Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations

Ferraioli, Giovanna; Wong, Vincent Wai‐Sun; Castéra, Laurent; Berzigotti, Annalisa; Sporea, Ioan; Dietrich, Christoph F.; Choi, Byung Ihn; Wilson, Stephanie R.; Kudo, Masatoshi; Barr, Richard G.

doi:10.1016/j.ultrasmedbio.2018.07.008

Cited by 443 publications

(466 citation statements)

References 212 publications

(251 reference statements)

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“…In this study, we found that the intraobserver and interobserver agreement coefficients were higher for both the 10‐ and 20‐mm diameters than for the 30‐mm diameter. In addition, the results of this study also indicated that a Q‐Box with a diameter of 30 mm had the largest CV of all diameters, which may have been due to SWE signal dropout and inhomogeneous regions that often occur at the borders of the field of view . Two‐dimensional SWE provides a real‐time quantitative LS map (elasticity map) that can be used to evaluate the spatial heterogeneity of LS .…”

Section: Discussionmentioning

confidence: 85%

“…Two‐dimensional SWE provides a real‐time quantitative LS map (elasticity map) that can be used to evaluate the spatial heterogeneity of LS . As a result, the placement of the Q‐Box was adjusted to avoid errors . However, a diameter of 30 mm for the Q‐Box represents the largest circle in the field of view; therefore, avoiding errors by adjusting the placement of the Q‐Box is not possible.…”

Section: Discussionmentioning

confidence: 99%

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Does Operator Experience and the Q‐Box Diameter Affect the Repeatability of Liver Stiffness Measurements Obtained by 2‐Dimensional Shear Wave Elastography?

Wang

Zheng

Liang

et al. 2019

J of Ultrasound Medicine

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Objectives The purpose of this research was to evaluate whether operator experience and the quantitative analysis system (Q‐Box; SuperSonic Imagine, Aix‐en‐Provence, France) diameter affect the repeatability of liver stiffness measurements. Methods We enrolled 417 outpatients. All measurements were performed by 2 operators, including an expert and a novice. Each patient was continuously measured 3 times by the 2 operators. The Q‐Box diameter was adjusted to 10, 20, and 30 mm each time, and the mean elasticity values were recorded. Intraobserver repeatability was evaluated by the intraclass correlation coefficient (ICC). Interobserver repeatability was evaluated by the ICC, coefficient of variation (CV), and Bland‐Altman plots. Results The study group included 241 male and 176 female patients. The expert operator had higher ICCs than the novice operator at each Q‐Box diameter. The overall interobserver agreement was excellent, and the results showed that compared to other groups, the ICC was the lowest and the CV was the largest for the 30‐mm‐diameter group. The ICC and CV values were similar between the 10‐ and 20 mm‐diameter groups. The Bland‐Altman plots showed that the mean difference was –0.2 kPa for the 10‐, 20‐, and 30 mm‐diameter groups. However, the limits of agreement were the largest in the 30‐mm‐diameter group and were similar between the 10‐ and 20‐mm‐diameter groups. Conclusions The repeatability of liver stiffness measurements is affected not only by experience but also by the Q‐Box diameter.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Does Operator Experience and the Q‐Box Diameter Affect the Repeatability of Liver Stiffness Measurements Obtained by 2‐Dimensional Shear Wave Elastography?

Wang

Zheng

Liang

et al. 2019

J of Ultrasound Medicine

View full text Add to dashboard Cite

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“…The interquartile range measures the statistical dispersion between the upper and lower quartiles. A data set of the liver is considered good with an IQR/median of less than 0.3 (elastography measured in kilopascals) or less than 0.15 (elastography measured in meters per second) . Thresholds for ARFI values of the bowel wall are currently lacking and are an area of study.…”

Section: Unique Adjunctive Us Biomarkersmentioning

confidence: 99%

Bowel Ultrasound State of the Art: Grayscale and Doppler Ultrasound, Contrast Enhancement, and Elastography in Crohn Disease

Merrill

Medellin

et al. 2019

J of Ultrasound Medicine

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Bowel ultrasound (US) is accurate for assessing bowel inflammation and complications in Crohn disease. Additionally, contrast‐enhanced US provides a quantitative, objective measurement of inflammatory activity in inflammatory bowel disease, and shear wave elastography predicts the stiffness of bowel, an increase of which suggests less response to medical therapy, often necessitating surgery. Overall, bowel US is an excellent, safe, and repeatable choice for routine surveillance and for urgent imaging. We describe an approach to evaluating inflammatory bowel disease and review its features on standard grayscale US with Doppler imaging and show how contrast‐enhanced US and shear wave elastography can distinguish between inflammatory and fibrostenotic bowel.

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“…This has favoured the development of alternative non‐invasive strategies, which have been an area of intensive research over the past decade. Although none of the non‐invasive tests adequately discriminate NASH from simple steatosis in patients with NAFLD, they are now extensively used in liver clinics to detect advanced liver fibrosis and are recommended by international guidelines …”

Section: Introductionmentioning

confidence: 99%

Non‐invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healthcare and liver clinics

Castéra

2020

Liver International

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Despite affecting around one‐fourth of the general population worldwide, non‐alcoholic fatty liver disease (NAFLD) remains a largely under‐recognized disease in primary healthcare, with not more than 10% of patients diagnosed with NAFLD referred to specialists. The main challenge in clinical practice is the identification of those with advanced liver fibrosis or cirrhosis, as they are at the greatest risk of developing complications. Liver biopsy appears to be an unrealistic and unsuitable option because of the large number of high‐risk patients and the well‐known limitations of this technique. This has favoured the development of non‐invasive tests, which have been an area of intensive research in the past decade. Transient elastography, FIB‐4 and the NAFLD fibrosis score are the most extensively used and best validated tests, with summary AUROC values for detecting advanced fibrosis in NAFLD patients of 0.88, 0.84 and 0.84 respectively. Although much work remains to be done to establish cost‐effective strategies for the screening for advanced fibrosis, the sequential use of non‐invasive tests (serum biomarkers, then measurement of liver stiffness using transient elastography) appears to be the most promising strategy. The next step is to establish effective pathways in primary healthcare and/or diabetes clinics where most NAFLD patients are seen, to identify those who need to be referred to liver clinics for further assessment.

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Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations

Cited by 443 publications

References 212 publications

Does Operator Experience and the Q‐Box Diameter Affect the Repeatability of Liver Stiffness Measurements Obtained by 2‐Dimensional Shear Wave Elastography?

Does Operator Experience and the Q‐Box Diameter Affect the Repeatability of Liver Stiffness Measurements Obtained by 2‐Dimensional Shear Wave Elastography?

Bowel Ultrasound State of the Art: Grayscale and Doppler Ultrasound, Contrast Enhancement, and Elastography in Crohn Disease

Non‐invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healthcare and liver clinics

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