Prospective evaluation of liver shearwave elastography measurements with 3 different technologies and same day liver biopsy in patients with chronic liver disease

Assessment of liver involvement in Wilson's disease with different liver echo patterns based on liver stiffness evaluated on Transient elastography and Sound Touch Viscoelastography

Wilson's disease (WD) liver damage is caused by abnormal copper deposition in the liver. Whether the degree of hepatic impairment correlates with the severity of liver involvement on ultrasound imaging remains unclear. This study aimed to categorize the liver echo patterns of WD according to the B-ultrasound and correlated the degree of hepatic injury with different liver echo patterns based on Transient elastography (TE) and Sound Touch Viscoelastography (STVi). A retrospective study was conducted on 106 WD patients. A consistency analysis was performed on liver stiffness measurement (LSM) through TE and STVi. The liver echo characteristics of all patients were categorized through B-ultrasound, and the differences in LSMTE, LSMSTVi, demographic and anthropometric data, and serological indicators among different patterns were compared. Both TE and STVi measurements exhibited high consistency in intra-observer and inter-observer differences. There were 6 echo patterns in the liver parenchyma of WD, among which "block-like" fatty liver and nodule patterns were more characteristic. The 6 types of liver echo patterns were classified into three groups: fatty liver pattern, coarse pattern, and nodule pattern. There was no significant difference in age, gender, and body mass index among the three groups. The comparison results of LSMTE and LSMSTVi among the three groups showed that the coarse pattern was higher than the fatty liver pattern, and there was no significant difference between the nodule pattern and the coarse pattern or the fatty liver pattern. The P III N-P of fatty liver and coarse patterns was higher than that of the nodule pattern. Characteristic ultrasound features of liver parenchyma help us diagnose WD. The degree of liver involvement on imaging may not correspond consistently with the actual level of liver damage. STVi can be used as a reliability method to evaluate the degree of WD liver damage quantitatively, and its other application values in WD are worth further exploration.

Ultrasound shear wave viscoelastography to characterize liver nodules

Purpose. To investigate the diagnostic performance of ultrasound (US)-based shear wave speed (SWS), shear wave attenuation (SWA), and combination of them as shear wave viscoelastography (SWVE) methods in patients undergoing US to characterize focal liver nodules.Materials and methods. In this prospective cross-sectional study, 70 patients with 72 nodules were enrolled. Investigational US and clinical magnetic resonance imaging (MRI) examinations were performed in all participants. The composite reference standard included MRI or histopathology to differentiate benign and malignant nodules. A linear discriminant analysis (LDA) was used to assess the combination of SWVE methods. Analyzes included Mann-WhitneyUtest, receiver operating characteristic analysis, and computation of sensitivity and specificity at the point that maximized the Youden index.Results. Mean SWS was significantly higher in malignant than benign nodules (2.49 ± 0.76 m s-1vs. 1.72 ± 0.70,p< 0.001), whereas SWA was lower (0.56 ± 0.30 vs. 1.10 ± 0.43 Np/m/Hz,p< 0.001). To differentiate between malignant and benign nodules, SWS with a threshold of 2.43 m s-1achieved a sensitivity of 0.54 (95% confidence interval (CI): 0.38-0.69) and a specificity of 0.88 (CI: 0.74-0.95). SWA with a threshold of 0.81 Np/m/Hz yielded a sensitivity of 0.81 (CI: 0.66-0.90) and a specificity of 0.74 (CI: 0.58-0.86). Combining these SWVE methods using a LDA resulted in a sensitivity of 0.81 (CI: 0.66-0.91) and a specificity of 0.86 (CI: 0.71-0.94).Conclusion. Malignant nodules had higher SWS and lower SWA than benign ones. The combination of SWS and SWA in a LDA classification algorithm increased the diagnostic performance.

Accuracy of Non-Invasive Imaging Techniques for the Diagnosis of MASH in Patients With MASLD: A Systematic Review

BACKGROUND AND AIMS

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health problem. The secondary stage in MASLD is steatohepatitis (MASH), the co-existence of steatosis and inflammation, a leading cause of progression to fibrosis and mortality. MASH resolution alone improves survival. Currently, MASH diagnosis is via liver biopsy. This study sought to evaluate the accuracy of imaging-based tests for MASH diagnosis, which offer a non-invasive method of diagnosis.

METHODS

Eight academic literature databases were searched and references of previous systematic reviews and included papers were checked for additional papers. Liver biopsy was used for reference standard.

RESULTS

We report on 69 imaging-based studies. There were 31 studies on MRI, 27 on ultrasound, five on CT, 13 on transient elastography, eight on controlled attenuation parameter (CAP) and two on scintigraphy. The pathological definition of MASH was inconsistent, making it difficult to compare studies. 55/69 studies (79.71%) were deemed high-risk of bias as they had no preset thresholds and no validation. The two largest groups of imaging papers were on MRI and ultrasound. AUROCs were up to 0.93 for MRE, 0.90 for MRI, 1.0 for magnetic resonance spectroscopy (MRS) and 0.94 for ultrasound-based studies.

CONCLUSIONS

Our study found that the most promising imaging tools are MRI techniques or ultrasound-based scores and confirmed there is potential to utilise these for MASH diagnosis. However, many publications are single studies without independent prospective validation. Without this, there is no clear imaging tool or score currently available that is reliably tested to diagnose MASH.

