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Song SJ, Kim YR, Lee YH, Cho EY. Potential role of two-dimensional shear wave elastography, including liver stiffness measurement and dispersion slope, for management of chronic hepatitis B. Ultrasonography 2024; 43:384-392. [PMID: 39175218 PMCID: PMC11374586 DOI: 10.14366/usg.24091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE This study assessed the use of liver stiffness (LS) and dispersion slope (DS) in classifying patients with chronic hepatitis B (CHB) by the necessity of antiviral treatment. METHODS A retrospective review examined 249 patients with CHB (male:female, 107:142; mean age, 53±14 years) between April 2018 and March 2022. Patients for whom treatment was indicated, termed group 1, exhibited either serum alanine transaminase (ALT) and aspartate aminotransferase levels not exceeding five times the upper limit of normal and LS >13 kPa, or hepatitis B virus DNA >2,000 IU/mL and ALT >40 IU/L. The remaining patients comprised group 2 (treatment not required). In subgroup analysis, patients with LS <13 kPa were further examined. RESULTS Overall, group 1 exhibited significantly higher LS (12.64±6.76 vs. 6.31±1.67 kPa, P<0.001) and DS (15.52±4.95 vs. 11.04±1.93 [m/s]/kHz, P<0.001) than group 2. In subgroup analysis, group 1 also demonstrated significantly higher values (LS: 8.05±2.12 vs 6.31±1.67 kPa, P<0.001, DS: 13.06±2.75 vs. 11.04±1.93 [m/s]/kHz, P<0.001). The areas under the curve (AUCs) for LS and DS in group 1 were 0.855 (95% confidence interval [CI], 0.80 to 0.90; P<0.001) and 0.810 (95% CI, 0.75 to 0.86; P<0.001), respectively. In subgroup analysis, the AUCs for LS and DS in group 1 were 0.751 (95% CI, 0.69 to 0.81; P<0.001) and 0.711 (95% CI, 0.64 to 0.77; P<0.001), respectively. Within group 1, the AUCs for LS and DS did not differ significantly (P>0.05). CONCLUSION LS and DS assist in classifying patients with CHB by their need for antiviral treatment.
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Affiliation(s)
- Seung Ju Song
- Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Youe Ree Kim
- Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Young Hwan Lee
- Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Eun Young Cho
- Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
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Masud AA, Liu J. Ultrasonic surface acoustic wave elastography: A review of basic theories, technical developments, and medical applications. Med Phys 2024; 51:3220-3244. [PMID: 38597908 DOI: 10.1002/mp.17063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
Physiological and pathological changes in tissues often cause changes in tissue mechanical properties, making tissue elastography an effective modality in medical imaging. Among the existing elastography methods, ultrasound elastography is of great interest due to the inherent advantages of ultrasound imaging technology, such as low cost, portability, safety, and wide availability. However, most current ultrasound elastography methods are based on the bulk shear wave; they can image deep tissues but cannot image superficial tissues. To address this challenge, ultrasonic elastography methods based on surface acoustic waves have been proposed. In this paper, we present a comprehensive review of ultrasound-based surface acoustic wave elastography techniques, including their theoretical foundations, technical implementations, and existing medical applications. The goal is to provide a concise summary of the state-of-the-art of this field, hoping to offer a reliable reference for the further development of these techniques and foster the expansion of their medical applications.
