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Lupsor-Platon, Monica, Teodora Serban, Alexandra-Iulia Silion, Alexandru Tirpe, and Mira Florea. "Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease: A Step Forward for Better Evaluation Using Ultrasound Elastography." Cancers 12, no. 10 (September 28, 2020): 2778. http://dx.doi.org/10.3390/cancers12102778.
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The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population prompts for a quick response from physicians. As NAFLD can progress to liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), new non-invasive, rapid, cost-effective diagnostic methods are needed. In this review, we explore the diagnostic performance of ultrasound elastography for non-invasive assessment of NAFLD and NAFLD-related HCC. Elastography provides a new dimension to the conventional ultrasound examination, by adding the liver stiffness quantification in the diagnostic algorithm. Whilst the most efficient elastographic techniques in staging liver fibrosis in NAFLD are vibration controlled transient elastography (VCTE) and 2D-Shear wave elastography (2D-SWE), VCTE presents the upside of assessing steatosis through the controlled attenuation parameter (CAP). Hereby, we have also critically reviewed the most important elastographic techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography (pSWE) and 2D-SWE. As our paper shows, elastography should not be considered as a substitute for FLL biopsy because of the stiffness values overlap. Furthermore, by using non-invasive, disease-specific surveillance tools, such as US elastography, a subset of the non-cirrhotic NAFLD patients at risk for developing HCC can be detected early, leading to a better outcome. A recent ultrasomics study exemplified the wide potential of 2D-SWE to differentiate benign FLLs from malignant ones, guiding the clinician towards the next steps of diagnosis and contributing to better long-term disease surveillance.
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Liu, Yu, Jingfei Liu, Brett Z. Fite, Josquin Foiret, Asaf Ilovitsh, J. Kent Leach, Erik Dumont, Charles F. Caskey, and Katherine W. Ferrara. "Supersonic transient magnetic resonance elastography for quantitative assessment of tissue elasticity." Physics in Medicine and Biology 62, no. 10 (April 20, 2017): 4083–106. http://dx.doi.org/10.1088/1361-6560/aa6674.
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Taru, Madalina-Gabriela, Lidia Neamti, Vlad Taru, Lucia Maria Procopciuc, Bogdan Procopet, and Monica Lupsor-Platon. "How to Identify Advanced Fibrosis in Adult Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) Using Ultrasound Elastography—A Review of the Literature and Proposed Multistep Approach." Diagnostics 13, no. 4 (February 19, 2023): 788. http://dx.doi.org/10.3390/diagnostics13040788.
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Non-alcoholic fatty liver disease (NAFLD), and its progressive form, non-alcoholic steatohepatitis (NASH), represent, nowadays, real challenges for the healthcare system. Liver fibrosis is the most important prognostic factor for NAFLD, and advanced fibrosis is associated with higher liver-related mortality rates. Therefore, the key issues in NAFLD are the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis. We critically reviewed the ultrasound (US) elastography techniques for the quantitative characterization of fibrosis, steatosis, and inflammation in NAFLD and NASH, with a specific focus on how to differentiate advanced fibrosis in adult patients. Vibration-controlled transient elastography (VCTE) is still the most utilized and validated elastography method for liver fibrosis assessment. The recently developed point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) techniques that use multiparametric approaches could bring essential improvements to diagnosis and risk stratification.
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Shirokova, Elena N., Chavdar S. Pavlov, Anna D. Karaseva, Aliya M. Alieva, Alla V. Sedova, and Vladimir T. Ivashkin. "Elastography in the Diagnosis of Non-Alcoholic Fatty Liver Disease." Annals of the Russian academy of medical sciences 74, no. 1 (April 3, 2019): 5–13. http://dx.doi.org/10.15690/vramn1071.
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Currently, there has been a progressive increase in prevalence of one of the most common diffuse chronic liver diseases ― non-alcoholic fatty liver disease (NAFLD). Assessment of the stages of liver fibrosis and steatosis is prognostically significant in diagnosis of NAFLD. Routine diagnostic methods are either not able to accurately assess the severity of fibrosis and steatosis (ultrasound, laboratory tests), or cannot be used as a simple screening tool (liver biopsy) due to such limitations as invasiveness, dependence on pathologist qualification, high cost, and limited region of interest. Over the last two decades, the great progress has been made in non-invasive visualization of pathological changes in liver diseases. In this review, we examined the diagnostic characteristics of the most widely used non-invasive imaging methods in clinical practice, available for quantitative determination of fat and fibrosis in the liver: transient elastography with controlled attenuation parameter (CAP), acoustic radiation force impulse (ARFI) and shear wave elastography (SWE). Comparing these methods and their limitations, we came to conclusion, that elastographic methods (slightly more ARFI and SWE) are able to verify the F3, F4 stages of fibrosis in NAFLD with high sensitivity and specificity (90%); however, they are less accurate for early stages. Elastographic techniques have moderate accuracy in identifying the degree of steatosis due to the lack of uniform standardized cut-off values of CAP.
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Patra, Sayantan, and Shabnam Bhandari Grover. "Physical Principles of Elastography: A Primer for Radiologists." Indographics 01, no. 01 (January 2022): 027–40. http://dx.doi.org/10.1055/s-0042-1742575.
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AbstractElastography is the noninvasive method of qualitative and quantitative evaluation of strain and elastic modulus distribution in soft tissues. In simpler terms, elastography is the science of measuring tissue stiffness, the deviation of which correlates with pathology of the tissue/organs being evaluated. Whereas, elasticity, refers to the property of solid matter to return to their original shape and size after removal of the deforming forces. In all forms of elastography, irrespective of the types of deforming forces or moduli, the deformation of tissue occurs in the form of shear deformation. The velocity of shear waves in the deformed tissue depends on its density and on the shear modulus. The direction of propagation of shear wave is perpendicular to the inciting mechanical or acoustic wave. The shear wave is then subsequently tracked using multiple tracking pulses, which measures tissue displacement in response to the passing shear wave. The calculated speed of the shear wave is then converted to conventional Young's modulus for the purpose of computing the tissue stiffness.The currently used elastography techniques are static or quasi-static elastography and dynamic elastography. Strain elastography (a form of static or quasi-static elastography) is based on the principle of acquisition of radio-frequency (RF) signals before and after the application of a deforming force in the form of slight compression of tissue by a transducer. RF signals are compared between the pre-compression image data set and the post-compression image data set and correlated between the two data sets.Dynamic elastography may be either ultrasound (US) based or magnetic resonance (MR) based. The types of dynamic US elastography are: acoustic radiation force impulse imaging (ARFI), transient elastography (TE), point shear wave elastography (pSWE), and shear wave elastography (SWE). ARFI uses a standard transducer to produce and propagate rapid bursts of long focused ultrasound pulses, also called as “push pulses” which cause tissue deformity, the propagation of which is tracked using radio-frequency echo tracking. In TE, a probe mounted on a vibrator is used to produce a small thump by piston like motion of transducer. The shear wave which arises from the edges of the transducer is tracked using high pulse repetition frequency tissue Doppler and computed using M-mode for display of quantitative parameters. Point shear wave, also known as quantitative ARFI, uses shear waves generated using transient tissue displacement caused by ARFI and are subsequently subjected to tracking by Doppler. Shear wave elastography is based on the principles of imaging shear wave speed. An acoustic radiation force impulse is transmitted along the acoustic axis to produce tissue displacement and deformation at points of acoustic axis. The generated shear wave is imaged using RF echo tracking over a grid of points, which is translated into a real time image. MR elastography is a dynamic technique and the basic principles of MR elastography are the same as other forms of dynamic elastography. MR elastography has limited utility in iron-overload states and in addition, due to the large amount of time required for acquisition, the technique is not suitable for unstable patients.This review presents a simplified summary of the principles of elastography along with definition of the terms and the types of elastography which are currently available to radiologists for clinical application and concludes with a brief on the newer developments for the future.
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Sporea, Ioan, Ruxandra Mare, Raluca Lupușoru, Alexandra Sima, Roxana Șirli, and Romulus Timar. "Liver Stiffness Evaluation by Transient Elastography in Type 2 Diabetes Mellitus Patients with Ultrasound-proven Steatosis." Journal of Gastrointestinal and Liver Diseases 25, no. 2 (June 1, 2016): 167–74. http://dx.doi.org/10.15403/jgld.2014.1121.252.lsf.
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Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. The aim of our study was to evaluate a population of diabetic patients regarding the severity of liver steatosis and liver fibrosis.
Methods: The study included 392 type 2 diabetic patients prospectively randomized, evaluated in the same session by transabdominal ultrasound to assess steatosis and by liver elastography to assess fibrosis (Transient Elastography – TE, FibroScan, EchoSens). Steatosis severity was graded using a semi-quantitative scale (S0-no steatosis; S1-mild steatosis; S2-moderate steatosis; S3-severe steatosis). For differentiation between stages of liver fibrosis, the following cut-off values were used (Wong et al., 2010): F2-F3: 7-10.2kPa, F4≥10.3 kPa.
Results: Reliable elastographic measurements were obtained in 76% (298/392) patients. By using the proposed cut-off values, significant fibrosis (F2-F3) was found in 18.8% (56) patients with steatosis, while 13.8% (41) had cirrhosis (F4). Significant fibrosis (F2-F3) was found in 20.4% (20/98) of the patients with S1, in 18.6% (22/118) of those with S2 and in 31.8% (14/44) of those with S3, while cirrhosis (F4) was diagnosed in 7.1% (7/98) patients with S1, in 20.3% (24/118) of those with S2 and in 22.7% (10/44) of those with S3.
Conclusions: Liver steatosis diagnosed by ultrasound is very frequently found in type 2 diabetes mellitus patients, more than half of them having moderate/severe steatosis. A significant liver stiffness increase was found in more than 30% of these patients. Liver stiffness assessment in type 2 diabetic patients should be performed systematically to identify those with significant liver fibrosis. .
