1
|
Dajti E, Marasco G, Ravaioli F, Alemanni LV, Rossini B, Colecchia L, Vestito A, Festi D, Colecchia A. The role of liver and spleen elastography in advanced chronic liver disease. Minerva Gastroenterol (Torino) 2021; 67:151-163. [PMID: 34027932 DOI: 10.23736/s2724-5985.20.02793-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Portal hypertension is the main driver of complications in patients with advanced chronic liver disease (ACLD). In the last decade, many non-invasive tests, such us liver and spleen elastography, have been proposed and validated for the identification of patients with clinically significant portal hypertension (CSPH) and its complications, mainly hepatic decompensation and liver-related morbidity and mortality. Moreover, elastography accurately stratifies for the risk of HCC development, HCC recurrence and decompensation after liver surgery. Recent studies suggest a role of SSM in monitoring response to treatments and interventions in ACLD, such as viral eradication, non-selective beta-blockers and transjugular intrahepatic portosystemic shunt placement. However, one of the most indications to perform elastography in ACLD still remains the screening for esophageal varices. In fact, according to the Baveno VI consensus, liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm3 can safely identify patients at low risk of varices requiring treatment (VNT) and could therefore avoid invasive upper invasive endoscopy; LSM>20-25 kPa can accurately rule-in CSPH in patients with viral etiology. Spleen stiffness measurement (SSM) is a direct surrogate of portal hypertension and has been demonstrated more accurate in predicting portal hypertension severity and VNT. A combined model including Baveno VI Criteria and SSM (≤46 kPa) can significantly increase the number of spared endoscopies (>40-50%), maintaining a low (<5%) of missed VNT.
Collapse
Affiliation(s)
- Elton Dajti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luigina V Alemanni
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Benedetta Rossini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luigi Colecchia
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Amanda Vestito
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy -
| |
Collapse
|
2
|
Seko Y, Yamaguchi K, Tochiki N, Yano K, Takahashi A, Okishio S, Kataoka S, Okuda K, Umemura A, Moriguchi M, Itoh Y. The Effect of Genetic Polymorphism in Response to Body Weight Reduction in Japanese Patients with Nonalcoholic Fatty Liver Disease. Genes (Basel) 2021; 12:genes12050628. [PMID: 33922278 PMCID: PMC8145113 DOI: 10.3390/genes12050628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
Background: weight loss as a result of lifestyle intervention is effective when treating non-alcoholic fatty liver disease (NAFLD). We estimated the effects of PNPLA3 rs738409 and HSD17B13 rs6834314 variants in response to diet therapy in Japanese patients with NAFLD. Methods: we analyzed the correlation between the change in liver stiffness and change in body weight in 140 patients administered diet therapy for 1-year, according to PNPLA3 and HSD17B13 genotypes. Results: the bodyweight (BW) reduction rate was greater in patients with the PNPLA3 genotype CC than CG and GG (p = 0.035). Change in liver stiffness measurement (LSM) was significantly associated with a change in BW in PNPLA3 CG/GG (r = 0.279/0.381), but not in PNPLA3 CC (p = 0.187). Change in LSM was correlated with change in BW only in patients with HSD17B13 AG/GG (r = 0.425), but not the AA genotype (p = 0.069). A multivariate analysis identified that a change in LSM was correlated with a change in BW in carriers of HSD17B13 AG/GG (B = 3.043, p = 0.032), but not HSD17B13 AA. The change in LSM of patients with a BW reduction of more than 7% (0.50) was significantly greater than that of patients with a BW reduction of less than 7% (0.83) (p = 0.038). Conclusions: in Japanese patients with NAFLD, HSD17B13 rs6834314 polymorphism is associated with the change in LSM by lifestyle intervention. The approach, including genetic assessments, may contribute to the establishment of appropriate therapeutic strategies to treat NAFLD.
Collapse
|
3
|
The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6635963. [PMID: 33928154 PMCID: PMC8051526 DOI: 10.1155/2021/6635963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022]
Abstract
Background Baveno VI criteria, based on liver stiffness (LS) measured by transient elastography and platelet counts (PLT), have been proposed to avoid unnecessary endoscopy screening for high-risk varices (HRVs). However, the cut-off value of LS measured by 2D-SWE and PLT to predict HRVs in compensated hepatitis B-related cirrhotic patients remains unknown. Aims To prospectively analyze the cut-off of the combination of LS measured by 2D-SWE and PLT in predicting HRVs and the influence of antiviral therapies in its efficacy. Methods Serum parameters, LS, and endoscopy results were obtained from 160 compensated hepatitis B-related cirrhotic patients. The accuracy of the combined algorithm was assessed in the whole cohort and subgroups with or without consecutive antiviral therapies in the past 6 months. Results In the whole cohort, the optimal cut-off value of LS for HRVs was 14.5 kPa. Patients with a LS value < 14.5 kPa with a PLT value > 110 × 109/L can be excluded from HRVs (NPV = 0.99, endoscopy saved rates = 0.68). Conversely, a LS value of ≥14.5 kPa and a PLT value of ≤110 × 109/L indicated HRVs, with accurate rates of 82.35%, and 10.63% of patients can avoid additional endoscopy screening. Moreover, antiviral therapy had no significant effect on the accuracy and rates saved from further endoscopy screening, when comparing patients with or without antiviral therapies (all p values > 0.05). Conclusions The combination of LS (14.5 kPa) measured by 2D-SWE and PLT (110 × 109/L) can predict HRVs accurately in compensated hepatitis B-related cirrhotic patients without significant interference of antiviral therapy histories.
