Noninvasive Assessment of Liver Fibrosis

2015 ◽  
Vol 33 (4) ◽  
pp. 498-503 ◽  
Author(s):  
Laurent Castera
Keyword(s):  
Clinical Practice ◽  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Viral Hepatitis ◽  
Esophageal Varices ◽  
Transient Elastography ◽  
Antiviral Treatment ◽  
Liver Stiffness ◽  
Noninvasive Methods ◽  
Excellent Tool

Background: The prognosis and management of chronic liver diseases greatly depend on the amount and progression of liver fibrosis with the risk of developing cirrhosis. Liver biopsy, traditionally considered as the reference standard for the staging of fibrosis, has been challenged over the past decade by the development of novel noninvasive methodologies. Key Messages: Noninvasive methods rely on two different but complementary approaches: a ‘biological' approach based on the dosage serum biomarkers, and a ‘physical' approach based on the measurement of liver stiffness using transient elastography (TE). There are two clinically relevant endpoints for the staging of liver fibrosis: (1) significant fibrosis (indication for antiviral treatment in viral hepatitis B and C), and (2) cirrhosis (indication for screening of esophageal varices and hepatocellular carcinoma). TE (FibroScan®), FibroTest® and APRI have been the most extensively studied and validated methods, mainly in chronic hepatitis C. Combining two unrelated methods, such as TE and biomarkers, is an attractive approach that increases diagnostic performance and limits the drawback of both methodologies. TE appears to be an excellent tool for the early detection of cirrhosis with likely prognostic value in this setting. Thus far, however, it cannot replace upper endoscopy for screening of esophageal varices. The main limitation of TE in clinical practice is the impossibility of obtaining reliable liver stiffness measurements in around 20% of cases, mainly comprising obese patients. Conclusion: An increasing number of reliable noninvasive methods are now available that are widely used in clinical practice, mostly in viral hepatitis, resulting in a significant decrease in the need for liver biopsy.

Reliability of Transient Elastography as a non-Invasive Technique for Detection of Fibrosis in Budd Chiari Syndrome Patients after Endovascular Intervention

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed F Montasser ◽  
Eman M Barakat ◽  
Mohamed S Ghazy ◽  
Sara M Abdelhakam ◽  
Hend E Ebada ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Endovascular Intervention ◽  
Invasive Technique ◽  
Budd Chiari Syndrome ◽  
Metavir Score ◽  
Before And After ◽  
Chiari Syndrome

Abstract Aim of the work To test the reliability of fibroscan in detection of fibrosis in patients with Budd Chiari syndrome before and after endovascular intervention (after elimination of hepatic congestion). Background transient elastography (TE) is a noninvasive methodology that has been used to monitor liver stiffness in patients with chronic viral hepatitis. One of the limitations for accurate assessment of liver fibrosis by TE is the liver congestion. Liver congestion can result from Budd Chiari syndrome (BCS).The treatment of BCS is through restoring the flow of the blood between the portal vein to the inferior vena cava, which will lead to decongestion of the liver.TE, will be tested after liver decongestion for proper detection of liver fibrosis. Patients and methods This was a prospective cohort study conducted on 25 Egyptian patients with confirmed diagnosis of primary Budd-Chiari Syndrome (BCS) in the period from June 2017 to September 2019. TE was performed three days before endovascular intervention and three months after it. Liver biopsy was taken during the intervention for assessment of METAVIR score. Comparison was done between TE assessments before and after intervention in detection of the degree of liver fibrosis in comparison to METAVIR score measured in liver biopsy. Results FVLM was the most common hypercoagulable cause in the involved patients. There was significant drop in Liver Stiffness Measurements (LSM) measured three months post-intervention indicating improvement of liver fibrosis after relieving liver congestion but still not correlated to the METAVIR scores measured in the liver biopsy. Conclusion Liver congestion has high impact on Liver stiffness measurement giving overestimation which improves significantly after decongestion of the liver by the endovascular intervention.

scholarly journals Liver stiffness in chronic hepatitis C virus infection

2019 ◽  
Vol 57 (2) ◽  
pp. 85-98
Author(s):  
Romeo-Gabriel Mihăilă
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Chronic Hepatitis C ◽  
Esophageal Varices ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Stiffness Measurement ◽  
A Value

