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.

Liver Fibrosis Assessed by Transient Elastography in Adult Thalassemia Intermedia Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5406-5406
Author(s):  
Maria Rosaria Fasulo ◽  
Mirella Fraquelli ◽  
Claudia Cesaretti ◽  
Cristina Rigamonti ◽  
Elena Cassinerio ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Liver Damage ◽  
Transient Elastography ◽  
Hcv Rna ◽  
Thalassemia Intermedia ◽  
Non Invasive ◽  
Iron Load ◽  
Increased Risk ◽  
Invasive Method

Abstract Concomitant HCV infection and iron overload are responsible for increased risk of chronic liver disease (CLD) in thalassemic patients. Liver biopsy remains so far the gold standard to assess histological activity and iron burden, although it is an invasive method poorly accepted by patients and it can not be repeated regularly. MRI ferriscan is a good tool recently introduced to estimate hepatic and cardiac iron load but it does not allow to evaluate the tissue liver damage. Transient Elastography (TE) is a new non-invasive device that measures liver stiffness (LSM) and assesses liver damage, namely fibrosis and cirrhosis. TE use in thalassemic patients is still limited, thus the aim of this study was to evaluate LSM by TE in a cohort of adults affected by Thalassemia Intermedia (TI) in order to assess the liver damage. Ninety consecutive TI patients followed at a single Italian tertiary Thalassemia Care Center in Milan were enrolled in this study. Eighteen patients (20%) were regularly transfused, 28 (31%) occasionally transfused, 44 (49%) never transfused. No one patient was on regular chelation treatment. Table 1 summarizes the demographic, clinical and laboratory features at time of TE evaluation. Males n° (%) 43 (47.8%) LDH U/l * 570±296 *Mean ± SD TE (FibroScan®) was performed according to Fraquelli et al. and was expressed in KPa. Only the examination with at least 10 validated measurements, a success rate greater than 60% and the interquartile range of all validated measurements lower than 30% of the mean value were considered reliable. TE cut-off to diagnose different stages of hepatic fibrosis was >7.9 kPa for F>2, >10.3 for F>3 and >11.9 for F>4 (cirrhosis). Forty-eight patients underwent T2* Magnetic Resonance Imaging (MRI) in order to estimate liver iron concentration (LIC). Forty-three patients (48%) had normal TE values (TE≤5.0 KPa), 35 (39%) had F>1 (5.0<TE≤7.9 KPa), 5 (6%) had F>2, 2 (2%) had F>3, 5 (6%) had F>4. Mean ± SD TE value was 6.0±2.8 KPa. A significant correlation (p<0.05) was observed between LSM and age (p<0.001), transfusion regimen (p=0.017), serum ferritin (p=0.006), AST (p<0.001), ALT (p<0.001), GGT (p=0.003), bilirubin (p=0.003), albumin (p=0.017), IgG (p=0.006) and HCV positivity (HCV-Ab p<0.001; HCV-RNA p=0.028). AGE yrs * 40.5±11.1 BILIRUBIN (tot) mg/dl * 2.8±1.8 BMI kg/m2 * 21.8±2.9 BILIRUBIN (conj) mg/dl * 0.5±0.3 Hb g/dl * 8.9±1.3 ALBUMIN g/dl * 4.6±0.3 FERRITIN LEVELS ng/ml* 730±690 IgG mg/dl * 1611±543 AST U/l * 32±17 SPLENECTOMY n° (%) 49 (54.4%) ALT U/l * 29±22 CHOLECYSTECTOMY n° (%) 38 (42.2%) ALP U/l * 72±25 HCV-Ab + n° (%) 18 (20.0%) GGT U/l * 24±23 HCV-RNA + n° (%) 8 (8.8%) CHE U/l * 5617±1664 LIC mg Fe/g dry weight * 7.37±5.03 Table 2 describes TE results based on transfusion regimen, ferritin levels and HCV-RNA positivity. TE (mean ± SD) Transfusion regimen Never 5.4±2.2 Occasionally 6.4±3.5 Regular 7.2±2.9 Ferritin levels ng/ml <500 5.4±2.9 500–1000 5.5±2.8 >1000 8.2±3.4 HCV-RNA Positive 7.7±2.9 Negative 5.9±2.8 Moreover, splenectomy (p=0.014) and cholecystectomy (p<0.001) positively correlated with TE values. No significant correlations were found between TE values and sex, BMI, Hb, ALP, LDH, CHE and LIC by MRI. This study showed that fibrosis is common in TI patients and relates with iron load estimated by ferritin and with HCV positivity. Liver fibrosis can progress to cirrhosis and eventually to liver cancer, thus TE is a reliable non-invasive method for assessing liver fibrosis and for monitoring its progression in TI patients. It is advisable to introduce TE in the follow-up of thalassemic patients, although its role as a surrogate of liver biopsy remains to be established. The relationship between LSM and LIC measured by T2* MRI needs further investigations.