Abbreviations: 2D-SWE: Two Dimensional Shear Waves Elastography; ALT: alanine aminotransferase; AP: alkaline phosphatase; ARFI: Acoustic Radiation Force Impulse; AST: aspartate aminotransferase; AUROC: area under the receiver operating characteristic; BMI: body mass index; DM: diabetes mellitus; GGT: gammaglutamyl transpeptidase; HbA1c: glycated hemoglobin; HBsAg: hepatitis B virus surface antigen; HBV: hepatitis B virus; HCV: hepatitis C virus; LC: liver cirrhosis; LS: liver stiffness; NAFLD: nonalcoholic fatty liver disease; NASH: nonalcoholic steatohepatitis; TE: transient elastography; US: ultrasound.
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Diomidova, Valentina N., Olga V. Valeeva, Lidiya N. Vasilyeva, and Ekaterina A. Razbirina. "INFORMATIVENESS OF TRANSIENT AND TWO-DIMENSIONAL SHEAR WAVE ELASTOGRAPHY IN ASSESSING OF LIVER STIFFNESS IN POST-COVID-19 AND CARDIOHEPATIC SYNDROMES." Acta medica Eurasica, no. 4 (December 27, 2023): 31–43. http://dx.doi.org/10.47026/2413-4864-2023-4-31-43.
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Ultrasound elastography of diffuse liver diseases allows to assess liver stiffness and predict the further course of the disease, determine the tactics of patient’s management for post-Covid and cardiohepatic syndrome. The purpose of the research – to study the diagnostic informativeness and evaluate the correlation between one-dimensional and two-dimensional shear wave elastography technologies with elastometry in assessing liver stiffness in patients with post-COVID and cardiohepatic syndromes. Materials and methods. A comparative analysis of the information content and correlation between the results of one-dimensional and two-dimensional shear wave elastography of the liver was carried out in 85 patients with post-COVID (N1; n = 30) and cardiohepatic (N2; n = 25) syndromes. The control group (N3; n = 30) consisted of patients without the new coronavirus infection COVID-19 and without any pathology of the liver and biliary system. In the control group, the study of liver parenchyma stiffness using shear wave elastography was carried out by lobes and segments. Standard variation statistics algorithms were used, taking into account the type of data distribution in the statistical analysis. Quantitative indicators with a normal distribution were described using arithmetic means (M) and standard deviations (SD), boundaries of the 95% confidence interval (95% CI). In the absence of a normal distribution, quantitative data were described using the median (Me) and lower and upper quartiles (Q1–Q3). Research results. The stiffness values (Emean) in the projection of segments VI, VII had larger values (p = 0.02) when compared with other segments. We obtained the following Emean values in transient elastography: in the group of patients with post-COVID syndrome (N1) – 10.02 kPa; in the group of patients with chronic heart failure (N2) – 14.09 kPa, which turned out to be significantly higher than the stiffness of the liver parenchyma among healthy individuals, where the Emean value was 4.90 kPa (p = 0.05). With shear wave elastography, the results were also higher in the group of patients with chronic heart failure (N2), where Emean was 20.90 kPa, compared to the group of patients with post-COVID syndrome (N1) – 11.86 kPa. Conclusions. The results of shear wave elastography were successful in 100% of cases, the results of transient elastography in 84.6% of cases. Correlation analysis of connections in a group of patients with chronic heart failure according to TE and SWE showed a weak positive direct linear correlation. A positive direct linear correlation of medium strength was obtained in assessing the correlation in the group of patients with post-COVID syndrome.
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Kim, Hyun-Jin, Hae-Kag Lee, Jae-Hwan Cho, and Han-Jun Yang. "Quantitative comparison of transient elastography (TE), shear wave elastography (SWE) and liver biopsy results of patients with chronic liver disease." Journal of Physical Therapy Science 27, no. 8 (2015): 2465–68. http://dx.doi.org/10.1589/jpts.27.2465.
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Esposto, Giorgio, Paolo Santini, Linda Galasso, Irene Mignini, Maria Elena Ainora, Antonio Gasbarrini, and Maria Assunta Zocco. "Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication: A systematic review and meta-analysis." World Journal of Gastroenterology 30, no. 10 (March 14, 2024): 1450–60. http://dx.doi.org/10.3748/wjg.v30.i10.1450.
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BACKGROUND Direct-acting antiviral agents (DAAs) are highly effective treatment for chronic hepatitis C (CHC) with a significant rate of sustained virologic response (SVR). The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis progression. The assessment of fibrosis degree can be performed with transient elastography, magnetic resonance elastography or shear-wave elastography (SWE). Liver elastography could function as a predictor for hepatocellular carcinoma (HCC) in CHC patients treated with DAAs. AIM To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus (HCV). METHODS A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV clearance. In accordance with the study protocol, a qualitative and quantitative analysis of the evidence was planned. RESULTS At baseline and after 12 wk of follow-up, a trend was shown towards greater liver stiffness (LS) in those who go on to develop HCC compared to those who do not [baseline LS standardized mean difference (SMD): 1.15, 95% confidence interval (95%CI): 020-2.50; LS SMD after 12 wk: 0.83, 95%CI: 0.33-1.98]. The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source data. There was a statistically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not (0.64; 95%CI: 0.04-1.24). CONCLUSION SWE could be a promising tool for prediction of HCC occurrence in patients treated with DAAs. Further studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.
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Leung, Vivian Yee-fong, Jiayun Shen, Vincent Wai-sun Wong, Jill Abrigo, Grace Lai-hung Wong, Angel Mei-ling Chim, Shirley Ho-ting Chu, et al. "Quantitative Elastography of Liver Fibrosis and Spleen Stiffness in Chronic Hepatitis B Carriers: Comparison of Shear-Wave Elastography and Transient Elastography with Liver Biopsy Correlation." Radiology 269, no. 3 (December 2013): 910–18. http://dx.doi.org/10.1148/radiol.13130128.
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Cè, Maurizio, Natascha Claudia D'Amico, Giulia Maria Danesini, Chiara Foschini, Giancarlo Oliva, Carlo Martinenghi, and Michaela Cellina. "Ultrasound Elastography: Basic Principles and Examples of Clinical Applications with Artificial Intelligence—A Review." BioMedInformatics 3, no. 1 (January 6, 2023): 17–43. http://dx.doi.org/10.3390/biomedinformatics3010002.
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Ultrasound elastography (USE) or elastosonography is an ultrasound-based, non-invasive imaging method for assessing tissue elasticity. The different types of elastosonography are distinguished according to the mechanisms used for estimating tissue elasticity and the type of information they provide. In strain imaging, mechanical stress is applied to the tissue, and the resulting differential strain between different tissues is used to provide a qualitative assessment of elasticity. In shear wave imaging, tissue elasticity is inferred through quantitative parameters, such as shear wave velocity or longitudinal elastic modulus. Shear waves can be produced using a vibrating mechanical device, as in transient elastography (TE), or an acoustic impulse, which can be highly focused, as in point-shear wave elastography (p-SWE), or directed to multiple zones in a two-dimensional area, as in 2D-SWE. A general understanding of the basic principles behind each technique is important for clinicians to improve data acquisition and interpretation. Major clinical applications include chronic liver disease, breast lesions, thyroid nodules, lymph node malignancies, and inflammatory bowel disease. The integration of artificial intelligence tools could potentially overcome some of the main limitations of elastosonography, such as operator dependence and low specificity, allowing for its effective integration into clinical workflow.
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Borsukov, Aleksey V., Dmitry A. Doroshenko, and Anastasiia I. Skutar. "DIAGNOSTIC EFFECTIVENESS OF DIFFERENT LIVER ELASTOMETRY METHODS IN PATIENTS WITH HEART FAILURE DEPENDING ON THE STAGE OF THE DISEASE." Acta medica Eurasica, no. 2 (June 26, 2023): 1–13. http://dx.doi.org/10.47026/2413-4864-2023-2-1-13.
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Today, heart failure remains one of the most important public health problems. The leading pathogenetic mechanism of heart failure is stagnation in the systemic circulation, causing affection of one of the main target organs – the liver. Prolonged stagnation in the liver in combination with hypoperfusion of hepatocytes eventually results in liver fibrosis, followed by transformation into the so-called "cardiac cirrhosis". Biopsy with subsequent biopsy material examination remains the "gold standard" to diagnose liver damage, however, there are a number of limitations, risks, absolute and relative contraindications, due to which it is impossible to conduct an invasive diagnostic procedure in routine clinical practice settings. In recent years, medical community has paid much attention to an innovative non–invasive method of diagnosing liver fibrosis – ultrasound elastometry. To date, there are several types of this technique that are most commonly used in clinical practice: transient elastometry, point elastometry, two-dimensional shear wave elastography. Each of these methods has its advantages and disadvantages. The aim is to study and compare the diagnostic effectiveness (sensitivity, specificity and accuracy) of various types of ultrasound elastometry in diagnosing liver fibrosis in cardiac patients, depending on the stage of heart failure. Materials and methods. The study was conducted on the basis of diagnostic and minimally invasive technologies department at Clinical Hospital № 1 in Smolensk in the period from October 2022 to March 2023 Three groups of patients with heart failure were examined: Group 1 – patients with stage I of the disease (n = 12), group 2 – with stage II (n = 16), group 3 – with stage III (n = 11), a total of 39 patients. Comparative opportunities of transient liver elastometry, point elastometry and two-dimensional shear wave elastography in patients with various stages of heart failure were determined. The sensitivity, specificity and accuracy of the methods were evaluated. The methods of statistical analysis, generalization, comparison and systematization of data were used. The reference method was multispiral computed tomography with a quantitative assessment of the liver structure, biochemical blood analysis with De Ritis ratio determination and the FIB-4 scale. Results. In group 1, the sensitivity, specificity and accuracy indices did not differ statistically in 3 methods. In group 2 in transient elastometry: sensitivity made 58.1%, specificity – 67.4%, accuracy – 61.2%; in point elastometry: sensitivity made 64.7%, specificity – 82.6%, accuracy – 76.3%; in two–dimensional shear wave elastography: sensitivity made 87.4%, specificity – 93.1%, accuracy – 90.8%. In group 3, in transient elastometry, the study was uninformative, in point elastometry: sensitivity made 48.6%, specificity – 60.1%, accuracy – 52.3%; in two–dimensional shear wave elastography: sensitivity made 85.1%, specificity – 92.3%, accuracy – 88.4%. Conclusions. 1. In patients with stage I heart failure, the choice of a strictly defined elastometry technique is not fundamental, since the indicators of all three methods did not differ statistically. For patients with stage II and III heart failure, the use of shear wave elastometry is preferable, wherein at a late stage (stage III), the diagnostic effectiveness of two-dimensional shear wave elastography is higher than that of point elastometry. 2. Transient elastometry is less informative in patients with heart failure compared to shear wave elastometry.