Abstract Introduction. The severity of liver fibrosis can be assessed noninvasively today by liver stiffness measurements. Vibration-controlled transient elastography, shear wave elastography or magnetic resonance elastography are techniques increasingly used for this purpose. Methods. This article presents the recent advances in the use of new techniques for liver fibrosis assessment in chronic hepatitis C: the correlation between liver stiffness values and liver fibrosis estimated by liver biopsies, the prognosis role of liver stiffness values, their usefulness in monitoring the treatment response, in assessing the severity of portal hypertension and in estimating the presence of esophageal varices. Scientific articles from January 2017 to January 2018 were searched in PubMed and PubMed Central databases, using the terms “liver stiffness” and “hepatitis C”. Results. The median liver stiffness values measured with different techniques are not identical, so that FibroScan thresholds cannot be used on any other elastographic machine. The higher the liver’s stiffness measurement, the higher the liver-related events in patients with chronic hepatitis C. A liver stiffness measurement over 17 kPa could be an independent predictor for the presence of esophageal varices as well as a spleen with a longitudinal span ≥ 15 cm for patients with a value of liver stiffness < 17 kPa. A progressive and persistent decrease in liver stiffness is dependent on sustained virological response achievement. The lack of liver stiffness decrease has been associated with relapsers and a low value of liver stiffness at baseline. Conclusion. Liver stiffness provides clues about the severity and evolution of liver disease.

NONINVASIVE ASSESSMENT OF HEPATIC FIBROSIS

2014 ◽  
pp. 5-11
Author(s):  
Thi Khanh Tuong Tran ◽  
Trong Thang Hoang
Keyword(s):  
Clinical Practice ◽  
Liver Fibrosis ◽  
Hepatic Fibrosis ◽  
Liver Stiffness ◽  
Treatment Decision ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Noninvasive Methods ◽  
Non Invasive ◽  
Noninvasive Assessment

Staging of hepatic fibrosis is crucial for prognosis, surveillance and treatment decision in patients with chronic liver diseases in clinical practice. Liver biopsy has still the gold standard for assessment of hepatic fibrosis, but it has some limitations. To overcome this, non-invasive methods were developed. The methods of noninvasive assessment of liver fibrosis were divided into two main groups: serum biomarkers and techniques measuring liver stiffness. Each method has its own advantages and limits. Some studies suggest that the effectiveness of noninvasive methods for assessing liver fibrosis may increase when they are combined. The aim of this article is to review and update the different non invasive methods for assessment of hepatic fibrosis, their advantages, disadvantages, diagnostic accuracy and their applications in clinical practice. Key words: hepatic fibrosis, liver stiffness, chronic liver disease

New non-invasive tool for assessment of liver fibrosis: transient elastography

2011 ◽  
Vol 152 (22) ◽  
pp. 860-865 ◽  
Author(s):  
Gábor Horváth
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Disease Progression ◽  
Liver Diseases ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Chronic Viral Hepatitis ◽  
Non Invasive ◽  
Life Threatening ◽  
Invasive Method

Formation of connective tissue causing liver fibrosis is the common trait of chronic liver diseases. The „gold-standard” of the evaluation of liver fibrosis is liver biopsy, but it is an invasive, painful procedure, and carries a significant, although small risk of life-threatening complications. It may have contraindications, and it is certainly not the ideal procedure for serially repeated assessment of disease progression. A new, non-invasive method for the assessment of liver fibrosis by measuring liver stiffness is the transient elastography. The velocity of the propagation of a shear wave is measured by ultrasound. The procedure is painless, rapid, and no needs any preparation. So far, transient elastography has been mostly validated in chronic hepatitis C, but it is applicable in liver diseases with other etiologies. The diagnostic accuracy of transient elastography increases with stage of fibrosis, and is more accurate in advanced fibrosis (F≥2, Metavir score) and in cirrhosis. Indication of antiviral therapy for chronic viral hepatitis B and C are the main field of the application of the transient elastography, and it is also a useful tool for follow-up the disease progression. It is applicable for early, non-invasive detection of graft damage after liver transplantation. Evaluation of liver damage, the stage of liver fibrosis by transient elastography may have an important role in the decision before surgery, or application of potentially hepatotoxic drugs. Histological examination of the liver tissue is not substituted in every case by transient elastography, but liver biopsy is supplanted by measuring liver stiffness for evaluation of liver fibrosis in many cases. Orv. Hetil., 2011, 152, 860–865.