scholarly journals Options of non-invasive assessment of liver fibrosis based on the clinical data

2015 ◽  
Vol 156 (2) ◽  
pp. 43-52 ◽  
Author(s):  
Anna Egresi ◽  
Gabriella Lengyel ◽  
Krisztina Hagymási
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Gold Standard ◽  
Liver Diseases ◽  
Causes Of Death ◽  
Therapeutic Response ◽  
Transient Elastography ◽  
Chronic Liver Diseases ◽  
Indirect Methods ◽  
Non Invasive

Liver cirrhosis is one of the leading causes of death worldwide. Liver biopsy is considered as the gold standard for the diagnosis of chronic liver diseases. Studies have focused on non-invasive markers for liver fibrosis because of the dangers and complications of liver biopsy. The authors review the non-invasive direct as well as indirect methods for liver fibrosis assessment and present the positive and negative predictive value, sensitivity and specificity of those. Clinical utilities of transient elastography (Fibrsocan) is also reviewed. Non-invasive methods are useful in the assessment of liver fibrosis, monitoring disease progression and therapeutic response. Their accuracy can be increased by the combined or sequential use of non-invasive markers. Orv. Hetil., 2015, 156(2), 43–52.

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.

Non-invasive methods in the assessment of portal hypertension severity

2021 ◽  
Vol 75 (2) ◽  
pp. 125-133
Author(s):  
Soňa Franková ◽  
Jan Šperl
Keyword(s):  
Portal Hypertension ◽  
Liver Fibrosis ◽  
Shear Wave ◽  
Transient Elastography ◽  
Venous Pressure ◽  
Liver Stiffness ◽  
Invasive Technique ◽  
Hepatic Veins ◽  
Oesophageal Varices ◽  
Non Invasive

Portal hypertension represents a wide spectrum of complications of chronic liver diseases and may present by ascites, oesophageal varices, splenomegaly, hypersplenism, hepatorenal and hepatopulmonary syndrome or portopulmonary hypertension. Portal hypertension and its severity predicts the patient‘s prognosis: as an invasive technique, the portosystemic gradient (HPVG – hepatic venous pressure gradient) measurement by hepatic veins catheterisation has remained the gold standard of its assessment. A reliable, non-invasive method to assess the severity of portal hypertension is of paramount importance; the patients with clinically significant portal hypertension have a high risk of variceal bleeding and higher mortality. Recently, non-invasive methods enabling the assessment of liver stiffness have been introduced into clinical practice in hepatology. Not only may these methods substitute for liver biopsy, but they may also be used to assess the degree of liver fibrosis and predict the severity of portal hypertension. Nowadays, we can use the quantitative elastography (transient elastography, point shear-wave elastrography, 2D-shear-wave elastography) or magnetic resonance imaging. We may also assess the severity of portal hypertension based on the non-invasive markers of liver fibrosis (i.e. ELF test) or estimate clinically signifi cant portal hypertension using composite scores (LSPS – liver spleen stiff ness score), based on liver stiffness value, spleen diameter and platelet count. Spleen stiffness measurement is a new method that needs further prospective studies. The review describes current possibilities of the non-invasive assessment of portal hypertension and its severity.

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.