Collapse
|
4
|
Schulz M, Kleinjans M, Strnad P, Demir M, Holtmann TM, Tacke F, Wree A. Shear Wave Elastography and Shear Wave Dispersion Imaging in the Assessment of Liver Disease in Alpha1-Antitrypsin Deficiency. Diagnostics (Basel) 2021; 11:diagnostics11040629. [PMID: 33807358 PMCID: PMC8066059 DOI: 10.3390/diagnostics11040629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 12/19/2022] Open
Abstract
Liver affection of Alpha1-antitrypsin deficiency (AATD) can lead to cirrhosis and hepatocellular carcinoma (HCC). A noninvasive severity assessment of liver disease in AATD is urgently needed since laboratory parameters may not accurately reflect the extent of liver involvement. Preliminary data exist on two-dimensional shear wave elastography (2D-SWE) being a suitable method for liver fibrosis measurement in AATD. AATD patients without HCC were examined using 2D-SWE, shear wave dispersion imaging (SWD) and transient elastography (TE). Furthermore, liver steatosis was assessed using the controlled attenuation parameter (CAP) and compared to the new method of attenuation imaging (ATI). 29 AATD patients were enrolled, of which 18 had the PiZZ genotype, eight had PiMZ, two had PiSZ and one had a PiZP-Lowell genotype. 2D-SWE (median 1.42 m/S, range 1.14–1.83 m/S) and TE (median 4.8 kPa, range 2.8–24.6 kPa) values displayed a significant correlation (R = 0.475, p < 0.05). 2D-SWE, ATI (median 0.56 dB/cm/MHz, range 0.43–0.96 dB/cm/MHz) and CAP (median 249.5 dB/m, range 156–347 dB/m) values were higher in PiZZ when compared to other AATD genotypes. This study provides evidence that 2D-SWE is a suitable method for the assessment of liver disease in AATD. The newer methods of SWD and ATI require further evaluation in the context of AATD.
Collapse
Affiliation(s)
- Marten Schulz
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.D.); (T.M.H.); (F.T.); (A.W.)
- Correspondence:
| | - Moritz Kleinjans
- Medical Clinic III, Gastroenterology, Metabolic Diseases, and Intensive Care, University Hospital, RWTH Aachen, 52074 Aachen, Germany; (M.K.); (P.S.)
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network (ERN) “Rare Liver” and the European Association for the Study of the Liver (EASL) Registry Group “Alpha1-Liver”, 52074 Aachen, Germany
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases, and Intensive Care, University Hospital, RWTH Aachen, 52074 Aachen, Germany; (M.K.); (P.S.)
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network (ERN) “Rare Liver” and the European Association for the Study of the Liver (EASL) Registry Group “Alpha1-Liver”, 52074 Aachen, Germany
| | - Münevver Demir
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.D.); (T.M.H.); (F.T.); (A.W.)
| | - Theresa M. Holtmann
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.D.); (T.M.H.); (F.T.); (A.W.)
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.D.); (T.M.H.); (F.T.); (A.W.)
| | - Alexander Wree
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.D.); (T.M.H.); (F.T.); (A.W.)
| |
Collapse
|
5
|
Chen BB, Mu PY, Lu JT, Wang G, Zhang R, Huang DD, Shen DH, Jiang TT. Sinistral portal hypertension associated with pancreatic pseudocysts - ultrasonography findings: A case report. World J Clin Cases 2021; 9:463-468. [PMID: 33521116 PMCID: PMC7812887 DOI: 10.12998/wjcc.v9.i2.463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sinistral portal hypertension associated with pancreatic pseudocysts is rare, often caused by extrinsic compression of splenic vein, the follow-up examinations by ultrasonography for early diagnosis are quietly necessary since haematemesis, a life-threatening condition. Few studies have reported the ultrasonography findings of sinistral portal hypertension.