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Affiliation(s)
- Abdullah Al Masud
- Biomedical Acoustics Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas, USA
| | - Jingfei Liu
- Biomedical Acoustics Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas, USA
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Bera C, Hamdan-Perez N, Patel K. Non-Invasive Assessment of Liver Fibrosis in Hepatitis B Patients. J Clin Med 2024; 13:1046. [PMID: 38398358 PMCID: PMC10889471 DOI: 10.3390/jcm13041046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
The aim of this review is to provide updated information on the clinical use of non-invasive serum and imaging-based tests for fibrosis assessment in chronic hepatitis B (CHB) virus infection. In recent years, non-invasive tests (NIT) have been increasingly used to determine eligibility for treatment. Liver biopsy is still considered the gold standard for assessing inflammatory activity and fibrosis staging, but it is an invasive procedure with inherent limitations. Simple serum markers such as APRI and FIB-4 are limited by indeterminate results but remain useful initial tests for fibrosis severity if imaging elastography is not available. Point-of-care US-based elastography techniques, such as vibration-controlled transient elastography or 2D shear wave elastography, are increasingly available and have better accuracy than simple serum tests for advanced fibrosis or cirrhosis, although stiffness cut-offs are variable based on E-antigen status and inflammatory activity. Current NITs have poor diagnostic performance for following changes in fibrosis with antiviral therapy. However, NITs may have greater clinical utility for determining prognosis in patients with CHB that have advanced disease, especially for the development of hepatocellular carcinoma and/or liver decompensation. Algorithms combining serum and imaging NITs appear promising for advanced fibrosis and prognostic risk stratification.
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Affiliation(s)
- Chinmay Bera
- Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; (N.H.-P.)
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Sonderup MW, Kamath PS, Awuku YA, Desalegn H, Gogela N, Katsidzira L, Tzeuton C, Bobat B, Kassianides C, Spearman CW. Managing cirrhosis with limited resources: perspectives from sub-Saharan Africa. Lancet Gastroenterol Hepatol 2024; 9:170-184. [PMID: 38215781 DOI: 10.1016/s2468-1253(23)00279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 01/14/2024]
Abstract
Cirrhosis represents the end stage of chronic liver disease. Sub-Saharan Africa, a resource-constrained region, has a high burden of chronic liver disease, with causes including chronic viral hepatitis, excessive alcohol use, and metabolic dysfunction-associated steatotic liver disease (MASLD), the risk of which is burgeoning. The development of liver cirrhosis predicts for morbidity and mortality, driven by both liver dysfunction and the consequences of portal hypertension. Compensated cirrhosis portends a better prognosis than decompensated cirrhosis, highlighting the need for the early diagnosis of cirrhosis and its causes. With resource challenges, the diagnosis and management of cirrhosis is demanding, but less costly and less invasive interventions with substantial benefits, ranging from simple blood tests to transient elastography, are feasible in such settings. Simple interventions are also available to manage the complex manifestations of decompensation, such as β blockers in variceal bleeding prophylaxis, salt restriction and appropriate diuretic use in ascites, and lactulose and generic rifaximin in hepatic encephalopathy. Ultimately, managing the underlying causative factors of liver disease is key in improving prognosis. Management demands expanded policy interventions to increase screening and treatment for hepatitis B and C and reduce alcohol use and the metabolic factors driving MASLD. Furthermore, the skills needed for more specialised interventions, such as transjugular intrahepatic portosystemic shunt procedures and even liver transplantation, warrant planning, increased capacity, and support for regional centres of excellence. Such centres are already being developed in sub-Saharan Africa, demonstrating what can be achieved with dedicated initiatives and individuals.
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Affiliation(s)
- Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | | | - Yaw A Awuku
- Department of Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Hailemichael Desalegn
- Department of Internal Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Neliswa Gogela
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Christian Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences of Douala, University of Douala, Douala, Cameroon
| | - Bilal Bobat
- Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Ichikawa H, Yasuda E, Kumada T, Takeshima K, Ogawa S, Tsunekawa A, Goto T, Nakaya K, Akita T, Tanaka J. Intra-individual comparison of liver stiffness measurements by magnetic resonance elastography and two-dimensional shear-wave elastography in 888 patients. Ultrasonography 2023; 42:65-77. [PMID: 36366945 PMCID: PMC9816707 DOI: 10.14366/usg.22052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Quantitative elastography methods, such as ultrasound two-dimensional shear-wave elastography (2D-SWE) and magnetic resonance elastography (MRE), are used to diagnose liver fibrosis. The present study compared liver stiffness determined by 2D-SWE and MRE within individuals and analyzed the degree of agreement between the two techniques. METHODS In total, 888 patients who underwent 2D-SWE and MRE were analyzed. Bland-Altman analysis was performed after both types of measurements were log-transformed to a normal distribution and converted to a common set of units using linear regression analysis for differing scales. The expected limit of agreement (LoA) was defined as the square root of the sum of the squares of 2D-SWE and MRE precision. The percentage difference was expressed as (2D-SWEMRE)/ mean of the two methods×100. RESULTS A Bland-Altman plot showed that the bias and upper and lower LoAs (ULoA and LLoA) were 0.0002 (95% confidence interval [CI], -0.0057 to 0.0061), 0.1747 (95% CI, 0.1646 to 0.1847), and -0.1743 (95% CI, -0.1843 to -0.1642), respectively. In terms of percentage difference, the mean, ULoA, and LLoA were -0.5944%, 19.8950%, and -21.0838%, respectively. The calculated expected LoA was 17.1178% (95% CI, 16.6353% to 17.6002%), and 789 of 888 patients (88.9%) had a percentage difference within the expected LoA. The intraclass correlation coefficient of the two methods indicated an almost perfect correlation (0.8231; 95% CI, 0.8006 to 0.8432; P<0.001). CONCLUSION Bland-Altman analysis demonstrated that 2D-SWE and MRE were interchangeable within a clinically acceptable range.