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Soon, Gwyneth, and Aileen Wee. "Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective." Clinical and Molecular Hepatology 27, no. 1 (January 1, 2021): 44–57. http://dx.doi.org/10.3350/cmh.2020.0181.
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Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a major cause of liver fibrosis and cirrhosis. Accurate assessment of liver fibrosis is important for predicting disease outcomes and assessing therapeutic response in clinical practice and clinical trials. Although noninvasive tests such as transient elastography and magnetic resonance elastography are preferred where possible, histological assessment of liver fibrosis via semiquantitative scoring systems remains the current gold standard. Collagen proportionate area provides more granularity by measuring the percentage of fibrosis on a continuous scale, but is limited by the absence of architectural input. Although not yet used in routine clinical practice, advances in second harmonic generation/two-photon excitation fluorescence (SHG/TPEF) microscopy imaging show great promise in characterising architectural features of fibrosis at the individual collagen fiber level. Quantification and calculation of different detailed variables of collagen fibers can be used to establish algorithm-based quantitative fibrosis scores (e.g., qFibrosis, q-FPs), which have been validated against fibrosis stage in NAFLD. Artificial intelligence is being explored to further refine and develop quantitative fibrosis scoring methods. SHG-microscopy shows promise as the new gold standard for the quantitative measurement of liver fibrosis. This has reaffirmed the pivotal role of the liver biopsy in fibrosis assessment in NAFLD, at least for the near-future. The ability of SHG-derived algorithms to intuitively detect subtle nuances in liver fibrosis changes over a continuous scale should be employed to redress the efficacy endpoint for fibrosis in NASH clinical trials; this approach may improve the outcomes of the trials evaluating therapeutic response to antifibrotic drugs.
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Cabibi, Daniela, Fabrizio Bronte, Rossana Porcasi, Sabrina Ingrao, Antonino Giulio Giannone, Marcello Maida, Maria Grazia Bavetta, Salvatore Petta, Vito Di Marco, and Vincenza Calvaruso. "Comparison of Histochemical Stainings in Evaluation of Liver Fibrosis and Correlation with Transient Elastography in Chronic Hepatitis." Analytical Cellular Pathology 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/431750.
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Background and Aim. The best staining to evaluate liver fibrosis in liver hepatitis is still a debated topic. This study aimed to compare Masson’s trichrome (MT), Sirius Red (SR), and orcein stainings in evaluating liver fibrosis in chronic HCV hepatitis (CHC) with semiquantitative and quantitative methods (Collagen Proportionate Area (CPA) by Digital Image Analysis (DIA)) and correlate them with transient elastography (TE).Methods. Liver stiffness evaluation of 111 consecutive patients with CHC was performed by TE. Semiquantitative staging by Metavir score system and CPA by DIA were assessed on liver biopsy stained with MT, SR, and orcein.Results. MT, SR, and orcein staining showed concordant results in 89.6% of cases in staging CHC, without significant difference in both semiquantitative and quantitative evaluations of fibrosis. TE values were concordant with orcein levels in 86.5% of the cases and with MT/RS in 77.5% (P<0.001). No significant correlation between the grade of necroinflammatory activity and TE values was found.Conclusion. In CHC, SR/MT and orcein stainings are almost concordant and when discordant, orcein staining is better related to TE values than MT/RS. This suggests that elastic fibers play a more important role than reticular or collagenous ones in determining stiffness values in CHC.
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Isgro, G., T. Luong, L. Andreana, M. Garcovich, S. Maimone, P. Manousou, V. Calvaruso, et al. "PP-011 Collagen proportionate area: a continuous quantitative of histological collagen has the best correlation with transient elastography." Gut 59, Suppl 1 (April 2010): A44.2—A44. http://dx.doi.org/10.1136/gut.2009.209015c.
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Franková, Soňa, and Jan Šperl. "Non-invasive methods in the assessment of portal hypertension severity." Gastroenterologie a hepatologie 75, no. 2 (April 30, 2021): 125–33. http://dx.doi.org/10.48095/ccgh2021125.
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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.
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Maimunah, Ummi, Ulfa Kholili, Rheza Rahmadika Putra, Dio Brimantyo, and Hendy Wirantara. "Increased Levels of TNF-α, IL-6, and IL-10 are Associated with The Degree of Liver Fibrosis in Chronic Hepatitis B Patients with NUC Therapy." Indonesian Biomedical Journal 16, no. 1 (February 23, 2024): 72–8. http://dx.doi.org/10.18585/inabj.v16i1.2848.
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BACKGROUND: Liver fibrosis in chronic hepatitis B (CHB) involves the host immune responses mainly T-lymphocyte regulatory cells and cytokines production. Tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 have been reported to play a crucial role in the development of liver fibrosis. However, their association with liver fibrosis in treated CHB patients remains unclear. Therefore, this study was conducted to investigate the association between TNF-α, IL-6, and IL-10 with the degree of liver fibrosis in treated CHB patients.METHODS: This was a cross-sectional prospective study including 101 treated chronic hepatitis B subjects. TNF-α, IL-6, and IL-10 serum levels were measured with quantitative sandwich enzyme-linked immunosorbent assay (ELISA) kit. Transient elastography result was classified according to METAVIR score. Data was analyzed by the Spearman correlation test with a p<0.05 was considered statistically significant.RESULTS: From 101 subjects, there were significant differences were seen in TNF-α, IL-6, and IL-10 between patients with mild, significant and advance fibrosis. TNF-α (r=0.292; p<0.05), IL-6 (r=0.221; p<0.05), and IL-10 (r=0.208; p<0.05) were significantly correlated with the degree of fibrosis. After multivariate analysis, TNF-α was the only one cytokine parameter which significantly correlated with the degree of fibrosis.CONCLUSION: Levels of TNF-α, IL-6 and IL-10 are associated with the degree of liver fibrosis. These parameters may potentially be used to evaluate the development of liver fibrosis in treated CHB patients.KEYWORDS: chronic hepatitis B, liver fibrosis, cytokines, transient elastography
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Teufel-Schäfer, Ulrike, Christa Flechtenmacher, Alexander Fichtner, Georg Friedrich Hoffmann, Jens Peter Schenk, and Guido Engelmann. "Transient elastography correlated to four different histological fibrosis scores in children with liver disease." European Journal of Pediatrics 180, no. 7 (March 11, 2021): 2237–44. http://dx.doi.org/10.1007/s00431-021-04001-6.
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AbstractCurrently, liver histology is the gold standard for the detection of liver fibrosis. In recent years, new methods such as transient elastography (TE) have been introduced into clinical practice, which allow a non-invasive assessment of liver fibrosis. The aim of the present study was to investigate the predictive value of TE for higher grade fibrosis and whether there is any relevance which histologic score is used for matching. For this purpose, we compared TE with 4 different histologic scores in pediatric patients with hepatopathies. Furthermore, we also determined the aspartate aminotransferase-to-platelet ratio (APRI) score, another non-invasive method, to investigate whether it is equally informative. Therefore, liver fibrosis in 75 children was evaluated by liver biopsy, TE and laboratory values. Liver biopsies were evaluated using four common histological scoring systems (Desmet, Metavir, Ishak and Chevalier’s semi-quantitative scoring system). The median age of the patients was 12.3 years. TE showed a good correlation to the degree of fibrosis severity independent of the histological scoring system used. The accuracy of the TE to distinguish between no/minimal fibrosis and severe fibrosis/cirrhosis was good (p = 0.001, AUC-ROCs > 0.81). The optimal cut-off value for the prediction of severe fibrosis was 10.6 kPa. In contrast, the APRI score in our collective showed no correlation to fibrosis.Conclusion: TE shows a good correlation to the histological findings in children with hepatopathy, independent of the used histological scoring system. What is Known:• The current gold standard for detecting liver fibrosis is liver biopsy. Novel non-invasive ultrasound-based methods are introduced to clinical diagnostics.• Most histological scores have been developed and evaluated in adult populations and for only one specific liver disease.What is New:• Transient elastography (TE) in children showed a good correlation to fibrosis severity irrespective of the utilized histological scoring system.• The aspartate aminotransferase-to-platelet ratio (APRI) showed no correlation with different stages of liver fibrosis in children.
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Ogawa, Eiichi, Norihiro Furusyo, Kazuhiro Toyoda, Hiroaki Takeoka, Shigeru Otaguro, Maki Hamada, Masayuki Murata, Yasunori Sawayama, and Jun Hayashi. "Transient elastography for patients with chronic hepatitis B and C virus infection: Non-invasive, quantitative assessment of liver fibrosis." Hepatology Research 37, no. 12 (December 2007): 1002–10. http://dx.doi.org/10.1111/j.1872-034x.2007.00160.x.
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Ogawa, Eiichi, Norihiro Furusyo, Kazuhiro Toyoda, Hiroaki Takeoka, Shinji Maeda, and Jun Hayashi. "The longitudinal quantitative assessment by transient elastography of chronic hepatitis C patients treated with pegylated interferon alpha-2b and ribavirin." Antiviral Research 83, no. 2 (August 2009): 127–34. http://dx.doi.org/10.1016/j.antiviral.2009.04.002.
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Suresh, Mithil Gowda, Maya Gogtay, Yuvaraj Singh, Lekha Yadukumar, Ajay Kumar Mishra, and George M. Abraham. "Case-control analysis of venous thromboembolism risk in non-alcoholic steatohepatitis diagnosed by transient elastography." World Journal of Clinical Cases 11, no. 34 (December 6, 2023): 8126–38. http://dx.doi.org/10.12998/wjcc.v11.i34.8126.