CASE SUMMARY A 52-year-old man presented with acute abdominal pain after drinking, steatorrhea, weight loss and accidentally melena in the past 2 mo. He underwent ultrasound-guided fine needle aspiration in other hospital and diagnosed with pancreatic pseudocysts. Ultrasonography imaging, in our department, appeared as cystic heterogeneous hypoechoic area with the size of 4.7 cm × 3.8 cm that located posterior to the body and tail of pancreas, adjacent to splenic vein associated with thrombosis resulted from compression. Spleen incrassated to approximately 7.3 cm, but no dilation of main portal vein was presented. Color Doppler Flow Imaging demonstrated the formation of splenic venous collateral, nevertheless no significantly flow signals was observed in splenic vein. Pulsed Doppler revealed that the peak velocity of splenic venous collateral was 18.4 cm/s with continuous waveform. Laparotomy confirmed sinistral portal hypertension associated with pancreatic pseudocysts, subsequently distal pancreatectomy combined with splenectomy and partial gastrectomy was performed.
CONCLUSION It’s important clinically to know the ultrasound appearance of sinistral portal hypertension associated with pancreatic pseudocysts for sonographer and physician.
Collapse
Affiliation(s)
- Bei-Bei Chen
- Department of Ultrasound, Postgraduate Training Base of Jinzhou Medical University, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Pei-Yuan Mu
- Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Jing-Tai Lu
- Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Gong Wang
- Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Rui Zhang
- Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Dan-Dan Huang
- Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Dong-Hua Shen
- Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Ting-Ting Jiang
- Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| |
Collapse
|
6
|
Aquino-Matus J, Uribe M, Chavez-Tapia N. Liver and spleen elastography as predictor of portal hypertension and esophageal varices. Minerva Gastroenterol (Torino) 2020; 67:122-128. [PMID: 33337116 DOI: 10.23736/s2724-5985.20.02779-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Liver stiffness is related to the degree of hepatic fibrosis which ultimately causes portal hypertension and gastroesophageal varices. Variceal bleeding is a worrisome and potentially fatal complication of cirrhosis, primary prophylaxis has demonstrated a reduction in decompensation and mortality. Portal hypertension and esophageal varices needing treatment could be predicted through noninvasive methods, including elastography, that evaluates the mechanical properties of liver or spleen tissue in concordance to the propagation of mechanical waves. The accurate prediction of the risk of gastroesophageal varices could spare unnecessary endoscopies in patients with low probability of finding varices needing treatment. In the current review, we discuss the elastography modalities available and the current evidence for its implementation in daily clinical practice.
Collapse
|
7
|
Giuffrè M, Campigotto M, Colombo A, Visintin A, Budel M, Aversano A, Navarria L, Piccin A, Cavalli CA, Sigon R, Balestra R, Tinè F, Abazia C, Masutti F, Crocè LS. The role of elastography in alcoholic liver disease: fibrosis staging and confounding factors, a review of the current literature. Minerva Gastroenterol (Torino) 2020; 67:112-121. [PMID: 33222430 DOI: 10.23736/s2724-5985.20.02777-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Alcohol-related liver disease (ALD) was estimated to have a prevalence of 2% among the USA population. Since severe fibrosis in compensated patients is the main predictor of long-term survival, it is of utmost importance to early detect patients with severe fibrosis before decompensation occurs. Liver elastography has been used to stage liver fibrosis. However, there is a widespread lack in guidelines for the correct use of liver stiffness (LS) in ALD. EVIDENCE ACQUISITION A structured search was carried out on MEDLINE/PubMed database. From the original 225 research articles identified, only 12 studies met the inclusion criteria, with 10 studies being eventually included. EVIDENCE SYNTHESIS According to reported data, patients with aspartate aminotransferase (AST)>100 IU/L and 50 IU/L showed significantly higher values of LS if compared to patients with the same fibrosis stage. Also, excessive alcohol consumption greatly influences elastography, leading to false fibrosis staging. When LS values >5-6 kPa are detected, several aspects should be taken into account. First of all, the patient should be asked about the current alcohol consumption (i.e. active vs. abstinence, determination of abstinence period, and quantification of alcohol intake), and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. Secondly, clinicians should check liver transaminases level, and if AST are above 100 IU/L, they should be aware of a possible overestimation of fibrosis. However, whether transaminases-adapted cut-off values should be used for ad-hoc decisions in patients with no time or option to withdraw from alcohol consumption is still a matter of debate. CONCLUSIONS We hope that our review article may serve as a reference point in the prospect of futures guidelines.
