Elastography Techniques for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

Honda, Yoshihiro; Yoneda, Masato; Imajo, Kento; Nakajima, Atsushi

doi:10.3390/ijms21114039

Cited by 43 publications

(39 citation statements)

References 88 publications

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“…Various non-invasive diagnostic methods have been developed based on the assessment of liver stiffness measurement (LSM), which is a promising surrogate biomarker of liver fibrosis stage [ 37 ]. Among the elastography techniques available, magnetic resonance elastography (MRE), a magnetic resonance imaging (MRI)-based technique, has shown promising results [ 8 , 39 ]. However, MRE has several disadvantages which have limited its use in clinical practice and in people with obesity.…”

Section: Assessment Of Liver Fibrosis In Nafldmentioning

confidence: 99%

“…Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease and the leading cause of chronic liver disease worldwide [ 8 , 9 ]. NAFLD is strongly linked to obesity [ 10 , 11 , 12 ], with a reported prevalence of approximately 80% in people with obesity and only 16% in people with a normal BMI and no known metabolic risk factors [ 10 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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The Use of Two-Dimensional Shear Wave Elastography in People with Obesity for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

Chimoriya

Piya

Simmons

et al. 2020

JCM

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Obesity is associated with significant comorbidities, including non-alcoholic fatty liver disease (NAFLD). Given its potential to progress to advanced liver disease, monitoring the extent and progress of liver fibrosis and assessing its fibrosis stage are essential. Although liver biopsy is considered to be the gold standard for liver fibrosis staging, it is an invasive procedure with risk of complications. Considering the rising prevalence of obesity and NAFLD globally, developing non-invasive diagnostic methods is a priority. Transient elastography (TE) is increasingly being used to assess the severity of liver disease. However, in the presence of severe obesity, the increased thickness of subcutaneous adipose tissue and changes in anatomy may affect its diagnostic accuracy. Two-dimensional shear wave elastography (2D-SWE) assesses the liver stiffness in real time along with simultaneous anatomic B-mode ultrasound imaging and allows selection of the region of interest. This would suggest that 2D-SWE has several advantages over TE in patients with severe obesity. The purpose of this review is to examine the current literature addressing the use of 2D-SWE in the assessment of liver fibrosis in patients with NAFLD. This review also examines the evidence on the use of 2D-SWE in patients with obesity and NAFLD and compares it to TE as a novel and non-invasive method of assessing liver fibrosis.

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Section: Assessment Of Liver Fibrosis In Nafldmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Use of Two-Dimensional Shear Wave Elastography in People with Obesity for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

Chimoriya

Piya

Simmons

et al. 2020

JCM

View full text Add to dashboard Cite

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“…Yajima et al have shown that the combination of ultrasonographical findings of liver–kidney contrast, vascular blurring, and deep attenuation enables us to grade fatty change semi-quantitatively [ 8 ]. Magnetic resonance elastography (MRE) and ultrasound elastography have been reported as effective methods to compensate for these problems [ 11 , 12 ]. MRE has a higher area under the receiver operating characteristic curve (AUROC) value than one type of ultrasound elastography, FibroScan (Echosens, Paris, France) [ 12 , 13 ], but it is costly to implement.…”

Section: Introductionmentioning

confidence: 99%

“…Magnetic resonance elastography (MRE) and ultrasound elastography have been reported as effective methods to compensate for these problems [ 11 , 12 ]. MRE has a higher area under the receiver operating characteristic curve (AUROC) value than one type of ultrasound elastography, FibroScan (Echosens, Paris, France) [ 12 , 13 ], but it is costly to implement. FibroScan is an evidence-based, transient elastography instrument for non-invasive evaluation of liver steatosis and fibrosis [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of FibroScan and Factors Affecting Measurements