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BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Studies have shown a strong association between non-alcoholic steatohepatitis (NASH) cirrhosis and portal vein thrombosis. Specifically, there is paucity of data on the association of NASH and venous thromboembolism (VTE), with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized patients. The mechanism is believed to be a hepatocellular injury, which causes a chronic inflammatory state leading to the unregulated activation of procoagulant factors. There has been no prior analysis of the degree of steatosis and fibrosis (measured using transient elastography, commonly known as FibroScan) in NASH and its association with VTE. AIM To examine the association between the degree of hepatic steatosis and fibrosis, quantified by transient elastography, and the incidence of VTE in patients with NASH. METHODS In our case-control study, we included patients with a documented diagnosis of NASH. We excluded patients with inherited thrombophilia, hemoglobinopathy, malignancy, alcohol use disorder, autoimmune hepatitis, and primary biliary cirrhosis. The collected data included age, demographics, tobacco use, recreational drug use, medical history, and vibration controlled transient elastography scores. VTE-specific data included the location, type of anticoagulant, need for hospital stay, and history of VTE recurrence. Steatosis was categorized as S0-S1 (mild) and S2-S3 (moderate to severe) based on the controlled attenuation parameter score. Fibrosis was classified based on the kilopascal score and graded as F0-F1 (Metavir stage), F2, F3, and F4 (cirrhosis). χ2 and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses, respectively. Furthermore, we performed a logistic regression using VTE as the dependent variable. RESULTS A total of 415 patients were analyzed, and 386 met the inclusion criteria. 51 and 335 patients were included in the VTE and non-VTE groups, respectively. Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group (P < 0.014). Patients with VTE had a higher body mass index (31.14 kg/m² vs 29.30 kg/m²) and a higher prevalence of diabetes mellitus (29.4% vs 13.1%). The history of NASH was significantly higher in the VTE group (45.1% vs 30.4%, P < 0.037). Furthermore, moderate-to-severe steatosis was significantly higher in the VTE group (66.7% vs 47.2%, P < 0.009). Similarly, the F2-F4 fibrosis grade had a prevalence of 58.8% in the VTE group compared to 38.5% in the non-VTE group (P < 0.006). On logistic regression, using VTE as a dependent variable, diabetes mellitus had an odds ratio (OR) =1.702 (P < 0.015), and F2-F4 fibrosis grade had an OR = 1.5 (P < 0.033). CONCLUSION Our analysis shows that NASH is an independent risk factor for VTE, especially deep vein thrombosis. There was a statistically significant association between the incidence of VTE, moderate-to-severe steatosis, and fibrosis. All hospitalized patients should be considered for medical thromboprophylaxis, particularly those with NASH.
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Dvoryakovskaya, Galina M., S. A. Ivleva, I. V. Dvoryakovskiy, A. N. Surkov, A. S. Potapov, O. S. Gundobina, and I. E. Smirnov. "Comprehensive ultrasound diagnosis in the evaluation of liver parenchyma and stages of fibrosis in children with autoimmune hepatitis." Russian Pediatric Journal 19, no. 1 (April 29, 2019): 4–8. http://dx.doi.org/10.18821/1560-9561-2016-19-1-4-8.
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There are presented data of the comprehensive ultrasound examination of 88 children, aged from 3 to 16 years, with autoimmune hepatitis (AIH), types 1 and 2. There was performed a comparative evaluation of morphological and ultrasound (US) changes in the structure of the liver parenchyma in 67 children with AIH with the use of non-invasive ultrasound techniques Acoustic Structure Quantification (Live ASQ) for transient elastography of the liver (TEL) and quantitative estimation of the structure of the liver parenchyma. It was established that in 5 patients the mean value of the density index (DI) was equal to 1.69, and the elasticity of 5.40 kPa, that corresponded on data of the morphological study to minimal and moderate fibrosis according to the METAVIR scoring system (F1-2). In advancedfibrosis in 19 children with AIH DI in average was equaled to 2.47 and values of elasticity were 10.90 kPa (F3). In 49 patients at the stage of liver cirrhosis (LC) (F4) the elasticity value was 26.10 kPa and DI - 3.63. These consistencies indicate to the diagnostic significance of ultrasound non-invasive techniques ASQ and TEL and the appropriateness of their use in pediatrics.
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Dimzova, Marija, Irena Kondova-Topuzovska, Zvonko Milenkovic, Magdalena Gaseva, Viktorija Chaloska-Ivanova, Vladimir Serafimoski, and Nikola Orovcanec. "Clinical Significance of Quantitative HBs Antigen in the Prediction of Liver Fibrosis in Patients with Chronic Hepatitis B." PRILOZI 39, no. 1 (July 1, 2018): 51–58. http://dx.doi.org/10.2478/prilozi-2018-0023.
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Abstract The assessment of liver fibrosis in patients with chronic hepatitis B (CHB) is of great importance in evaluating the phases of chronic hepatitis B viral infection, prompt administration of antiviral therapy, prevention of disease progression and late complications of CHB infection. Aim: to investigate the clinical significance of quantitative HBs antigen as a predictor for liver fibrosis in patients with HBe antigen negative chronic hepatitis B and inactive carriers. Material and Methods: the study included 44 treatment naïve patients with chronic hepatitis B, divided into two groups, HBeAg negative chronic HBV infection or inactive carriers (IC) and HBeAg negative chronic hepatitis B patients. All patients underwent laboratory, serologic testing, ultrasound and transient elastography (TE). In both patient groups, quantitative HBs antigen (HBsQ), alanine aminotransferase (ALT), hepatitis B virus deoxyribonucleic acid (HBV DNA) and liver fibrosis were analyzed. Results: The value of HBsQ is significantly higher in patients with HBeAg negative CHB 2477.02±4535.44 IU/ml than in the IC group 8791±11891 IU/ml; Z=3.32, p<0.001 (p=0.0009). In IC patients, 1 (4.76%) had fibrosis and 20 (95.24%)) did not have fibrosis. Out of 23 patients with HBeAg negative chronic hepatitis B, 8 (34.78%) had fibrosis and 15 (65.22%) did not have fibrosis. Patients with HBeAg negative hepatitis B had significantly higher liver fibrosis than IC; Fisher Exact Test p<0.05 (p=0.02). The increase of HBsQ for one single unit (IU/ml) does not have predictive value for fibrosis (Ext (B) =1.00), 95% C.I. for EXP (B): 1.00-1.00 / p>0.05. Conclusion: Quantitative hepatitis B surface antigen has intermediate weak statistically insignificant prediction for liver fibrosis R=0.25 (p<0.10).
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Bastian, Winda P., Irsan Hasan, C. Rinaldi A. Lesmana, Ikhwan Rinaldi, and Rino A. Gani. "Gut Microbiota Profiles in Nonalcoholic Fatty Liver Disease and Its Possible Impact on Disease Progression Evaluated with Transient Elastography: Lesson Learnt from 60 Cases." Case Reports in Gastroenterology 13, no. 1 (March 7, 2019): 125–33. http://dx.doi.org/10.1159/000498946.
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Background: Dysbiosis of the gut microbiota has been considered to have a role in nonalcoholic fatty liver disease (NAFLD) progression. However, there is still lack of studies regarding this phenomenon. Aim: To find the difference in the proportion of gut microbiota in NAFLD patients based on the stages of liver fibrosis. Patients and Methods: A cross-sectional study was conducted at Dr. Cipto Mangunkusumo Hospital, which is the largest tertiary referral center. Human fecal samples from NAFLD patients who came to the outpatient clinic were collected consecutively. The stool sample examination was performed using an isolation DNA kit (Tiangen) and quantitative real-time polymerase chain reaction (Fast 7500). Clinical and laboratory data were also collected. The stage of fibrosis was diagnosed based on transient elastography (FibroScan® 502 Touch; Echosens, France). Results: Of 60 NAFLD human fecal samples, 35 patients had nonsignificant fibrosis and 25 patients had significant fibrosis (46.7% male and 53.3% female; median age 56 years). Most patients had diabetes (85%), dyslipidemia (58.3%), obesity (58.3%), and central obesity (90%). The proportion of Bacteroides was higher when compared to Lactobacillus and Bifidobacteria. Of these 3 microbiota, the proportion of Bacteroides was significantly higher in the significant fibrosis group when compared to the nonsignificant fibrosis group. Conclusion: There is a change in the composition of gut microbiota in NAFLD patients. The proportion of Bacteroides is significantly higher in significant liver fibrosis, which may play a role in NAFLD progression.
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Dvoryakovskiy, I. V., S. A. Ivleva, Galina M. Dvoryakovskaya, A. N. Surkov, A. S. Potapov, and I. E. Smirnov. "Modern technologies of ultrasound diagnostics of cirrhosis in chronic liver diseases in children." Russian Pediatric Journal 19, no. 4 (April 30, 2019): 202–8. http://dx.doi.org/10.18821/1560-9561-2016-19-4-202-208.
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By methods of ultrasound (US) diagnostics there were examined 177 children at the age offrom 2 months to 17 years, with liver cirrhosis (LC) in the outcome of chronic hepatitis (CH) of various etiologies. It was found that, irrespective of the etiological factor there is noted a large number of general ultrasound characters typical for stages of the formation of the LC: «streaking» of the hepatic image, cirrhotic nodes, splenomegaly and signs ofportal hypertension. The rate of the formation of LC was analyzed in dependence on the etiological factor. It was established that often, and in a short time LS develops in the outcome of CHD, autoimmune hepatitis and cryptogenic chronic hepatitis. In the examination of 135 children there were included invasive (biopsy) and non-invasive ultrasound methodologies for the quantitative assessment of the liver parenchyma structure: Acoustic Structure Quantification (ASQ) and Transient elastography (TEP). Based on a comparative analysis of US and morphological data SP values> 2.77 and elasticity> 13.90 were established to indicate LC (F4) according to METAVIR system. There were established additional diagnostic criteria for the assessment of the severity of the state of LC patients: density index (DI) increased significantly as far as the disease progresses. The use of non-invasive techniques dramatically expands the diagnostic capabilities of a traditional ultrasound examination of the liver.
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Gervain, Judit. "The diagnosis of hepatitis C viral infection." Orvosi Hetilap 155, no. 26 (June 2014): 1019–23. http://dx.doi.org/10.1556/oh.2014.29972.
