgrove
- Division of Radiology, Imperial and Kings Colleges, London, UK
| | | | - Dominique Amy
- Breast Center, 21 ave V. Hugo, 13100 Aix-en-Provence, France
| | - Jeffrey C Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Richard Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio and Radiology Consultants Inc., Youngstown, Ohio, USA
| | - Yi-Hong Chou
- Department of Radiology, Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Andre Farrokh
- Department of Gynecology and Obstetrics, Franziskus Hospital, Bielefeld, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | | | | | - Mark L Palmeri
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Fritz Schafer
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus, Kiel, Germany
| | - Tsuyoshi Shiina
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Suzuki
- Department of Endocrinology and Surgery, Fukushima University, Fukushima, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Japan.
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Cui XW, Friedrich-Rust M, Molo CD, Ignee A, Schreiber-Dietrich D, Dietrich CF. Liver elastography, comments on EFSUMB elastography guidelines 2013. World J Gastroenterol 2013; 19:6329-6347. [PMID: 24151351 PMCID: PMC3801303 DOI: 10.3748/wjg.v19.i38.6329] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/11/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
Recently the European Federation of Societies for Ultrasound in Medicine and Biology Guidelines and Recommendations have been published assessing the clinical use of ultrasound elastography. The document is intended to form a reference and to guide clinical users in a practical way. They give practical advice for the use and interpretation. Liver disease forms the largest section, reflecting published experience to date including evidence from meta-analyses with shear wave and strain elastography. In this review comments and illustrations on the guidelines are given.
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Paparo F, Cevasco L, Zefiro D, Biscaldi E, Bacigalupo L, Balocco M, Pongiglione M, Banderali S, Forni GL, Rollandi GA. Diagnostic value of real-time elastography in the assessment of hepatic fibrosis in patients with liver iron overload. Eur J Radiol 2013; 82:e755-61. [PMID: 24050879 DOI: 10.1016/j.ejrad.2013.08.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/12/2013] [Accepted: 08/18/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of our prospective monocentric work was to determine the diagnostic value of real-time elastography (RTE) in the assessment of liver fibrosis in patients with iron overload, using transient elastography (TE) as reference standard. METHODS Sixty-seven consecutive patients with MRI detectable iron overload (T2*<6.3 ms) were enrolled. TE and RTE were performed on the same day as MRI. Elastograms were acquired by an experienced operator and analyzed by calculating the elastic ratio between perihepatic soft tissues and liver parenchyma. An elliptical ROI of 1cm(2) (Z1) was positioned in the liver parenchyma and a smaller elliptical ROI of 2mm(2) (Z2) was positioned in a homogeneously soft (red) region of the diaphragm, which was considered as internal control to calculate the elastic ratio Z2/Z1. RESULTS Seven patients were excluded because of invalid TE or RTE examinations. The remaining 60 patients were 57% males and 43% females (mean age: 42 [21-76] years), including 37 homozygous-β-thalassemics, 13 patients with β-thalassemia intermedia, 6 with primary hemochromatosis, and 4 with myelodysplastic syndrome. Increasing elastic ratios were significantly correlated with increasing TE values (r=0.645, 95% CI 0.468-0.772, P<0.0001). The mean elastic ratios for each METAVIR group were as follows: F0/1 = 1.9 ± 0.4; F2 = 2.2 ± 0.4; F3 = 2.9 ± 0.5; F4 = 3.2 ± 0.4. The diagnostic accuracy of RTE for F ≥ 2 evaluated by AUC-ROC analysis was 0.798 (95% CI 0.674-0.890). The diagnostic accuracy of RTE for F ≥ 3 was 0.909 (95% CI 0.806-0.968). At a cut-off ≥ 2.75, RTE showed a sensitivity of 70% (95% CI 45.7-88.1) and a specificity of 97.5% (95% CI 86.8-99.9). CONCLUSIONS In patients with MRI-detectable liver iron-overload RTE allows to discriminate between F0/1-F2 and F3-F4 with a reasonable diagnostic accuracy.
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Affiliation(s)
- Francesco Paparo
- Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy
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Orlacchio A, Bolacchi F, Antonicoli M, Coco I, Costanzo E, Tosti D, Francioso S, Angelico M, Simonetti G. Liver elasticity in NASH patients evaluated with real-time elastography (RTE). ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:537-544. [PMID: 22341049 DOI: 10.1016/j.ultrasmedbio.2011.12.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 11/23/2011] [Accepted: 12/29/2011] [Indexed: 05/31/2023]
Abstract
Liver elasticity as assessed by real-time elastography (RTE) has been shown to be correlated to liver fibrosis in various chronic liver diseases. The aim of our study was to assess the RTE performance in the evaluation of liver fibrosis in nonalcoholic steatohepatitis (NASH), as well as the histopathologic variables determining the eventual discordance between the RTE-predicted and the biopsy-proven fibrosis. Fifty-two consecutive biopsy proven NASH patients and 20 controls were studied. Liver tissue elasticity measurements were performed using the Hitachi EUB-8500 sonographer and the EUP-L52 Linear (3-7 MHz) probe. RTE liver tissue mean elasticity (TME) values were calculated and correlated to the histologic fibrosis, activity and steatosis scores. A decrease in TME was observed with increasing fibrosis (r = -0.75). Similarly, TME varied together consistently with steatosis (r = -0.3). In contrast, TME did not show any correlation with the severity of inflammation. Multiple regression analysis showed that fibrosis was the only variable able to significantly (p < 0.0001) modify TME values. The diagnostic accuracy of TME measurement for F > 0 evaluated by AUC-ROC analysis was 0.86. The diagnostic accuracy of TME measurement for F ≥ 2 was 0.92. We suggest that RTE could be used as a complementary imaging method to evaluate liver fibrosis in NASH patients. Future studies of larger patient cohorts are necessary for the validation of the technique.