Modern ultrasound techniques for diagnosing liver steatosis and fibrosis: A systematic review with a focus on biopsy comparison

BACKGROUND

This review evaluated the diagnostic effectiveness of various ultrasound (US) methods compared to liver biopsy.

AIM

To determine the diagnostic accuracy of US techniques in assessing liver fibrosis and steatosis in adults, using the area under the receiver operating characteristic curve (AUROC) as the standard measure.

METHODS

The review included original retrospective or prospective studies published in the last three years in peer-reviewed medical journals, that reported AUROC values. Studies were identified through PubMed searches on January 3 and April 30, 2024. Quality was assessed using the QUADAS-2 tool. Results were tabulated according to the diagnostic method and the type of liver pathology.

RESULTS

The review included 52 studies. For liver fibrosis detection, 2D-shear wave elastography (SWE) AUROCs ranged from 0.54 to 0.994, showing better accuracy for advanced stages. Modifications, including 2D-SWE with propagation map guidance and supersonic imagine achieved AUROCs of 0.84 to nearly 1.0. point SWE and classical SWE had AUROCs of 0.741-0.99, and 0.507-0.995, respectively. Transient elastography (TE), visual TE, vibration-controlled TE (VCTE), and FibroTouch reported AUROCs close to 1.0. For steatosis, VCTE with controlled attenuation parameter showed AUROCs up to 0.89 (for ≥ S1), acoustic radiation force impulse ranged from 0.762 to 0.784, US attenuation parameter from 0.88 to 0.93, and normalized local variance measurement from 0.583 to 0.875. Most studies had a low risk of bias across all or most domains, but evidence was limited by variability in study quality and small sample sizes. Innovative SWE variants were evaluated in a single study.

CONCLUSION

Modern US techniques can serve as effective noninvasive diagnostic tools for liver fibrosis and steatosis, with the potential to reduce the reliance on biopsies.

Two-Dimensional Shear Wave Ultrasound Elastography for Monitoring Pediatric Liver Transplantation: A Review of Recent Advances

Pediatric liver transplantation (PLT) is a life-saving procedure for children with end-stage liver disease. However, post-transplant monitoring, particularly the diagnosis and prognosis of complications such as allograft fibrosis, remains challenging. Traditionally, liver biopsy has been the gold standard for assessing allograft fibrosis, despite its invasive nature and inherent procedural risks. Recently, shear wave ultrasound elastography (SWE) has seen increasing use as a noninvasive method to provide real-time, quantitative measurements of liver stiffness as a proxy for fibrosis. In this review, the latest developments in the use of SWE as a method to assess allograft fibrosis post-PLT are presented, including the current technical challenges associated with its clinical implementation.

Advancements of non‐invasive imaging technologies for the diagnosis and staging of liver fibrosis: Present and future

Liver fibrosis is a reparative response triggered by liver injury. Non‐invasive assessment and staging of liver fibrosis in patients with chronic liver disease are of paramount importance, as treatment strategies and prognoses depend significantly on the degree of fibrosis. Although liver fibrosis has traditionally been staged through invasive liver biopsy, this method is prone to sampling errors, particularly when biopsy sizes are inadequate. Consequently, there is an urgent clinical need for an alternative to biopsy, one that ensures precise, sensitive, and non‐invasive diagnosis and staging of liver fibrosis. Non‐invasive imaging assessments have assumed a pivotal role in clinical practice, enjoying growing popularity and acceptance due to their potential for diagnosing, staging, and monitoring liver fibrosis. In this comprehensive review, we first delved into the current landscape of non‐invasive imaging technologies, assessing their accuracy and the transformative impact they have had on the diagnosis and management of liver fibrosis in both clinical practice and animal models. Additionally, we provided an in‐depth exploration of recent advancements in ultrasound imaging, computed tomography imaging, magnetic resonance imaging, nuclear medicine imaging, radiomics, and artificial intelligence within the field of liver fibrosis research. We summarized the key concepts, advantages, limitations, and diagnostic performance of each technique. Finally, we discussed the challenges associated with clinical implementation and offer our perspective on advancing the field, hoping to provide alternative directions for the future research.

Improvement of liver histology in hepatic sarcoidosis due to treatment with corticosteroids and ursodeoxycholic acid: a case report

We report the case of a 48-year-old male with a history of pulmonary and ocular sarcoidosis. Non-caseating granulomas, identified histologically, are the most characteristic manifestation of sarcoidosis. Hepatic sarcoidosis is difficult to diagnose using radiological imaging. In the patient reported in this study, ultrasound and contrast-enhanced computed tomography scans identified multiple intra-abdominal lymphadenopathies, with evidence of liver and splenic infiltrations. The first liver biopsy revealed non-caseating granulomatous hepatitis consistent with hepatic sarcoidosis. The patient was treated with ursodeoxycholic acid (UDCA), but his laboratory parameters did not improve. Prednisone was initiated at a dose of 30 mg daily and slowly tapered. At a dose of 12.5 mg daily, marked improvements in the fibrotic and sarcoid-like lesions were noted at the second biopsy. A third biopsy was performed, with the patient on a prednisone taper of 5 mg/day showed mild fibrous expansion in the portal tracts and mild parenchymal necro-inflammatory lesions. However, overall, fibrosis marker levels remained stable over the course of treatment. A fourth biopsy was performed after a 5-year course of 5 mg/day prednisone. This revealed minimal lobular inflammation without fibrosis. Thus, treatment of this patient with corticosteroids and UDCA resulted in marked improvements in his biochemical and histological parameters.