Collapse
Affiliation(s)
- Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy - .,Italian Liver Foundation, Basovizza, Trieste, Italy - .,Pathologies of the Liver Clinic, A.S.U. Giuliano Isontina, Trieste, Italy -
| | - Michele Campigotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Colombo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessia Visintin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Martina Budel
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Aversano
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Navarria
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Piccin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Carolina A Cavalli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Riccardo Sigon
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Fabio Tinè
- Pathologies of the Liver Clinic, A.S.U. Giuliano Isontina, Trieste, Italy
| | - Cristiana Abazia
- Pathologies of the Liver Clinic, A.S.U. Giuliano Isontina, Trieste, Italy
| | - Flora Masutti
- Pathologies of the Liver Clinic, A.S.U. Giuliano Isontina, Trieste, Italy
| | - Lory S Crocè
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Italian Liver Foundation, Basovizza, Trieste, Italy.,Pathologies of the Liver Clinic, A.S.U. Giuliano Isontina, Trieste, Italy
| |
Collapse
|
8
|
Spleen Stiffness Predicts Survival after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3860390. [PMID: 33282945 PMCID: PMC7685811 DOI: 10.1155/2020/3860390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022]
Abstract
Objectives Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications. Little is known about the ability of spleen stiffness (SS) for predicting the survival of cirrhotic patients undergoing TIPS. This study is to evaluate the influence of SS detected by point shear wave elastography (pSWE) in predicting survival after TIPS. Methods This retrospective cohort study screened consecutive patients who underwent TIPS and reliable pSWE measurement between October 2014 and September 2017 from our prospectively maintained database. SS values were measured before TIPS. The primary endpoint was the overall survival after TIPS. The Cox regression analysis model was used for univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to calculate the sensitivity, specificity, and positive and negative predictive values. Results A total of 89 patients were involved in the final analysis. 24 patients (27.0%) died during a median follow-up time of 31 m. Multivariable Cox regression analysis confirmed that higher SS value (P < 0.001), LS value (P = 0.008), diameter of shunt (P = 0.001), and older age (P < 0.001) were independent prognostic factors of survival after TIPS. The risk of death rose 57.440-fold for each SS unit (m/s) increase. SS was also correlated with liver failure after TIPS. ROC analysis showed that the best SS cutoff value was 3.60 m/s for predicting survival, with a sensitivity of 54.2% and specificity of 90.8%. Conclusions The SS value determined by pSWE in cirrhotic patients was an independent predictive factor for survival after TIPS.
Collapse
|
9
|
Giuffrè M, Giuricin M, Bonazza D, Rosso N, Giraudi PJ, Masutti F, Palmucci S, Basile A, Zanconati F, de Manzini N, Tiribelli C, Palmisano S, Crocè LS. Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery. Diagnostics (Basel) 2020; 10:diagnostics10100795. [PMID: 33036418 PMCID: PMC7601552 DOI: 10.3390/diagnostics10100795] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Obesity is a primary limiting factor in liver stiffness measurement (LSM). The impact of obesity has always been evaluated in terms of body mass index (BMI), without studying the effects of skin-to-liver distance (SLD) on LSM. We studied the impact of SLD on LSM in a cohort of obese patients undergoing bariatric surgery and intra-operatory liver biopsy. Materials and Methods: 299 patients underwent LSM by point-shear wave elastography (ElastPQ protocol), with two different ultrasound machines. SLD was measured as the distance between the skin and the liver capsule, perpendicular to where the region of interest (ROI) was positioned. We used the following arbitrary cut-offs: <5.7 kPa, F0–1; 5.7–7.99 kPa, F2; ≥8 kPa, F3–4. Results: We developed two logistic regression models using elastography–histology agreement (EHA) as the dependent variable and SLD as the independent variable. The model based on the second machine showed strongly more performant discriminative and calibration metrics (AIC 38.5, BIC 44.2, Nagelkerke Pseudo-R2 0.894, AUROC 0.90). The SLD cut-off value of 34.5 mm allowed a correct EHA with a sensitivity of 100%, a specificity of 93%, negative predictive value of 100%, positive predictive value of 87%, an accuracy of 96%, and positive likelihood ratio of 3.56. Conclusion: The impact of SLD is machine-dependent and should be taken into consideration when interpreting LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in obese patients.
Collapse
Affiliation(s)
- Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
- Correspondence:
| | - Michela Giuricin
- General Surgery Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, 34149 Trieste, Italy;
| | - Deborah Bonazza
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Department of Pathology, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy
| | - Natalia Rosso
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
| | - Pablo José Giraudi
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
| | - Flora Masutti
- Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy;
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies G.F. Ingrassia University of Catania, 95124 Catania, Italy; (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies G.F. Ingrassia University of Catania, 95124 Catania, Italy; (S.P.); (A.B.)
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Department of Pathology, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- General Surgery Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, 34149 Trieste, Italy;
| | - Claudio Tiribelli
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
| | - Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- General Surgery Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, 34149 Trieste, Italy;
| | - Lory Saveria Crocè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (D.B.); (F.Z.); (N.d.M.); (S.P.); (L.S.C.)
- Italian Liver Foundation, 34149 Trieste, Italy; (N.R.); (P.J.G.); (C.T.)
- Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, 34149 Trieste, Italy;
| |
Collapse
|