The impact of direct-acting antivirals on liver fibrosis in Egyptian hepatitis C virus patients: a single center experience

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nadia Abdelaaty Abdelkader ◽  
Amira Mahmoud AlBalakosy ◽  
Ahmed Fouad Helmy Sherief ◽  
Mohamed Soliman Gado
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Treatment Unit ◽  
Non Invasive ◽  
One Year ◽  
The Impact

Abstract Background Hepatitis C virus (HCV) infection affects approximately 170 million people worldwide, causing liver cirrhosis and hepatocellular carcinoma (HCC) and leading to liver transplantation and ultimately death. Accurate evaluation of liver fibrosis in patients with chronic liver diseases is crucial, as liver fibrosis is important in order to make therapeutic decisions, determine prognosis of liver disease and to follow-up disease progression. Multiple non-invasive methods have been used successfully in the prediction of fibrosis; however, early changes in noninvasive biomarkers of hepatic fibrosis under effective antiviral therapy are widely unknown. The aim of this study is to evaluate changes of transient elastography values as well as FIB-4 and AST to platelet ratio index (APRI) in patients treated with DAAs. Objectives The aim beyond this study is to evaluate the changes in liver stiffness in hepatitis C Egyptian patients before and at least one year after treatment with DAAs using transient elastography and non-invasive liver fibrosis indices as FIB-4 and APRI scores. Patients and methods The present study was conducted on 100 patients with chronic hepatitis C patients attended to Ain Shams University Hospitals, Viral hepatitis treatment unit between October 2017 and December 2018, who were followed-up during treatment and after treatment for at least one year (retrospective and prospective study). Total number of cases during the study period was 117 patients. 17 patients were excluded from the study due to missed follow-up. Eventually, 100 patients were enrolled in the study fulfilling the inclusion criteria. Results The mean age of our patients is 47.9 years with Male predominance (52 males and 48 females). There was a significant improvement of, platelets counts, ALT and AST levels, which in turn cause significant improvement in FIB-4 and APRI scores. There was a significant improvement of liver stiffness after end of treatment, regardless of the DAA regimen used, as evidenced by Fibroscan. Conclusion Fibrosis regression –assessed by non-invasive markers of fibrosis is achievable upon removal of the causative agent.

scholarly journals NON-INVASIVE ASSESSMENT OF LIVER FIBROSIS USING LIVER ELASTOGRAPHY (FIBROSCAN) IN PATIENTS WITH CHRONIC INFECTION HBV AND HCV

2016 ◽  
Vol 19 (3) ◽  
pp. 55-59
Author(s):  
Andreea Rădășan ◽  
◽  
Mihai Voiculescu ◽  
Laura Elena Iliescu ◽  
◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Viral Hepatitis ◽  
Chronic Viral Hepatitis ◽  
Economic Problem ◽  
Non Invasive ◽  
Treatment And Prevention ◽  
Viral Hepatitis C ◽  
B Virus ◽  
Liver Elastography

Introduction. In recent years there have been major advances in the treatment and prevention of viral hepatitis, but this pathology is still a major health and socio-economic problem. The defining element for this disease is the liver fibrosis, a histological component of particular importance due to its role in the formation of liver lesions of cirrhosis. Thus, an essential step in the management of chronic viral hepatitis is the detection and measurement of liver fibrosis. Today we have invasive methods for detecting liver fibrosis, the liver puncture biopsy, and non-invasive methods, which in turn are divided into serum methods and imaging methods (2). Purpose of the Study. The aim of this study is to determine if transcutaneous elastography (FibroScan) is equally reliable in case of viral hepatitis B, as with viral hepatitis C. Material and Method: The study comprises a total of 1,127 patients with liver disease of HBV and HCV aetiology. These patients were examined using FibroScan in the period July 2009 - April 2011. Results: Of the 1,177 patients investigated using FibroScan, 40 underwent liver biopsy as well. Of these, 82% have obtained same stages of liver fibrosis in these two investigations, and 18% achieved different stages of fibrosis in these two tests. For the patients with HCV infection, we obtained a 67.81% match of the two non-invasive tests, FibroScan and FibroMax, and a 79.16% match of FibroScan compared to the Liver Biopsy. For the B virus, the compliance is even better, of 75% (FibroScan - FibroMax), and 80% for FibroScan - LB. Conclusions: FibroScan is one of the non-invasive assessment methods of liver fibrosis with diagnose accuracy similar to FibroMax and close to Liver Biopsy.

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