Elastogram quality assessment score in vibration‐controlled transient elastography: Diagnostic performance compared to digital morphometric analysis of liver biopsy in chronic hepatitis C

Mendes, Luciano; Ferreira, Paulo Roberto Abrão; Miotto, Noelle; Zanaga, Letícia Pisoni; Gonçales, Eduardo S L; Pedro, Matheus Kahakura Franco; Lazarini, Mariana; Júnior, Fernando Lopes Gonçales; Stucchi, Raquel Silveira Bello; Vigani, Alive G.

doi:10.1111/jvh.12822

Cited by 9 publications

(9 citation statements)

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“…Regarding fibrosis, collagen proportionate area has been deeply analysed in chronic viral hepatitis 7,16‐22 . Different indications for liver biopsy and peculiarities of NAFLD fibrosis with a predominant centrilobular but not portal pattern, as well as a slower rate of progression compared to chronic hepatitis C, may justify why our samples have higher F0 values (5.4% in our cohort vs 2.7% on average for viral hepatitis cohorts) and lower F4 measurements (13.2% in our cohort vs 20.7% on average for viral hepatitis cohorts) 16‐20,22,38 .…”

Section: Discussionmentioning

confidence: 81%

“…Digital pathology is based on scanning stained tissue slides into digital images, allowing quantitative analysis 15 . Previous studies used digital analysis for the quantification of collagen fibres and its correlation with fibrosis grade, mainly in chronic viral hepatitis patients 7,16‐22 . Regarding NAFLD, conflicting results have been published for collagen evaluation 23,24 .…”

Section: Introductionmentioning

confidence: 99%

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Digital pathology: accurate technique for quantitative assessment of histological features in metabolic‐associated fatty liver disease

Martí-Aguado¹,

Rodríguez-Ortega²,

Mestre‐Alagarda³

et al. 2020

Aliment Pharmacol Ther

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Summary Background Histological evaluation of metabolic‐associated fatty liver disease (MAFLD) biopsies is subjective, descriptive and with interobserver variability. Aims To examine the relationship between different histological features (fibrosis, steatosis, inflammation and iron) measured with automated whole‐slide quantitative digital pathology and corresponding semiquantitative scoring systems, and the distribution of digital pathology measurements across Fatty Liver Inhibition of Progression (FLIP) algorithm and Steatosis, Activity and Fibrosis (SAF) scoring system Methods We prospectively included 136 consecutive patients who underwent liver biopsy for MAFLD at three Spanish centres (January 2017‐January 2020). Biopsies were scored by two blinded pathologists according to the Non‐alcoholic Steatohepatitis (NASH) Clinical Research Network system for fibrosis staging, the FLIP/SAF classification for steatosis and inflammation grading and Deugnier score for iron grading. Proportionate areas of collagen, fat, inflammatory cells and iron deposits were measured with computer‐assisted digital image analysis. A test‐retest experiment was performed for precision repeatability evaluation. Results Digital pathology showed strong correlation with fibrosis (r = 0.79; P < 0.001), steatosis (r = 0.85; P < 0.001) and iron (r = 0.70; P < 0.001). Performance was lower when assessing the degree of inflammation (r = 0.35; P < 0.001). NASH cases had a higher proportion of collagen and fat compared to non‐NASH cases (P < 0.005), whereas inflammation and iron quantification did not show significant differences between categories. Repeatability evaluation showed that all the coefficients of variation were ≤1.1% and all intraclass correlation coefficient values were ≥0.99, except those of collagen. Conclusion Digital pathology allows an automated, precise, objective and quantitative assessment of MAFLD histological features. Digital analysis measurements show good concordance with pathologists´ scores.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Digital pathology: accurate technique for quantitative assessment of histological features in metabolic‐associated fatty liver disease

Martí-Aguado¹,

Rodríguez-Ortega²,

Mestre‐Alagarda³

et al. 2020

Aliment Pharmacol Ther

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“…An additional parameter to consider for maintaining a high quality of the examination is the elastogram pattern that appears on the screen for each measurement. Three categories have been described based on the length of the graphic representation and shear wave dispersal (level of parallelism displayed in the elastogram) [21]. A comparison with biopsy data showed that the diagnostic accuracy of TE was significantly greater if based on the quality of each individual measurement.…”

