The usefulness of transient elastography, acoustic-radiation-force impulse elastography, and real-time elastography for the evaluation of liver fibrosis

Chung, Jong Hee; Ahn, Hyung Su; Kim, Sang Gyune; Lee, Yun Nah; Kim, Young Seok; Jeong, Soung Won; Jang, Jae Young; Lee, Sae Hwan; Kim, Hong Soo; Kim, Boo Sung

doi:10.3350/cmh.2013.19.2.156

Cited by 38 publications

(47 citation statements)

References 40 publications

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“…Hence, we could not incorporate their predictive performances in this review. Considering that these elastography methods had similar diagnostic performances to predict liver cirrhosis [78,79,80,81] and that spleen stiffness had showed the promising results to assess the portal hypertension from more recent investigations [82,83,84], further studies are required to find whether they have the better predictive performances to predict postoperative outcomes.…”

Section: Limitations Of Te and Future Perspectivesmentioning

confidence: 99%

Clinical Application of Liver Stiffness Measurement Using Transient Elastography: A Surgical Perspective

Kim¹,

Han²

2013

Digestion

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Liver biopsy (LB) remains the gold standard for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra-/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are ineligible in real clinical practice. Thus, due to the pressing need for non-invasive surrogates, over the past decade, significant progress has been made in non-invasively assessing liver fibrosis. Of the methods now available, transient elastography (TE) appears to be an excellent tool for assessing liver fibrosis and also has some prognostic value in surgical settings. Recent studies have proposed the extended role of TE in the surgical field, based on the concept that TE values show significant correlations with portal hypertension and hepatocellular carcinoma development. TE appears promising in predicting postoperative short-term outcomes such as hepatic insufficiency or complications and long-term outcomes such as recurrence or liver-related death. Furthermore, TE may be useful in predicting the severity of liver fibrosis progression due to recurrence of hepatitis C virus infection or other underlying liver diseases after transplantation. TE cannot completely replace other tests accompanied with hepatic surgical treatments, including LB, endoscopic examination, hepatic venous pressure gradient evaluation, or the indocyanine green retention test. However, TE represents an important non-invasive tool that enables more efficient and tailored management strategies for patients who were treated with liver resection or transplantation. This review discusses extended TE applications in the surgical setting, such as hepatic resection or transplantation.

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Section: Limitations Of Te and Future Perspectivesmentioning

confidence: 99%

Clinical Application of Liver Stiffness Measurement Using Transient Elastography: A Surgical Perspective

Kim¹,

Han²

2013

Digestion

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“…Improved RTE results have been reported in numerous studies (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) (Table I) due to the development of heartbeat-based compression techniques, as opposed to freehand operation, and the development of software for the calculation of elasticity parameters by Hitachi Medical Systems (Tokyo, Japan). Tatsumi et al (14) first used quantitative parameters to evaluate liver fibrosis with a EUB-8500 digital ultrasound scanner (Hitachi Medical Systems).…”

Section: Introductionmentioning

confidence: 99%

“…The elasticity score, which was presented on a scale of 0-5, evaluated the degree of liver hardness using color on the RTE images; however, the scoring was subjective. RTE was observed to exhibit poor diagnostic performance in cases examining the differentiation of liver fibrosis (9). Since the absolute value of liver stiffness in RTE was variable, the ʻStrain Ratioʼ parameter was constructed.…”

Section: Introductionmentioning

confidence: 99%

Clinical value of real-time elastography quantitative parameters in evaluating the stage of liver fibrosis and cirrhosis

Shi

Song

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to assess the value of real-time elastography (RTE) quantitative parameters, namely the liver fibrosis (LF) index and the ratio of blue area (%AREA), in evaluating the stage of liver fibrosis. RTE quantitative analysis software was used to examine 120 patients with chronic hepatitis in order to obtain the values for 12 quantitative parameters from the elastic images. The diagnostic performance of two such parameters, the LF index and %AREA, were assessed with a receiver operating characteristic (ROC) curve to determine the optimal diagnostic cut-off values for liver cirrhosis and fibrosis. A good correlation was observed between the LF index and %AREA with the fibrosis stage. The areas under the ROC curve for the LF index were 0.985 for the diagnosis of liver cirrhosis and 0.790 for liver fibrosis. With regard to %AREA, the areas under the ROC curve for the diagnosis of liver cirrhosis and fibrosis were 0.963 and 0.770, respectively. An LF index of >3.25 and a %AREA of >28.83 for the diagnosis of cirrhosis stage resulted in sensitivity values of 100 and 100%, specificity values of 88.9 and 85.9% and accuracy values of 90.8 and 88.3%, respectively. The LF index and %AREA parameters exhibited higher reliability in the diagnosis of liver cirrhosis compared with the diagnosis of the liver fibrosis stage. However, the two parameters possessed a similar efficacy in the diagnosis of liver cirrhosis and the stage of liver fibrosis. Therefore, the quantitative RTE parameters of the LF index and %AREA may be clinically applicable as reliable indices for the early diagnosis of liver cirrhosis, without the requirement of an invasive procedure.

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“…Our cut-off value was lower than most of the studies in Western countries [9,10,22]. However, the cut-off value is similar to reports from Korea [37] and China with low ALT levels [38]. Therefore, we set the mean ARFI cut-off value for liver cirrhosis to be 1.523 m/sec for the non-treatment group.…”

Section: Discussionmentioning

confidence: 68%

Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy

et al. 2017

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Inflammation has significant impacts on liver fibrosis measurement by ultrasound elastography. The interpretation requires further optimization in patients with or without anti-viral therapy. We prospectively enrolled a consecutive series of patients with chronic hepatitis B who received liver histology analysis and acoustic radiation force impulse (ARFI). 146 patients who underwent liver biopsy (50.9%) or tumor resection (49.1%) were enrolled. 34 patients (23.3%) had been receiving anti-hepatitis B therapy of various duration. The areas under the receiver-operating characteristic (AUROC) for the diagnosis of Metavir F4 by mean ARFI was 0.820 in the non-treatment group and 0.796 in the treatment group. The ARFI tended to be not lower (100%) than the corresponding Metavir grading in patients with treatment within 12 months, equal (75%) from 13 to 31 months, and lower (71.4%) after 32 months. We conclude that ARFI is a reliable tool for measurement of liver fibrosis in chronic hepatitis B patients with ALT (alanine aminotransferase) <5x the upper limit of normal. For those patients under anti-HBV therapy, the optimal timing for ARFI analysis will be over 1-2.5 years of nucleos(t)ide analogue therapy. The ARFI measurement after 2.5 years tends to be lower than the corresponding histology grading.

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The usefulness of transient elastography, acoustic-radiation-force impulse elastography, and real-time elastography for the evaluation of liver fibrosis

Cited by 38 publications

References 40 publications

Clinical Application of Liver Stiffness Measurement Using Transient Elastography: A Surgical Perspective

Clinical Application of Liver Stiffness Measurement Using Transient Elastography: A Surgical Perspective

Clinical value of real-time elastography quantitative parameters in evaluating the stage of liver fibrosis and cirrhosis

Interpretation US Elastography in Chronic Hepatitis B with or without Anti-HBV Therapy

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