scholarly journals Transient elastography for noninvasive assessment of liver fibrosis in patients with primary biliary cirrhosis

2018 ◽  
Vol 75 (4) ◽  
pp. 374-379
Author(s):  
Tamara Milovanovic ◽  
Ana Copertino ◽  
Ivan Boricic ◽  
Biljana Milicic ◽  
Aleksandra Pavlovic-Markovic ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Primary Biliary Cirrhosis ◽  
Liver Biopsy ◽  
Transient Elastography ◽  
Fibrosis Stage ◽  
Biliary Cirrhosis ◽  
Noninvasive Methods ◽  
Significant Difference ◽  
Apri Score ◽  
Noninvasive Markers

Backgrund/Aim. In recent decades noninvasive methods for the assessment and monitoring of liver fibrosis have been developed and evaluated in numerous chronic liver diseases. The aim of this study was to evaluate the diagnostic accuracy of noninvasive markers for fibrosis assessment transient elastography (TE) and biochemical markers using liver biopsy as reference in patients with primary biliary cirrhosis (PBC). Methods. One hundred and twenty-two patients underwent both liver biopsy and blood tests on the same day and TE in a month following the biopsy and the tests. Liver biopsies were reviewed by a single pathologist using the METAVIR scoring system for assessment of liver fibrosis. Aspartate aminotransferase (AST), platelet ratio index (APRI), Forns scores, AST and alanine transaminase (ALT) ratio and TE were compared with liver fibrosis stage in order to determine the best noninvasive marker of liver fibrosis. Results. There was a statistically significant difference (p < 0.05) for the APRI score, Forns index and TE according to stages of liver fibrosis. TE showed superior diagnostic performance when compared to other surrogate markers of liver fibrosis that were investigated. Optimal cut-off for TE were 4.25 and 5.9 kPa for diagnosing the presence of fibrosis and distinguishing mild/moderate and advanced stages of fibrosis respectively. The areas under the receiver operating characteristic (AUROC) of TE were 0.963 and 0.865, respectively. Conclusion. Based on our investigation the APRI score, Forns index and TE adequately predict fibrosis stage in patients with primary biliary cirrhosis, but the most sensitive and specific parameter appears to be TE. Using noninvasive markers and methods in the evaluation of patients in daily clinical practice may reduce, but not eliminate, the need for invasive diagnostic procedures.

scholarly journals Assessment of Liver Fibrosis by Transient Elastography in Children with Chronic Hepatitis B Virus Infection

2021 ◽  
Author(s):  
Zhiqiang Xu ◽  
Jinfang Zhao ◽  
Jiaye Liu ◽  
Yi Dong ◽  
Fuchuan Wang ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Liver Fibrosis ◽  
Hepatitis B ◽  
Liver Biopsy ◽  
Chronic Hepatitis B ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Activity Grade ◽  
Advanced Fibrosis ◽  
Chronic Hepatitis B Virus