Section: Methodsmentioning

confidence: 99%

Liver Involvement in Patients With Systemic Sclerosis: Role of Transient Elastography in the Assessment of Hepatic Fibrosis and Steatosis

Cuomo¹,

Iandoli²,

Galiero³

et al. 2023

Preprint

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Background Systemic sclerosis (SSc) is a rare, multisystemic disorder of connective tissue, characterized by widespread inflammation, vascular abnormalities, and both skin and visceral organ fibrosis. Tissue fibrosis is the final phase of a complex biological process of immune activation and vascular damage. Objectives The aim of study was to assess hepatic fibrosis and steatosis in SSc patients by transient elastography (TE). Methods Fifty-nine SSc patients, satisfying the 2013 ACR/EULAR classification criteria, were recruited. Clinical and laboratory findings, modified Rodnan skin score (mRSS), ac-tivity index, video-capillaroscopy, echocardiography, and lung function data were ana-lyzed. Liver stiffness (LS) was measured by transient elastography (TE), with 7 kPa used as the cut-off value for significant liver fibrosis and steatosis. Specifically, values ≥ 238 CAP ≤ 259 dB/m were considered consistent with mild steatosis (S1), 260 ≥ CAP ≤ 290 dB/m with moderate steatosis (S2) and ≥291 dB/m with severe steatosis (S3) Results The median age of patients was 51 years, with a median disease duration of 6 years. Median LS was 4.5 (2.9–8.3) kPa; 41 patients (69.5%) had no evidence of fibrosis (F=0), 16 (27.1%) displayed LS values between 5.2 and 7 kPa; only 2 patients (3.4%) had LS values >7 kPa (F3). The median CAP value for liver steatosis was 223 dB/m (IQR: 164–343). Overall, 39 patients (66.1%) did not show evidence of steatosis (CAP values <238 dB/m); 9 patients (15.2%) showed values consistent with mild (S1) steatosis (CAP value ≥238 ≤259 dB/m); 8 patients (13.5%) had moderate (S2) steatosis (CAP value ≥260 ≤290 dB/m); 3 patients (5.1%) were deemed to have severe steatosis (S3) due to CAP values ≥291 dB/m. Conclusions Only 3.4% of our patient population showed evidence of marked liver fibrosis, which is the same prevalence as that expected in the general population. Likewise, the prevalence of significant steatosis was low (5.1%) and depending on the same variables associated with fatty liver in the general population. TE was shown to be an easy and valuable method for detection and screening of liver fibrosis in SSc patients with no additional risk factors for liver disease.

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“…Liver fibrosis assessed by vibration-controlled transient elastography correlated with that of liver biopsies for all classes and levels of fibrosis, but this noninvasive modality to estimate liver fibrosis is influenced by the accuracy of individual measurements [15] and the examiner's experience [1]. In addition, the elastography technique has other limits, too, as ultrasound cannot propagate through any environment: recent meal examination, patient obesity, cholestasis or congestion of the liver veins, necroinflammation, presence of ascites [1].…”

Section: Attempts To Assess Liver Fibrosis By Imaging Meansmentioning

confidence: 99%

Liver stiffness in chronic hepatitis C virus infection

Mihăilă

2019

Romanian Journal of Internal Medicine

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

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Elastogram quality assessment score in vibration‐controlled transient elastography: Diagnostic performance compared to digital morphometric analysis of liver biopsy in chronic hepatitis C

Cited by 9 publications

References 31 publications

Digital pathology: accurate technique for quantitative assessment of histological features in metabolic‐associated fatty liver disease

Digital pathology: accurate technique for quantitative assessment of histological features in metabolic‐associated fatty liver disease

Liver Involvement in Patients With Systemic Sclerosis: Role of Transient Elastography in the Assessment of Hepatic Fibrosis and Steatosis

Liver stiffness in chronic hepatitis C virus infection

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