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The successful therapy of hepatitis C viral infection requires that the illness is diagnosed before the development of structural changes of the liver. Testing is stepwise consisting of screening, diagnosis, and anti-viral therapy follow-up. For these steps there are different biochemical, serological, histological and molecular biological methods available. For screening, alanine aminotransferase and anti-HCV tests are used. The diagnosis of infection is confirmed using real-time polymerase chain reaction of the viral nucleic acid. Before initiation of the therapy liver biopsy is recommended to determine the level of structural changes in the liver. Alternatively, transient elastography or blood biomarkers may be also used for this purpose. Differential diagnosis should exclude the co-existence of other viral infections and chronic hepatitis due to other origin, with special attention to the presence of autoantibodies. The outcome of the antiviral therapy and the length of treatment are mainly determined by the viral genotype. In Hungary, most patients are infected with genotype 1, subtype b. The polymorphism type that occurs in the single nucleotide located next to the interleukin 28B region in chromosome 19 and the viral polymorphism type Q80K for infection with HCV 1a serve as predictive therapeutic markers. The follow-up of therapy is based on the quantitative determination of viral nucleic acid according to national and international protocols and should use the same method and laboratory throughout the treatment of an individual patient. Orv. Hetil., 2014, 155(26), 1019–1023.
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El-Beshlawy, Amal, Dalia Omran, Hala Mohsen Abdullatif, Niveen Salama, Mohamed Ahmed Abdel Naeem, Mona El ghamrawy, and Amina Abdel-Salam. "Non Invasive Evaluation of Hepatic Iron Concentration By Fibroscan in Transfusion-Dependent Egyptian Patients with Chronic Hemolytic Anemia." Blood 132, Supplement 1 (November 29, 2018): 1061. http://dx.doi.org/10.1182/blood-2018-99-118695.
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Abstract Background: Transient elastography (Fibroscan®) is an ultrasound technique used to measure liver stiffness (LS), and thus assess for liver fibrosis, in patients with various chronic hepatic disorders. It can also be used to predict severity in multiple other diseases that might affect LS such as amyloidosis and possibly conditions associated with iron overload. Objectives: To assess the frequency of liver fibrosis in patients with chronic hemolytic anemia using Transient elastography (Fibroscan®), and to determine the reliability of this tool as a non-invasive method to predict hepatic iron content as compared to liver iron concentration (LIC) measured by magnetic resonance imaging (MRI). Patients and methods: Seventy-five transfusion dependent patients (50 β-thalassemia major;25 sickle cell disease) with a mean age of 13.4±5.2 years in addition to 75 -age and sex matched- healthy children were recruited. All subjects underwent assessment of LS in kilopascals (kPa), by Transient elastography measurement using FibroScan (Echosens, Paris, France І). Steady state serum ferritin (SF), and hepatitis B serologies (HBsAg and antiHB core antibodies) were assessed by enzyme linked immunoassay (ELISA). LIC values, within 6 months' duration, as identified by quantitative MRI of hepatic iron stores as a signal intensity ratio method based on T1 and T2* contrast imaging without gadolinium were retrieved. Informed consent was obtained from patients' legal guardians prior to enrollment in the study. Results: The median SF was 2280 ng/ml (84% had values exceeding 1000 ng/ml). The median LIC was 13.86 mg/g dw (78.7% patients showed LIC above 7 mg/g dw). The median cardiac T2* was 30.8 ms (3 patients had values below 20). Fifty-two (69.3%) patients were categorized as F0-1 and 21 (28%) were stage F2, 2 (1.3%) were stage F3, and 2 patients had severe fibrosis. The mean and median fibroscan (FS) values were 6.19 ±1.76 kPa and 5.9 kPa (range 3 to 14.1) respectively. Patients had significantly higher mean FS compared to control group (p ˂0.001). Patients with no or mild fibrosis (F0-1) had lower FS values (5.3kPa) compared to patients with fibrosis grades 2-4 (p ˂0.001). FS values were not affected by disease type (thalassemia or sickle cell disease), age (above 12 years), or HCV sero-positivity. FS values correlated with SF (r=0.410, p˂ 0.001). Simple regression analysis of the two variables suggested that changes in SF were associated with minimal but significant changes in FS values (p=0.04) with good agreement (kappa =0.324, p=0.003). LIC did not differ in relation to grade of fibrosis (p>0.05), did not correlate with FS values (r= 0.014, p=0.908), and no changes in FS were expected with LIC changes on regression analysis (p=0.466) with low agreement between LIC and FS at cutoff value 5.3 kPa (kappa = 0.015, p=0.9). Sensitivity and specificity of FS values to predict LIC were high at cutoff values ranging between 3.2 to 3.75 kPa but decreased markedly at higher cutoff values. On comparing sensitivity and specificity of FS values in prediction of iron overload at different cutoff values by ROC curve, it could not significantly predict iron overload (p=0.7). No correlations were found between LIC and other variables including SF (r=0.2), and changes in SF were not significantly associated with changes in LIC values (p =0.089). However, sensitivity and specificity of SF in predicting LIC were good at cutoff 1003.85 ng/ml but decreased markedly at higher cutoff values. Comparing its sensitivity and specificity to that of SF in the prediction of iron overload at different cutoff values by ROC curve, FS could not predict iron overload accurately (p=0.9) and the degree of agreement between these two variables as indicators of iron overload was low (kappa=0.063, p=0.478). Conclusion: Fibroscan could be a valuable tool to assess the degree of liver fibrosis in patients with elevated SF, but it does not appear to reliably predict LIC in such group of patients especially with severe iron overload. FS values were not affected by disease type, age above 12 years, or HCV sero-positivity. Figure Figure. Disclosures No relevant conflicts of interest to declare.
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Chang, Young, Jae-A. Han, Suk Min Kang, Soung Won Jeong, Tom Ryu, Han Seul Park, Jeong-Ju Yoo, et al. "Clinical impact of serum exosomal microRNA in liver fibrosis." PLOS ONE 16, no. 9 (September 10, 2021): e0255672. http://dx.doi.org/10.1371/journal.pone.0255672.
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Background/aim We investigated alterations in the expression of serum exosomal miRNAs with the progression of liver fibrosis and evaluated their clinical applicability as biomarkers. Methods This study prospectively enrolled 71 patients who underwent liver biopsy at an academic hospital in Korea. Exosomes were extracted from serum samples, followed by next-generation sequencing (NGS) of miRNAs and targeted real-time quantitative polymerase chain reaction. A model was derived to discriminate advanced fibrosis based on miRNA levels and the performance of this model was evaluated. Validation of the effect of miRNA on liver fibrosis in vitro was followed. Results NGS data revealed that exosomal miR-660-5p, miR-125a-5p, and miR-122 expression were changed significantly with the progression of liver fibrosis, of which miR-122 exhibited high read counts enough to be used as a biomarker. The level of exosomal miR-122 decreased as the pathologic fibrosis grade progressed and patients with biopsy-proven advanced fibrosis had significantly lower levels of exosomal miR-122 (P < 0.001) than those without advanced fibrosis. Exosomal miR-122 exhibited a fair performance in discriminating advanced fibrosis especially in combination with fibrosis-4 score and transient elastography. In a subgroup of patients with a non-viral etiology of liver disease, the performance of exosomal miR-122 as a biomarker was greatly improved. Inhibition of miR-122 expression increased the proliferation of the human hepatic stellate cell line, LX-2, and upregulated the expression of various fibrosis related proteins. Conclusion Exosomal miR-122 may serve as a useful non-invasive biomarker for liver fibrosis, especially in patients with non-viral etiologies of chronic liver disease.
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Zhirkov, I. I., A. V. Gordienko, B. A. Chumak, I. M. Pavlovich, V. V. Yakovlev, and D. Yu Serdukov. "Prognostic mathematical models of the development of chronic non-viral liver diseases." Experimental and Clinical Gastroenterology, no. 8 (January 18, 2023): 84–91. http://dx.doi.org/10.31146/1682-8658-ecg-204-8-84-91.
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Chronic non-viral liver diseases are one of the most pressing problems of modern internal medicine. Over the past two decades, there has been a steady increase in diseases of this group due to the widespread prevalence of major risk factors, such as obesity, diabetes mellitus, physical inactivity, alcohol abuse, irrational use of medications, etc. Since most of the patients represent the most able-bodied and active part of the population, this circumstance inevitably leads to significant financial, economic and humanitarian losses, which gives the problem acute social significance. The purpose of the study. To develop mathematical prognostic models of the development of the most common chronic non-viral liver pathology using the most important predictors of these diseases. Material and methods. The contingent included in the study consisted of 412 young and middle-aged men, 138 of them with non-alcoholic fatty liver disease, 50 with alcoholic liver disease, 157 with alcoholic-metabolic fatty liver disease and 67 people without pathology. The subjects were measured anthropometric indicators (height, body weight, calculation of body mass index, waist circumference), determination of the type of alcohol consumption according to the AUDIT questionnaire, the level of physical activity according to the IPAQ questionnaire. In the biochemical study of blood serum, the parameters of alanine and aspartate aminotransferase, total and direct bilirubin, alkaline phosphatase, gamma-glutamyltranspeptidase, glucose, insulin, and lipid spectrum were determined. The study of the qualitative and quantitative composition of the intestinal microbiome was carried out by sowing feces on nutrient media, followed by the determination of the species of microorganisms and the assessment of their quantitative content using microscopy. Ultrasound examination of the hepatobiliary zone included measuring the main sizes of the right and left lobes of the liver, as well as identifying the main signs of diffuse liver damage. To assess steatosis and liver fibrosis, a FibroScan 530 device was used with the functions of evaluating the parameter of controlled attenuation of ultrasound and transient elastography by controlled vibration. Statistical processing and analysis of the results obtained were performed using the StatTech 2.8.8 program. Results. Mathematical prognostic models have been developed to determine the probability of developing non-alcoholic fatty liver disease, alcoholic fatty liver disease and alcoholic-metabolic fatty liver disease. All the regression models obtained were statistically significant with sensitivity and specificity of more than 90%. AUROC diagnostic accuracy values exceeded 0.9 units, which characterizes the quality of diagnostic models as excellent. Conclusions. The use of mathematical prognostic models using publicly available data from objective and laboratory research methods allows optimizing the diagnosis of chronic non-viral liver diseases.
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Zhang, Liang, Yueqing Huang, Min Huang, Chun-Hua Zhao, Yan-Jun Zhang, and Yi Wang. "Development of Cost-Effective Fatty Liver Disease Prediction Models in a Chinese Population: Statistical and Machine Learning Approaches." JMIR Formative Research 8 (February 16, 2024): e53654. http://dx.doi.org/10.2196/53654.