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Affiliation(s)
- Antonio Orlacchio
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology, and Radiation Therapy, University Hospital Tor Vergata, Rome, Italy.
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Jaffer OS, Lung PFC, Bosanac D, Shah A, Sidhu PS. Is ultrasound elastography of the liver ready to replace biopsy? A critical review of the current techniques. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2012. [DOI: 10.1258/ult.2011.011043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Accurate assessment of liver fibrosis in patients with chronic liver disease is necessary to determine prognosis, monitor disease progression and formulate treatment decisions. Currently, histological staging of liver biopsy is the most widely used reference standard for this purpose. Liver biopsy, however, has recognized risks, as well as sampling and observer error. These limitations have stimulated the search for new non-invasive approaches. Numerous methodologies, including serum markers, magnetic resonance elastography and ultrasound elastography, have evolved in the last decade to predict fibrosis in those with chronic liver disease. Ultrasound elastography methods assess liver fibrosis by determining liver stiffness and translate this into a quantifiable measurement for analysis. As these tests are non-invasive, without side-effect or discomfort, it is possible to conduct repeat examinations at much closer intervals than biopsy. The three most investigated ultrasound elastography methods are transient elastography, realtime elastography and acoustic radiation force impulse. Although significant strides have been made in the development of the technology, an unequivocal advocacy of elastography as a surrogate for biopsy is still not established. The aim of this review is to evaluate the advantages, limitations and clinical relevance of the three ultrasound-based modalities. Also, the review shall assess the current and possible future clinical application the modalities may serve both separate and in conjunction with liver biopsy.
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Affiliation(s)
- Ounali S Jaffer
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Phillip F C Lung
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Diana Bosanac
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Aarti Shah
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
| | - Paul S Sidhu
- King's College Hospital – Radiology Department, Denmark Hill, London SE5 9RS, UK
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Morikawa H, Fukuda K, Kobayashi S, Fujii H, Iwai S, Enomoto M, Tamori A, Sakaguchi H, Kawada N. Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C. J Gastroenterol 2011; 46:350-8. [PMID: 20697747 DOI: 10.1007/s00535-010-0301-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 07/15/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although histopathological examination by "invasive" liver biopsy remains the gold standard for evaluating disease progression in chronic liver disease, noninvasive tools have appeared and have led to great progress in diagnosing the stage of hepatic fibrosis. The aim of this study was to assess the value of real-time tissue elastography, using an instrument made in Japan, for the visible measurement of liver elasticity; in particular, comparing the results with those of transient elastography (Fibroscan). METHODS Real-time tissue elastography (RTE), transient elastography (Fibroscan), liver biopsy, and routine laboratory analyses were performed in 101 patients with chronic hepatitis C. The values for tissue elasticity obtained using novel software (Elasto_ver 1.5.1) connected to RTE were transferred to four image features, Mean, Standard Deviation (SD), Area, and Complexity. Their association with the stage of fibrosis at biopsy and with liver stiffness (kPa) obtained by Fibroscan was analyzed. RESULTS Colored images obtained by RTE were classified into diffuse soft, intermediate, and patchy hard patterns and the calculated elasticity differed significantly between patients according to and correlated with the stages of fibrosis (p < 0.0001). Mean, SD, Area, and Complexity showed significant differences between the stages of fibrosis (Tukey-Kramer test, p < 0.05). In discriminating patients with cirrhosis, the areas under the receiver operating characteristic curves (AUC) were 0.91 for Mean, 0.84 for SD, 0.91 for Area, 0.93 for Complexity, and 0.95 for Fibroscan. CONCLUSIONS RTE is a noninvasive instrument for the colored visualization of liver elasticity in patients with chronic liver disease.
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Affiliation(s)
- Hiroyasu Morikawa
- Department of Hepatology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka 545-8585, Japan
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Gheonea DI, Săftoiu A, Ciurea T, Gorunescu F, Iordache S, Popescu GL, Belciug S, Gorunescu M, Săndulescu L. Real-time sono-elastography in the diagnosis of diffuse liver diseases. World J Gastroenterol 2010; 16:1720-6. [PMID: 20380003 PMCID: PMC2852819 DOI: 10.3748/wjg.v16.i14.1720] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze whether computer-enhanced dynamic analysis of elastography movies is able to better characterize and differentiate between different degrees of liver fibrosis.
METHODS: The study design was prospective. A total of 132 consecutive patients with chronic liver diseases and healthy volunteers were examined by transabdominal ultrasound elastography. All examinations were done by two doctors.
RESULTS: Due to the limitations of the method, we obtained high-quality elastography information in only 73.48% of the patients. The κ-means clustering method was applied to assess the inter-observer diagnosis variability, which showed good variability values in accordance with the experience of ultrasound examination of every observer. Cohen’s κ test indicated a moderate agreement between the study observers (κ = 0.4728). Furthermore, we compared the way the two observers clustered the patients, using the test for comparing two proportions (t value, two-sided test). There was no statistically significant difference between the two physicians, regardless of the patients’ real status.
CONCLUSION: Transabdominal real-time elastography is certainly a very useful method in depicting liver hardness, although it is incompletely tested in large multicenter studies.
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Open questions in the assessment of liver fibrosis using real-time elastography. AJR Am J Roentgenol 2008; 190:W370-1; author reply W372-3. [PMID: 18492880 DOI: 10.2214/ajr.07.3434] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Reply. AJR Am J Roentgenol 2008. [DOI: 10.2214/ajr.07.3829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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