Increased liver stiffness by transient elastography and acoustic radiation force impulse imaging in patients with extrahepatic cholestasis

Darweesh, Samar K; Atef, Mira; Ramzy, Eman; Yousry, Ayman; Musa, Sherief

doi:10.1097/meg.0000000000001881

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…The inherent characteristics of an inflamed, potentially fibrotic liver do not fit well into this description, which is important to mention given an analysis that relies heavily on interconversion between results[ 28 , 29 ]. In a similar vein, a recent study by Darweesh et al [ 30 ] found that cholestasis itself can increase liver stiffness measurements in adult patients, separate to histologic findings of fibrosis; future studies must take this potential confounder into account. This meta-analysis must be interpreted within the context of these limitations, with future studies taking important steps to address potential limitations and barriers to interpretation during the study design, data collection and analysis phases of work.…”

Section: Discussionmentioning

confidence: 94%

Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis

Wagner¹,

Abdelgawad²,

Landry³

et al. 2022

WJG

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BACKGROUND Timely differentiation of biliary atresia (BA) from other infantile cholestatic diseases can impact patient outcomes. Additionally, non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized. Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness. The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies. AIM To assess the utility of elastography in: (1) BA diagnosis, and (2) post-Kasai fibrosis surveillance. METHODS A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up. Twenty studies met criteria for meta-analysis: Eleven for diagnosis and nine for follow-up post-Kasai. Estimated diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model using Meta-DiSc software. RESULTS Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA, with overall DOR 24.61, sensitivity 83%, and specificity 79%. Post-Kasai, mean liver stiffness was significantly higher in BA patients with varices than in patients without, with DOR 16.36, sensitivity 85%, and specificity 76%. Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03, sensitivity 96%, and specificity 89%. Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68, sensitivity 85%, and specificity 81%. CONCLUSION Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai. This paper’s limitations include inter-study method heterogeneity and small sample sizes. Future, standardized, multi-center studies are recommended.

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Section: Discussionmentioning

confidence: 94%

Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis

Wagner¹,

Abdelgawad²,

Landry³

et al. 2022

WJG

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“…Another study revealing a similar result was reported by Attia et al (2014), in which nearly half of the patients did not reach normal LS values at the end of the follow-up period, although the stiffness was found to be somewhat reduced. In the newly published report (Darweesh et al, 2020), it was noted that a reduction in LS was observed after adequate biliary drainage, even though the resultant values were slightly above the normal limits, measured using both TE and ARFI elastography. Failure to reach normal stiffness values indicates the impact of cofactors on LS.…”

Section: Discussionmentioning

confidence: 90%

Evaluation of the change in liver stiffness after biliary drainage in patients with extrahepatic cholestasis

Uzunkaya¹,

Soylu²,

Goren³

et al. 2021

JECM

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Increased liver stiffness (LS) due to extrahepatic cholestasis has been reported to reduce after biliary drainage. As far as we know, it has not been evaluated whether the method of drainage makes a difference in the change in liver stiffness until now. The aim of the study was to answer this question. The patients planned for endoscopic biliary drainage (EBD) or percutaneous biliary drainage (PBD) were enrolled for over an 18-months’ time period. In those without chronic liver disease or liver tumor, liver stiffness was measured before and 10 days after the intervention, using acoustic radiation force impulse (ARFI) elastography. A total of 30 patients were included in the study excluding the ones not fulfilling the criteria and were divided into two groups: EBD group (n = 15) and PBD group (n = 15). The measurements were above the cut-off value for severe fibrosis (1.55 m/s) in all patients with a mean of 2.50 ± 0.72 m/s before drainage. The pre-drainage values of the PBD group were significantly higher than of the EBD group (2.79 ± 0.58 m/s vs 2.22 ± 0.74 m/s, p = 0.02). In all patients except 11, a significant reduction was observed in the stiffness values. The reduction with PBD was more significant than with EBD (p = 0.04). Percutaneous biliary drainage provided a more significant reduction in liver stiffness in patients with extrahepatic cholestasis. However, this result appears to be related to the nature of obstruction rather than the method of drainage, making the comparison weaker than expected from the original design.

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“…Its parameters are related to the structure (1) and physiological state of the tissue, such as muscle tension and compression (2), stiffening of the penis during erection (3), and small changes in brain perfusion due to activity (4). These changes are also related to numerous diseases and responses to treatment (5)(6)(7)(8)(9)(10). Therefore, quantitative assessment of tissue viscoelasticity will further our understanding of the physiological condition of an organ, disease diagnosis, monitoring of treatment effects, and prognosis.…”

Section: Introductionmentioning

confidence: 99%

Clinical studies of magnetic resonance elastography from 1995 to 2021: Scientometric and visualization analysis based on CiteSpace

Li¹,

Gao²,

Chen³

et al. 2022

Quant Imaging Med Surg

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In all, 1,236 articles published by 726 authors from 540 institutions in 40 countries were included in this study. The top 10 authors published 57.6% of all included articles. The 3 most productive countries were the USA (n=631), Germany (n=202), and France (n=134), and the 3 most productive institutions were the Mayo Clinic (n=240), Charité (n=131), and the University of Illinois (n=56). The USA and the Mayo Clinic had the highest betweenness centrality among countries and institutions, respectively, and played an important role in the field of MRE. In this study, the 24,347 distinct references were clustered into 48 categories via reasonable clustering using specific keywords, forming the knowledge framework. Among the 294 co-occurring keywords, "hepatic fibrosis", "stiffness", "skeletal muscle", "acoustic strain wave", "in vivo", and "non-invasive assessment" were research hotspots. "Diagnostic performance", "diagnostic accuracy", "hepatic steatosis", "chronic hepatitis B", "radiation force impulse", "children", and "echo" were frontier topics.Conclusions: Scientometric and visualized analysis of MRE can provide information regarding the knowledge framework, research hotspots, frontier areas, and emerging trends in this field.

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Increased liver stiffness by transient elastography and acoustic radiation force impulse imaging in patients with extrahepatic cholestasis

Cited by 5 publications

References 19 publications

Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis

Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis

Evaluation of the change in liver stiffness after biliary drainage in patients with extrahepatic cholestasis

Clinical studies of magnetic resonance elastography from 1995 to 2021: Scientometric and visualization analysis based on CiteSpace

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