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Background The increasing prevalence of nonalcoholic fatty liver disease (NAFLD) in China presents a significant public health concern. Traditional ultrasound, commonly used for fatty liver screening, often lacks the ability to accurately quantify steatosis, leading to insufficient follow-up for patients with moderate-to-severe steatosis. Transient elastography (TE) provides a more quantitative diagnosis of steatosis and fibrosis, closely aligning with biopsy results. Moreover, machine learning (ML) technology holds promise for developing more precise diagnostic models for NAFLD using a variety of laboratory indicators. Objective This study aims to develop a novel ML-based diagnostic model leveraging TE results for staging hepatic steatosis. The objective was to streamline the model’s input features, creating a cost-effective and user-friendly tool to distinguish patients with NAFLD requiring follow-up. This innovative approach merges TE and ML to enhance diagnostic accuracy and efficiency in NAFLD assessment. Methods The study involved a comprehensive analysis of health examination records from Suzhou Municipal Hospital, spanning from March to May 2023. Patient data and questionnaire responses were meticulously inputted into Microsoft Excel 2019, followed by thorough data cleaning and model development using Python 3.7, with libraries scikit-learn and numpy to ensure data accuracy. A cohort comprising 978 residents with complete medical records and TE results was included for analysis. Various classification models, including logistic regression (LR), k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), light gradient boosting machine (LightGBM), and extreme gradient boosting (XGBoost), were constructed and evaluated based on the area under the receiver operating characteristic curve (AUROC). Results Among the 916 patients included in the study, 273 were diagnosed with moderate-to-severe NAFLD. The concordance rate between traditional ultrasound and TE for detecting moderate-to-severe NAFLD was 84.6% (231/273). The AUROC values for the RF, LightGBM, XGBoost, SVM, KNN, and LR models were 0.91, 0.86, 0.83, 0.88, 0.77, and 0.81, respectively. These models achieved accuracy rates of 84%, 81%, 78%, 81%, 76%, and 77%, respectively. Notably, the RF model exhibited the best performance. A simplified RF model was developed with an AUROC of 0.88, featuring 62% sensitivity and 90% specificity. This simplified model used 6 key features: waist circumference, BMI, fasting plasma glucose, uric acid, total bilirubin, and high-sensitivity C-reactive protein. This approach offers a cost-effective and user-friendly tool while streamlining feature acquisition for training purposes. Conclusions The study introduces a groundbreaking, cost-effective ML algorithm that leverages health examination data for identifying moderate-to-severe NAFLD. This model has the potential to significantly impact public health by enabling targeted investigations and interventions for NAFLD. By integrating TE and ML technologies, the study showcases innovative approaches to advancing NAFLD diagnostics.
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Vernuccio, Federica, Roberto Cannella, Tommaso Vincenzo Bartolotta, Massimo Galia, An Tang, and Giuseppe Brancatelli. "Advances in liver US, CT, and MRI: moving toward the future." European Radiology Experimental 5, no. 1 (December 2021). http://dx.doi.org/10.1186/s41747-021-00250-0.
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AbstractOver the past two decades, the epidemiology of chronic liver disease has changed with an increase in the prevalence of nonalcoholic fatty liver disease in parallel to the advent of curative treatments for hepatitis C. Recent developments provided new tools for diagnosis and monitoring of liver diseases based on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), as applied for assessing steatosis, fibrosis, and focal lesions. This narrative review aims to discuss the emerging approaches for qualitative and quantitative liver imaging, focusing on those expected to become adopted in clinical practice in the next 5 to 10 years. While radiomics is an emerging tool for many of these applications, dedicated techniques have been investigated for US (controlled attenuation parameter, backscatter coefficient, elastography methods such as point shear wave elastography [pSWE] and transient elastography [TE], novel Doppler techniques, and three-dimensional contrast-enhanced ultrasound [3D-CEUS]), CT (dual-energy, spectral photon counting, extracellular volume fraction, perfusion, and surface nodularity), and MRI (proton density fat fraction [PDFF], elastography [MRE], contrast enhancement index, relative enhancement, T1 mapping on the hepatobiliary phase, perfusion). Concurrently, the advent of abbreviated MRI protocols will help fulfill an increasing number of examination requests in an era of healthcare resource constraints.
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Trivedi, Palak J., Katherine Arndtz, Nadir Abbas, Alison Telford, Liam Young, Rajarshi Banerjee, Peter Eddowes, Kartik S. Jhaveri, and Gideon M. Hirschfield. "Quantitative MRCP and metrics of bile duct disease over time in patients with primary sclerosing cholangitis: A prospective study." Alimentary Pharmacology & Therapeutics, April 3, 2024. http://dx.doi.org/10.1111/apt.17944.
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SummaryBackgroundImaging markers of biliary disease in primary sclerosing cholangitis (PSC) have potential for use in clinical and trial disease monitoring. Herein, we evaluate how quantitative magnetic resonance cholangiopancreatography (MRCP) metrics change over time, as per the natural history of disease.MethodsIndividuals with PSC were prospectively scanned using non‐contrast MRCP. Quantitative metrics were calculated using MRCP+ post‐processing software to assess duct diameters and dilated and strictured regions. Additionally, a hepatopancreatobiliary radiologist (blinded to clinical details, biochemistry and quantitative biliary metrics) reported each scan, including ductal disease assessment according to the modified Amsterdam Cholangiographic Score (MAS).ResultsAt baseline, 14 quantitative MRCP+ metrics were found to be significantly different in patients with PSC (N = 55) compared to those with primary biliary cholangitis (N = 55), autoimmune hepatitis (N = 57) and healthy controls (N = 18). In PSC specifically, baseline metrics quantifying the number of strictures and the number and length of bile ducts correlated with the MAS, transient elastography and serum ALP values (p < 0.01 for all correlations). Over a median 371‐day follow‐up (range: 364–462), 29 patients with PSC underwent repeat MRCP, of whom 15 exhibited quantitative changes in MRCP+ metrics. Compared to baseline, quantitative MRCP+ identified an increasing number of strictures over time (p < 0.05). Comparatively, no significant differences in biochemistry, elastography or the MAS were observed between timepoints. Quantitative MRCP+ metrics remained stable in non‐PSC liver disease.ConclusionQuantitative MRCP+ identifies changes in ductal disease over time in PSC, despite stability in biochemistry, liver stiffness and radiologist‐derived cholangiographic assessment (trial registration: ISRCTN39463479).
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"Association of Liver Fibrosis based on Transient Elastography and Quantitative HBsAg Levels in HBeAg-Positive Chronic Hepatitis B Patients." International Journal of Pharmaceutical Research 12, no. 04 (June 2, 2020). http://dx.doi.org/10.31838/ijpr/2020.12.04.203.
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Silva, Rafaela V., Anna S. Morr, Helge Herthum, Stefan P. Koch, Susanne Mueller, Clara S. Batzdorf, Gergely Bertalan, et al. "Cortical matrix remodeling as a hallmark of relapsing–remitting neuroinflammation in MR elastography and quantitative MRI." Acta Neuropathologica 147, no. 1 (January 4, 2024). http://dx.doi.org/10.1007/s00401-023-02658-x.
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AbstractMultiple sclerosis (MS) is a chronic neuroinflammatory disease that involves both white and gray matter. Although gray matter damage is a major contributor to disability in MS patients, conventional clinical magnetic resonance imaging (MRI) fails to accurately detect gray matter pathology and establish a clear correlation with clinical symptoms. Using magnetic resonance elastography (MRE), we previously reported global brain softening in MS and experimental autoimmune encephalomyelitis (EAE). However, it needs to be established if changes of the spatiotemporal patterns of brain tissue mechanics constitute a marker of neuroinflammation. Here, we use advanced multifrequency MRE with tomoelastography postprocessing to investigate longitudinal and regional inflammation-induced tissue changes in EAE and in a small group of MS patients. Surprisingly, we found reversible softening in synchrony with the EAE disease course predominantly in the cortex of the mouse brain. This cortical softening was associated neither with a shift of tissue water compartments as quantified by T2-mapping and diffusion-weighted MRI, nor with leukocyte infiltration as seen by histopathology. Instead, cortical softening correlated with transient structural remodeling of perineuronal nets (PNNs), which involved abnormal chondroitin sulfate expression and microgliosis. These mechanisms also appear to be critical in humans with MS, where tomoelastography for the first time demonstrated marked cortical softening. Taken together, our study shows that neuroinflammation (i) critically affects the integrity of PNNs in cortical brain tissue, in a reversible process that correlates with disease disability in EAE, (ii) reduces the mechanical integrity of brain tissue rather than leading to water accumulation, and (iii) shows similar spatial patterns in humans and mice. These results raise the prospect of leveraging MRE and quantitative MRI for MS staging and monitoring treatment in affected patients.
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Green, Victoria, Joanne Lin, Morgan McGrath, Aaron Lloyd, Pearl Ma, Kelvin Higa, and Marina Roytman. "FIB-4 Reliability in Patients With Severe Obesity." Journal of Clinical Gastroenterology, November 3, 2023. http://dx.doi.org/10.1097/mcg.0000000000001937.
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Background: Liver biopsy is the gold standard to evaluate hepatic fibrosis; however, it has many drawbacks, especially in patients with severe obesity. Noninvasive testing such as the FIB-4 score is increasingly being used as the initial screening tool to identify patients at risk for advanced fibrosis. The broader applicability of FIB-4 and the precision of its cutoff values remain uncertain in metabolic dysfunction-associated steatotic liver disease and patients with severe obesity. Our study explored the correlation between FIB-4 scores and intraoperative liver biopsy in patients with severe obesity undergoing bariatric surgery. Methods: A total of 632 patients with severe obesity underwent preoperative vibration-controlled transient elastography and intraoperative liver biopsy during bariatric surgery from January 2020 to August 2021. Variables collected included patient demographics, laboratory values, abdominal ultrasound, vibration-controlled transient elastography, and liver biopsy results. ANOVA 1-way test, χ2 tests, and Fisher exact tests were used for quantitative and qualitative variables, respectively. The 95% CIs for the mean FIB-4 scores were used to generate surrogate cutoff values. The proposed FIB-4 cutoffs for F0-1, F2, F3, and F4 were 0.62 (CI: 0.59, 0.64), 0.88 (0.74, 1.01), 1.24 (0.94, 1.54), and 1.53 (0.82, 2.24), respectively. Area under the curve (AUC) methods were used to compare traditional to proposed cutoff values. Results: Applying the traditional FIB-4 cutoffs to approximate advanced fibrosis yielded an AUC of 0.5748. Use of the proposed FIB-4 cutoffs increased the AUC to 0.6899. The proposed FIB-4 cutoffs correctly identified 40 patients with biopsy-proven advanced fibrosis (F3-F4), all of which would have been missed using traditional cutoffs. Conclusion: Our study revealed that the use of the currently accepted FIB-4 cutoffs as the screening modality for identifying patients with advanced fibrosis due to metabolic dysfunction-associated steatotic liver disease is insufficient and will result in missing patients with histologically confirmed advanced fibrosis. Use of the revised FIB-4 scores should be considered to diagnose patients with severe obesity at high risk of liver disease progression.
