Shear wave elastography for liver fibrosis in chronic hepatitis B: Adapting the cut-offs to alanine aminotransferase levels improves accuracy

Zeng, Jie; Zheng, Jian; Jin, Jieyang; Mao, Yunfei; H, Guo; Lü, Ming-De; Zheng, Hairong; Zheng, Rongqin

doi:10.1007/s00330-018-5621-x

Cited by 35 publications

(21 citation statements)

References 26 publications

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“…With vibration-controlled transient elastography, the alanine aminotransferase-adapted cut-off values of liver stiffness reportedly improved the staging of liver fibrosis in patients with chronic hepatitis B in a single study (36). The consensus for the staging of liver fibrosis with vibration-controlled transient elastography, the consensus panel proposes a vendor-neutral "rule of four" (5, 9, 13, 17 kPa) for the ARFI techniques for viral etiologies and NAFLD: Liver stiffness of 5 kPa (1.3 m/sec) or less has high probability of being normal; liver stiffness less than 9 kPa (1.7 m/sec), in the absence of other known clinical signs, rules out cA-CLD; values between 9 kPa (1.7 m/sec) and 13 kPa (2.1 m/sec) are suggestive of cACLD but may need further test for confirmation; and values greater than 13 kPa (2.1 m/sec) are highly suggestive of cACLD.…”

Section: Recommendationsmentioning

confidence: 99%

Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement

Barr¹,

Wilson²,

Rubens³

et al. 2020

Radiology

304

295

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This multidisciplinary update of the Society of Radiologists in Ultrasound consensus statement on liver elastography incorporates the large volume of new information available in the literature since the initial publication. The recommended procedure for acquiring stiffness measurements is reviewed. There has been substantial improvement in the acoustic radiation force impulse (ARFI) technology-most notably the addition of a quality assessment of the shear wave propagation. Due to the efforts of the Quantitative Imaging Biomarkers Alliance, or QIBA, the variability of liver stiffness measurements between systems had decreased. There are now effective treatments for hepatitis B and hepatitis C, and follow-up after effective treatment should be based on the use of the delta change of the value obtained at viral eradication or suppression. Because the detection of compensated advanced chronic liver disease (cACLD) is very important, the new guidelines are made based on the probability of cACLD for given stiffness values. The panel recommends a vendor-neutral rule of four for interpretation for ARFI techniques. This new method simplifies interpretation of liver stiffness results and is more clinically relevant.

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Section: Recommendationsmentioning

confidence: 99%

Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement

Barr¹,

Wilson²,

Rubens³

et al. 2020

Radiology

304

295

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 98%

“…In this study, the children were seriously ill, and their ALT and AST levels were significantly higher than normal, leading to an insignificant correlation with LSM. Zeng et al 28 reported that the LSM values were affected in patients with significantly higher ALT levels, but they had no effect in the normal group or in groups with slightly higher ALT levels. Edema, inflammation, extrahepatic cholestasis, and congestion can increase liver stiffness and elevate the measurements, 12,13,28 which are associated with higher LSM values on TE and ARFI, if this is true also for 2D‐SWE 29 …”

Section: Discussionmentioning

confidence: 98%

“…Edema, inflammation, extrahepatic cholestasis, and congestion can increase liver stiffness and elevate the measurements, 12,13,28 which are associated with higher LSM values on TE and ARFI, if this is true also for 2D-SWE. 29 According to the obtained results, SWE measurements were strongly related to PV maximum velocity, PV direction, HARI, spleen diameter, and the presence of ascites.…”

Section: Discussionmentioning

confidence: 99%

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Shear wave elastography for evaluation of the urgency of liver transplantation in pediatric patients with biliary atresia

Fang

et al. 2020

Pediatric Transplantation

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Background: To investigate the role of two-dimensional shear wave elastography (2D-SWE) in the preoperative evaluation of pediatric patients with biliary atresia awaiting liver transplantation. Methods: Among a total of 152 pediatric patients enrolled in this single-institution prospective study between March 2018 and August 2019, 143 patients (age range, 4-97 months; median age, 7 months; 84 males, 59 females) who underwent successful routine ultrasound examination, SWE examination, and blood test before liver transplantation were included in the final analysis. The values of liver stiffness measured by SWE were compared with ultrasound and blood test parameters by Spearman's correlation analysis. Results: The overall median liver stiffness with 2D-SWE was 29.0 ± 10.9 kPa, with a range of 9.0-53.3 kPa. The success rate of 2D-SWE measurements was 98.0% (149/152). Liver stiffness measurement (LSMs) had no significant correlation with gender, age, weight, and height of the pediatric recipients. LSMs were correlated with ultrasound parameters including portal vein (PV) maximum velocity, PV direction, hepatic artery resistance index (HARI), spleen diameter, ascites, and blood test parameters (albumin level, platelet count level, and international normalized ratio). In the pediatric recipients with hepatofugal PV flow, high HARI (HARI ≧ 0.90), and ascites, or without Kasai operation, LSMs were significantly higher (P < .05). Conclusions: SWE is feasible and valuable for assessing liver damage in children with biliary atresia awaiting liver transplantation and might be used as selection criteria for children in need of priority access to liver transplantation.

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“…Another common confounder is the presence of acute liver inflammation, which increases liver stiffness. Different liver stiffness thresholds adapted to normal and abnormally elevated liver transaminase levels for the detection of significant fibrosis and cirrhosis have been proposed and successfully implemented in studies involving patients with HBV, HCV, and alcoholic liver disease . Other biological confounders that increase liver stiffness without fibrosis include hepatic venous congestion, cholestasis, right heart failure, and infiltrative diseases such as amyloidosis.…”

Section: Ultrasoundmentioning

confidence: 99%

Liver fibrosis imaging: A clinical review of ultrasound and magnetic resonance elastography

Zhang

Fowler

Ozturk

et al. 2019

Magnetic Resonance Imaging

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Liver fibrosis is a histological hallmark of most chronic liver diseases, which can progress to cirrhosis and liver failure, and predisposes to hepatocellular carcinoma. Accurate diagnosis of liver fibrosis is necessary for prognosis, risk stratification, and treatment decision‐making. Liver biopsy, the reference standard for assessing liver fibrosis, is invasive, costly, and impractical for surveillance and treatment response monitoring. Elastography offers a noninvasive, objective, and quantitative alternative to liver biopsy. This article discusses the need for noninvasive assessment of liver fibrosis and reviews the comparative advantages and limitations of ultrasound and magnetic resonance elastography techniques with respect to their basic concepts, acquisition, processing, and diagnostic performance. Variations in clinical contexts of use and common pitfalls associated with each technique are considered. In addition, current challenges and future directions to improve the diagnostic accuracy and clinical utility of elastography techniques are discussed. Level of Evidence: 5 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:25–42.

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Shear wave elastography for liver fibrosis in chronic hepatitis B: Adapting the cut-offs to alanine aminotransferase levels improves accuracy

Cited by 35 publications

References 26 publications

Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement

Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement

Shear wave elastography for evaluation of the urgency of liver transplantation in pediatric patients with biliary atresia

Liver fibrosis imaging: A clinical review of ultrasound and magnetic resonance elastography

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