et al. 2020

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Evaluating liver steatosis and fibrosis is important for patients with non-alcoholic fatty liver disease. Although liver biopsy and pathological assessment is the gold standard for these conditions, this technique has several disadvantages. The evaluation of steatosis and fibrosis using ultrasound B-mode imaging is qualitative and subjective. The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) determined using FibroScan are the evidence-based non-invasive measures of liver fibrosis and steatosis, respectively. The LSM and CAP measurements are carried out simultaneously, and the median values of more than ten valid measurements are used to quantify liver fibrosis and steatosis. Here, we demonstrate that the reliability of the LSM depends on the interquartile range to median ratio (IQR/Med), but CAP values do not depend on IQR/Med. In addition, the LSM is affected by inflammation, congestion, and cholestasis in addition to fibrosis, while CAP values are affected by the body mass index in addition to steatosis. We also show that the M probe provides higher LSM values but lower CAP values than the XL probe in the same population. However, there was no statistically significant difference between the diagnostic accuracies of the two probes. These findings are important to understand the reliability of FibroScan measurements and the factors influencing measurement values for all patients.

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“…It has shown good accuracy in MAFLD, particularly for advanced fibrosis and cirrhosis detection (6), and has been introduced into the practical guidelines for MAFLD diagnosis and management (7). However, TE has several limitations including imperfect prediction (8). Therefore, combinations of TE with other markers have been explored, for instance, a recent multi-center study developed and validated a score consisting of TE, controlled attenuation parameter (CAP) and aspartate aminotransferase (AST) to identify MAFLD patients with inflammatory activity, steatohepatitis and significant fibrosis (9).…”

Section: Introductionmentioning

confidence: 99%

Macrophage Markers Do Not Add to the Prediction of Liver Fibrosis by Transient Elastography in Patients With Metabolic Associated Fatty Liver Disease

et al. 2020

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Background and Aims: Non-invasive fibrosis staging is essential in metabolic associated fatty liver disease (MAFLD). Transient elastography (TE) is a well-established method for liver fibrosis assessment. We have previously shown that the macrophage marker sCD163 is an independent predictor for fibrosis in MAFLD. In the present study we tested whether the combination of macrophage markers and TE improves fibrosis prediction.Methods: We measured macrophage markers soluble (s)CD163 and mannose receptor (sMR) in two independent cohorts from Italy (n = 141) and Sweden (n = 70) with biopsy-proven MAFLD and available TE.Results: In the Italian cohort, TE and sCD163 showed similar moderate associations with liver fibrosis (rho = 0.56, p < 0.001 and rho = 0.42, p < 0.001, respectively). TE had an area under the Receiver Operating Characteristics curve (AUROC, with 95% CI) for fibrosis; F ≥ 2 = 0.79 (0.72–0.86), F ≥ 3 = 0.81 (0.73–0.89), F4 = 0.95 (0.90–1.0). sCD163 also predicted fibrosis well [F ≥ 2 = 0.71 (0.63–0.80), F ≥ 3 = 0.82 (0.74–0.90), F4 = 0.89 (0.76–1.0)]. However, combining sCD163 and TE did not improve the AUROCs significantly [F ≥ 2 = 0.79 (0.72–0.86), F ≥ 3 = 0.85 (0.78–0.92), F4 = 0.97 (0.93–1.0)]. In the Swedish cohort, TE showed a closer association with fibrosis (rho = 0.73, p < 0.001) than sCD163 (rho = 0.43, p < 0.001) and sMR (rho = 0.46, p < 0.001). TE predicted fibrosis well [F ≥ 2 = 0.88 (0.80–0.97), F ≥ 3 = 0.90 (0.83–0.97), F4 = 0.87 (0.78–0.96)], whereas sCD163 did not (best AUROC 0.75). sMR showed a better prediction [F ≥ 2 = 0.68 (0.56–0.81), F ≥ 3 = 0.82 (0.71–0.92), F4 = 0.79 (0.66–0.93)], but the addition of sMR did not further improve the prediction of fibrosis by TE.Conclusion: In these cohorts of MAFLD patients, TE was superior to macrophage markers for fibrosis prediction and in contrast to our hypothesis the addition of these markers to TE did not improve its predictive capability.

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Elastography Techniques for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

Cited by 43 publications

References 88 publications

The Use of Two-Dimensional Shear Wave Elastography in People with Obesity for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

The Use of Two-Dimensional Shear Wave Elastography in People with Obesity for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

Diagnostic Accuracy of FibroScan and Factors Affecting Measurements

Macrophage Markers Do Not Add to the Prediction of Liver Fibrosis by Transient Elastography in Patients With Metabolic Associated Fatty Liver Disease

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