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Hsieh, Chiao-Shan, Ming-Wei Lai, Chien-Chang Chen, Hsun-Chin Chao, Chiao-Yin Wang, Yung-Liang Wan, Zhuhuang Zhou, and Po-Hsiang Tsui. "Quantitative ultrasound envelope statistics imaging as a screening approach for pediatric hepatic steatosis and liver fibrosis: using biomarker and transient elastography as reference standards." Heliyon, November 2023, e22743. http://dx.doi.org/10.1016/j.heliyon.2023.e22743.
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Goyal, Prerna, Rahul Chopra, and Omesh Goyal. "Do Hepatic Fibrosis and Steatosis Measured by Hepatic Transient Elastography (FibroScan) Predict Cardiovascular Risk in Patients with Non-alcoholic Fatty Liver Disease: An Observational Cross-sectional Study." Indian Journal of Cardiovascular Disease in Women, April 20, 2024, 1–8. http://dx.doi.org/10.25259/ijcdw_2_2024.
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Objectives: Non-alcoholic fatty liver disease (NAFLD) has been associated with increased cardiovascular risk (CVR) in the previous studies. In the majority, ultrasonography has been used to diagnose and stage NAFLD, which lacks sensitivity and is non-quantitative. Other more sensitive, comprehensive, and quantitative diagnostic tools such as vibration-controlled transient elastography (TE) have largely been underused in research work. TE-driven liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) provide an accurate and simplified estimation of liver fibrosis and steatosis, respectively. Therefore, we aimed to analyze the association between these two objective, robust parameters and CVR. Materials and Methods: In this observational cross-sectional study, NAFLD participants were divided into two distinct categories of steatosis (CAP <290 and ≥290 dB) and fibrosis (LSM <10 and ≥10 kPa). Their CVR assessment was done by calculating Framingham risk score (FRS), American College of Cardiology/American Heart Association Pooled Cohort Equation Score (ACC/AHA PCES), and carotid intimal medial thickness (CIMT). Results: A greater number of participants presented with mild-moderate fibrosis (n = 41, 62.1%) as compared to severe fibrosis (n = 25, 37.8%) whereas severe steatosis participants predominated (n = 52, 78%) as compared to mild-moderate steatosis. The presence of significant fibrosis (LSM ≥10 kPa) was independently and significantly associated with FRS, ACC/AHA PCES, and CIMT. On the other hand, the presence of significant steatosis (CAP ≥290 dB/m) was not significantly associated with any CVR marker (FRS, ACC/AHA PCES, or CIMT), though a greater number of participants with CIMT >0.7 belonged to severe steatosis group. Conclusion: Subjects with severe fibrosis (LSM ≥10) had a significantly higher CVR, whereas severe steatosis (CAP ≥290) alone failed to predict CVR. Therefore, CVR reduction strategies can be targeted primarily in NAFLD subjects with fibrosis, particularly in resource-limited healthcare settings.
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P.V. Alves, Vinicius, Andrew T. Trout, Morgan Dewit, Marialena Mouzaki, Ana Catalina Arce-Clachar, Kristin S. Bramlage, Jonathan R. Dillman, and Stavra A. Xanthakos. "Clinical Performance of Transient Elastography with Comparison to Quantitative Magnetic Resonance Imaging, Ultrasound, and Biopsy in Children and Adolescents with Known or Suspected Fatty Liver Disease." Childhood Obesity, October 20, 2022. http://dx.doi.org/10.1089/chi.2022.0136.
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Matsuura, Kentaro, Nobuhiro Aizawa, Hirayuki Enomoto, Shuhei Nishiguchi, Hidenori Toyoda, Takashi Kumada, Etsuko Iio, et al. "Circulating let-7 Levels in Serum Correlate With the Severity of Hepatic Fibrosis in Chronic Hepatitis C." Open Forum Infectious Diseases 5, no. 11 (October 22, 2018). http://dx.doi.org/10.1093/ofid/ofy268.
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Abstract Background Evaluating the progression of hepatic fibrosis in chronic hepatitis C (CHC) is critical, and identifying a predictive biomarker for fibrosis will be helpful for implementing personalized surveillance of hepatocellular carcinoma after the elimination of hepatitis C virus by antiviral therapy. This study aimed to investigate the association of circulating let-7a-5p levels with severity of hepatic fibrosis. Methods We analyzed circulating let-7a-5p levels in serum and serum-derived extracellular vesicles (EVs) in 84 Japanese CHC patients who underwent a liver biopsy by quantitative real-time polymerase chain reaction, and investigated the association of its levels with histological hepatic fibrotic stage, liver stiffness, and several hepatic fibrotic markers. Results The levels of let-7a-5p in serum and EVs were significantly lower in patients with liver cirrhosis. Additionally, the serum let-7a-5p level correlated significantly with hepatic fibrotic markers, Mac-2 binding protein glycan isomer (M2BPGi), fibrosis-4 (FIB-4) index, aspartate aminotransferase-to-platelet ratio index (APRI), and liver stiffness, evaluated by transient elastography. Furthermore, the serum let-7a-5p level was superior to M2BPGi, FIB-4, and APRI and was comparable to liver stiffness in discriminating liver cirrhosis. Conclusions These results provide evidence that circulating let-7a-5p in serum may serve as a surrogate marker for severity of hepatic fibrosis in CHC.
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Rashad, H. S. M., E. M. Abdelhafez, R. Z. Elia, E. M. Barakat, and A. E. Rady. "Quantitative liver MR imaging with DWI sequence and Normalized ADC in diagnosis and staging of hepatitis C virus liver fibrosis and cirrhosis, a comparative study with transient elastography (Fibroscan) in egyptian patients." QJM: An International Journal of Medicine 113, Supplement_1 (March 1, 2020). http://dx.doi.org/10.1093/qjmed/hcaa068.009.
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Abstract Purpose To evaluate the diagnostic efficacy of quantitative liver MR imaging using diffusion-weighted imaging (DWI) and normalized apparent diffusion coefficient (ADC) in diagnosis and staging of liver fibrosis and cirrhosis in egyptian patients with hepatitis C virus (HCV) infection and compare the results with transient elastography (FibroScan). Materials and Methods Twenty-five patients known to have hepatitis C virus were enrolled after fulfilling inclusion and exclusion criteria.. Quantification of liver, spleen and muscle ADC values was done using MRI DWI sequences using 4 different b-values (0, 200, 400, 800). Normalized ADC was calculated as the ratio of liver ADC to spleen ADC.. Post processing was performed using 3D synapse ADC viewer Tool. Results Liver ADC failed to distinguish different stages of fibrosis, except between stages 2 and 3 (p = 0.016). Normalized liver ADC distinguished between individual groups of fibrosis , with significant differences between mild stages (stage 0/1) and sever stages of fibrosis (stages 3) and between stages 0/1 and cirrhosis (stage 4). There were significant differences between stages 0–2 and 3–4 using normalized liver ADC. There was a statistically significant moderate correlation between fibrosis stage and normalized liver ADC (r = −0.403; p = 0.009). ROC analysis revealed higher performance using normalized liver ADC compared with liver ADC, with higher AUC, sensitivity, and specificity for detection of cirrhosis (stage 0 vs 4 and stages 0–3 vs 4), moderate-to-advanced fibrosis (stages 2–4), and advanced fibrosis and cirrhosis (stages 3–4), reaching significance for all comparisons except for diagnosis of stage 4 (cirrhosis). Conclusion Our results suggest that normalizing liver ADC with spleen ADC improves diagnostic accuracy for detection of liver fibrosis and cirrhosis in egyptian population when using breath-hold diffusion-weighted imaging.
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Congly, Stephen E., Ahsan Syed, Sarah Haylock-Jacobs, Heidi Israelson, Jacqueline Pinto, Sarah Williams, Samuel S. Lee, and Carla S. Coffin. "A real-world retrospective single-centre study of the cost-effectiveness and long-term outcomes of pegylated interferon for chronic hepatitis B." Canadian Liver Journal, January 18, 2023. http://dx.doi.org/10.3138/canlivj-2022-0043.
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Background: Pegylated interferon (Peg-IFN) is recommended as first-line therapy for chronic hepatitis B (CHB) but has significant side effects and is rarely used compared to oral nucleos(t)ide analogues (NA). There are limited recent clinical efficacy or economic analysis data comparing approved CHB therapy in North America. Methods: This retrospective study examined clinical outcomes, off-treatment durability, and cost-effectiveness of Peg-IFN versus NA for CHB. Demographic (age, sex, ethnicity), clinical data (i.e., liver tests, hepatitis B virus DNA, serology, transient elastography) and documented side effects were collected by retrospective chart review of patients followed in the University of Calgary Liver Unit who received Peg-IFN therapy from January 2007 to December 2020. The cost-effectiveness of Peg-IFN versus NA therapy was modelled over a 10-year time horizon. Results: Sixty-eight CHB patients were treated with Peg-IFN (median age 45.65, 74% male, 84% Asian); 50/68 (74%) completed 48 weeks of treatment with a median follow-up of 6.54 years (interquartile range 5.07). At the last known follow-up, 23/68 (34%) have not required NA treatment and one had HBsAg loss; 27 have been started on NA. Predictors of obtaining a sustained virological response included being hepatitis B e antigen-negative at treatment end and a quantitative hepatitis B surface antigen <1000 IU/mL. Economic modelling showed that finite Peg-IFN was not cost-effective versus NA at a 10-year time horizon. Conclusions: PEG-IFN remains a potential treatment for CHB although there is a significant intolerance/failure rate. Using PEG-IFN based on patient preference is reasonable and optimal patient selection may improve treatment cost-effectiveness.