Abstract Background: This study aimed to investigate the effectiveness of transient elastography (TE) by comparing liver biopsies to assess liver fibrosis in children with chronic hepatitis B (CHB). Methods: A total of 157 CHB children aged 0 - 6 years in China were enrolled in this single-center prospective study. All patients underwent liver stiffness measurement (LSM) by TE and liver biopsy at an interval of less than a week. Results: LSM, aspartate aminotransferase (AST)-platelet ratio index (APRI), and fibrosis-4 score (FIB-4) positively correlated with activity grade and fibrosis stage in children with CHB. The area under receiver operating characteristic curves (AUCs) of LSM for identifying significant (F ≥ 2) and advanced fibrosis (F ≥ 3) were 0.732 and 0.94, the cut-off values were 5.6 kPa and 6.9 kPa, specificity of 75.7% and 91.5%, and sensitivity of 67.4% and 81.3%, respectively. Compared to LSM, the overall diagnostic performance of APRI and FIB-4 for significant and advanced fibrosis was suboptimal with low AUCs and sensitivity. Since LSM, platelet, and Log10HBsAg were independent factors with the fibrosis stages (F < 2 and F ≥ 2) on the liver biopsy, the LPS index was formulated to predict F ≥ 2 by combining LSM, platelet, and Log10HBsAg. The AUC of LPS for F ≥ 2 was increased to 0.792, which was higher than that of LSM (0.732, p < 0.05), with an improved sensitivity (76.6% vs 67.4%).Conclusions: TE represents a promising technology for the diagnosis of advanced fibrosis in CHB children aged 0 - 6 years.

EVALUATION THE LIVER FIBROSIS BY TRANSIENT LIVER ELASTOGRAPHY COMPARING TO LIVER ANAPATHOLOGY IN CHRONIC HEPATITIS

2015 ◽  
pp. 59-65
Author(s):  
Bao Nghi Tran ◽  
Thi Thanh Quyt Ngo ◽  
Trong Thang Hoang
Keyword(s):  
Chronic Hepatitis ◽  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Mean Values ◽  
Metavir Score ◽  
Liver Elastography ◽  
The Mean ◽  
Bedside Method

Background: Transient elastography (FibroScan) is a novel, noninvasive, safe and rapid bedside method, in assessement the liver stiffness in chronic hepatitis. Aims: To assess the degree of liver fibrosis in the chronic hepatitis patients in comparison with liver biopsy performed at the same time. Methods: We studied 66 consecutive patients with chronic hepatitis, in which liver stiffness was measured by FibroScan and liver biopsy was performed in the same session (assessed according to the Metavir score). Results: FibroScan values ranged from 3.8 to 75 kiloPascal (median, 16.46 kPa). According to the Metavir score of the 66 patients: 22,1% had F0 and F1, 12 had F2, 16.6% had F3 and 43,9% had F4. The mean values of liver stiffness in patients were: F0 & F1: 5.35 ± 2.73 kPa; F2: 8.59 ± 3.37 kPa; F3: 12.45 ± 4.69 kPa; F4: 32.44 ± 18.52 kPa. There were the significant positive correlation between the liver stiffness measured by FibroScan and liver biopsy (r = 0.6, p < 0.05). Conclusions: FibroScan is a simple and effective method in assessing liver fibrosis. The liver fibrosis measured by FibroScan was well correlated with the degree of liver fibrosis by Metavir index, serum albumin, bilirubin, AST, platelet, INR in chronic hepatitis. Keywords: Chronic hepatitis, Fibrosis, Transient elastography, Liver biopsy

scholarly journals Elastography in Hepatology

2007 ◽  
Vol 21 (12) ◽  
pp. 839-842 ◽  
Author(s):  
Ludovico Abenavoli ◽  
Christophe Corpechot ◽  
Raoul Poupon
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Liver Diseases ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Factors Associated ◽  
History Of ◽  
Elastic Shear

A common characteristic of all chronic liver diseases is the occurrence and progression of fibrosis toward cirrhosis. Consequently, liver fibrosis assessment plays an important role in hepatology. Besides its importance for prognosis, determining the level of fibrosis reveals the natural history of the disease and the risk factors associated with its progression, to guide the antifibrotic action of different treatments. Currently, in clinical practice, there are three available methods for the evaluation of liver fibrosis: liver biopsy, which is still considered to be the ‘gold standard’; serological markers of fibrosis and their mathematical combination – suggested in recent years to be an alternative to liver biopsy – and, more recently, transient elastography (TE). TE is a new, simple and noninvasive method used to measure liver stiffness. This technique is based on the progressing speed of an elastic shear wave within the liver. Currently, there are only a few studies that have evaluated TE effectiveness in chronic liver diseases, mostly in patients infected with the hepatitis C virus. Further studies are needed in patients with chronic liver disease, to assess the effectiveness of the fibrosis treatment.

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