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Yosef, Aya Lotfy, Hanan Hamed Soliman, Gamal El-Sayed Shiha, Mohiee El-Deen AbdEl-Aziz Awad, and Eslam El-Sayed El-Hawary. "Evaluation of Liver Fibrosis by FibroScan in β-Thalassemia Children Infected with Hepatitis C Virus Before and After Ledipasvir/Sofosbuvir Therapy." International Blood Research & Reviews, August 27, 2020, 9–17. http://dx.doi.org/10.9734/ibrr/2020/v11i330130.
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Background: Thalassemic children develop liver fibrosis because of liver iron overload and hepatitis C virus (HCV) infection. Transient elastography (FibroScan) can be a reliable non-invasive method for evaluating liver fibrosis in thalassemic patients. Treatment with ledipasvir/sofosbuvir (LED/SOF) direct acting antiviral agents can significantly affect liver stiffness measurement (LSM) by FibroScan.
Aims: To assess liver fibrosis by non-invasive FibroScan through LSM before and after generic LED/SOF therapy in multi-transfused β-thalassemic children infected with HCV.
Place and Duration of Study: Pediatric Hematology Unit, Tanta University Hospital, from November 2017 to May 2019.
Methodology: Fifty multi-transfused β-thalassemic treatment-naϊve children (aged 12-18 years and weighing ≥35kg) with chronic HCV infection were subjected to clinical evaluation, quantitative HCV PCR assay, FibroScan examination, and calculation of APRI, FIB4 index and AST/ ALT ratio. In addition to standard therapy, generic LED/SOF (90/400 mg) treatment was given for 12 weeks’ duration with follow up for further 12 weeks after end of treatment.
Results: A positive HCV PCR was changed into negative for all studied patients starting from week 4 after treatment. There was highly significant reduction in the LSM values by FibroScan in the studied patients after therapy (p-value <0.001) with median reduction of 19.4 %. The significant reduction in LSM values was particularly prominent in patients with significant (F2) and advanced (F3) liver fibrosis stages as well as cirrhotic patients (F4). There was significant reduction in the values of other non-invasive liver fibrosis markers FIB-4 index, APRI score and AST/ ALT ratio (p-value <0.001, <0.001 and 0.020 respectively) after therapy.
Conclusion: Generic LED/SOF therapy for 12 weeks’ duration resulted in eradication of HCV infection that was associated with significant decrease in LSM by FibroScan particularly those with higher baseline liver fibrosis stages.
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Chen, Xingying, Feng Tian, Jianfeng Wu, Lan Liu, Ye Li, Genfeng Yu, Hualin Duan, et al. "Associations of phthalates with NAFLD and liver fibrosis: A nationally representative cross-sectional study from NHANES 2017 to 2018." Frontiers in Nutrition 9 (November 22, 2022). http://dx.doi.org/10.3389/fnut.2022.1059675.
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ObjectiveAlthough phthalates are common environmental pollutants, few studies have focused on the relationship of phthalates exposure with non-alcoholic fatty liver disease (NAFLD) or liver fibrosis, and especially, the alternative phthalates have been questioned in recent years about whether they are better choices. Thus, this study aimed to explore the associations of exposure to major phthalates or alternative phthalates with NAFLD and liver fibrosis.MethodsData of 1450 adults from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were collected. The urinary metabolite concentrations of di-2-ethylhexyl phthalate (DEHP), diisononyl phthalate (DINP) and diisodecyl phthalate (DIDP) were detected. Controlled attenuation parameter (CAP) and median liver stiffness measurement (LSM) were acquired for quantitative diagnosis of NAFLD and liver fibrosis by vibration-controlled transient elastography. Multivariate logistic regression analysis and linear regression analysis were performed to examine the associations between phthalates and NAFLD and liver fibrosis.ResultsAfter adjustment of the potential factors, the prevalence of NAFLD was significantly elevated among those in the fourth quartile of mono-(2-ethyl-5-carboxypentyl) phthalate (OR, 95%CI = 2.719, 1.296, 5.700, P = 0.016), mono (2-ethyl-5-hydroxyhexyl) phthalate (OR, 95%CI = 2.073, 1.111, 3.867, P = 0.037). No significant association was found between the alternative phthalates and NAFLD. The similar result was gained by linear regression analysis that MECPP was still significantly associated with Ln CAP (Q4 vs. Q1: β, 95%CI = 0.067, 0.017, 0.118, P = 0.027). After adjustment for the same covariates, no significant association between phthalates and liver fibrosis was found in logistics regression analysis.ConclusionsAll in all, higher prevalence of NAFLD is correlated with DEHP but not DINP or DIDP in American adults. There is no significant relationship between phthalates and liver fibrosis defined as LSM ≥ 8 Kpa. Nevertheless, further research is needed to provide evidence of causality.
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Abdallah, Randa Hussein, Essam Mohamed Abdulhafez, and Manar Mohamed Soufy. "Role of hepatic Doppler as compared to Fibro-scan in evaluation of post virus C hepatic fibrosis." QJM: An International Journal of Medicine 114, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/qjmed/hcab106.037.
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Abstract Background Chronic infection with hepatitis C virus (HCV) is a disease of global importance with a large burden of morbidity and mortality. hepatitis c virus can cause progressive liver damage which may result in liver cirrhosis and hepato-cellular carcinoma . Aim of the work The aim of our study was to examine the efficacy of hepatic Doppler indices, namely hepatic vein wave form, hepatic vein maximum velocity ,hepatic artery RI and portal vein maximum velocity and portal vein wave form for evaluating the degree of hepatic fibrosis in chronic hepatitis C (CHC) patients as compared to transient elastography. Patients and methods our study was done over period from September 2018 till April 2019 included 40 patients from eldemerdash hospital designed to include all hepatitis c positive patients with any age or sex excluding other cause of liver cirrhosis (negative hepatitis B, negative auto immune hepatitis) in absence of obesity or ascites. hepatic vein maximum velocity, hepatic artery RI, portal vein maximum velocity, TE were performed to all patients. fibrosis was assessed on semi quantitative scoring system (METAVIR score ). we examine the efficacy of each of Doppler indices in differentiating different stages of hepatic fibrosis and their diagnostic accuracy in predicting significant fibrosis and cirrhosis . Results on comparing the fibrosis &non fibrosis groups by TE according to Doppler measurement we found statistically significant higher means of the portal vein maximum velocity (PVmax) for the non fibrosis group as compared to the fibrosis group (24.15±9.71 and 15.94±3.35 respectively with p value<0.001) also found significantly lower HAPSV/PVmax ratio for the non fibrosis as compared to fibrosis group (1.58±0.41 and 2.59±1.17 respectively with p value 0.011) finally, we found that there was significant change of the HV waveform pattern for the non fibrosis (normal triphasic ) as compared to fibrosis (monophasic or biphasic ) (x2=4.353 with p value 0.038)
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El-Ghandour, Ahmed, Tarek Youssif, Wesam Ibrahim, Hoda Ahmed Abdelsattar, Somia Abd elhamid Bawady, Mariam Wagih, and Sarah El-Nakeep. "The effect of different direct antivirals on hepatic steatosis in nondiabetic and naïve hepatitis C-infected Egyptian patients." Egyptian Journal of Internal Medicine 35, no. 1 (February 13, 2023). http://dx.doi.org/10.1186/s43162-023-00197-1.
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Abstract Background Hepatitis C is associated with metabolic effects and fatty liver disease. The effect of different direct antivirals on the liver steatosis, and the metabolic profile, still needs to be established. The aim of this study is to determine the effect of achieving the sustained virological response after 12 weeks (SVR-12 weeks) with different combinations of direct antiviral drugs, on the hepatic steatosis, and fibrosis presented by laboratory and transient elastography parameters. Our study population is nondiabetic, chronically infected HCV Egyptian patients and naïve to any form of HCV treatment. Methods This cohort study was carried on 100 nondiabetic HCV treatment-naïve patients attending the Hepatology Clinic, in the Gastroenterology and Hepatology Department, Ain Shams University, and Kobry El Koba Military Hospital. The patients were divided into four groups according to their treatment regimens as follows: group A: 25 patients who received sofosbuvir (400 mg) and daclatasvir (60 mg) daily for 12 weeks; group B: 25 patients who received sofosbuvir (400 mg) and ledipasvir (90 mg) daily for 12 weeks; group C: 25 patients who received ombitasvir (12.5 mg), paritaprevir (75 mg), and ritonavir (50 mg) daily for 12 weeks; and group D: 25 patients who received sofosbuvir (400 mg) and simeprevir (150 mg) daily for 12 weeks. All patients were subjected to the following investigations: HCV quantitative PCR before and after 12 weeks of treatment, clinical and laboratory metabolic evaluation including alfa-fetoprotein level, thyroid profile assessment, ferritin level, pelvi-abdominal ultrasound, and FibroScan examination. Results All patients achieved SVR after 12 weeks. FibroScan median decreased (P < 0.001) from 19.29 ± 6.97 kPa at baseline to 14.15 ± 6.48 kPa at SVR12. NAFLD score median increased from 1.88 (1.49–2.22) at baseline to 2.01 (1.61–2.33) after 12 weeks of treatment. The highest level of NAFLD score was in group C, and the lowest was in group B. The BMI mean decreased from 28.31 ± 1.53 at baseline to 28.07 ± 1.52 at SVR12. HbA1C level mean decreased from 5.73 ± 0.23 at baseline to 5.40 ± 0.24 at SVR12. In addition, liver enzymes, cholesterol, triglycerides, APRI score (AST-platelet ratio index), and HBA1C decreased after 12-week treatment with a statistically significant difference, while the mean LDL increased after 12 weeks of treatment. Conclusions DAAs affect the metabolic profile of the treated patients. There is a noticed improvement in the FibroScan, NAFLD score, and lipid profile after achieving the SVR-12 weeks. However, LDL is increased after viral cure, mostly due to viral-host molecular interaction.