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Affiliation(s)
- Hideo Ichikawa
- Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Eisuke Yasuda
- Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan,Correspondence to: Eisuke Yasuda, PhD, Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Mie 510- 0293, Japan Tel. +81-059-383-8991 Fax. +81-059-383-9666 E-mail:
| | - Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Kenji Takeshima
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Sadanobu Ogawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akikazu Tsunekawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tatsuya Goto
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koji Nakaya
- Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Dong B, Chen Y, Lyu G, Chen Y, Qin R. Quantitative Assessment of Portal Hypertension by Two-Dimensional Shear Wave Elastography in Rat Models of Nonalcoholic Fatty Liver Disease: Comparison With Four Composite Scores. Front Med (Lausanne) 2022; 9:844558. [PMID: 35433761 PMCID: PMC9008888 DOI: 10.3389/fmed.2022.844558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Measurement of hepatic venous pressure gradients is the gold standard for assessing portal hypertension (PH) but is invasive with potential complications. We aimed to assess the performance in liver and spleen stiffness measurement (LSM and SSM, respectively) by two-dimensional shear wave elastography (2D-SWE) and composite scores including liver stiffness-spleen diameter to platelet ratio score (LSPS), platelet (PLT) count/spleen diameter ratio (PSR), aspartate aminotransferase (AST)/alanine aminotransferase ratio (AAR), and AST-to-PLT ratio index (APRI) for diagnosing PH in nonalcoholic fatty liver disease (NAFLD) rat models. Methods Animal models with PH in NAFLD were established in 65 rats, which then underwent 2D-SWE measurements. Morphological and biological parameters were collected for calculation of four composite scores. Correlations of noninvasive methods with portal venous pressure were evaluated by Spearman correlation analysis. The area under the receiver operating characteristic curve (AUC) was used to assess the performance of noninvasive methods in predicting PH. Results LSM and SSM were significantly associated with portal venous pressure (r = 0.636 and 0.602, respectively; all P < 0.001). The AUCs of LSM and SSM in the diagnosis of PH were 0.906 (95% confidence interval [CI]:0.841–0.97) and 0.87 (95% CI:0.776–0.964), respectively, and were significantly higher than those in composite scores. The AUCs for LSPS, PSR, AAR, and APRI were 0.793, 0.52, 0.668, and 0.533, respectively, for diagnosing PH. The AUCs of the combined models of LSM and SSM, LSM and PLT, SSM and PLT, and LSM, SSM and PLT were 0.923, 0.913, 0.872, and 0.923, respectively. The four combined models showed no statistical differences compared to LSM and SSM in evaluating PH (all P > 0.05). Conclusions LSM and SSM by 2D-SWE can be used as promising noninvasive parameters for diagnosing PH in NAFLD and have higher accuracy than composite scores. The combined models, compared to LSM and SSM, did not significantly improve the performance in diagnosing PH.
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Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yuping Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
- *Correspondence: Guorong Lyu
| | - Yongjian Chen
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Ran Qin
- Department of Ultrasound, Chenggong Hospital, Xiamen University, Xiamen, China
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Dong B, Chen Y, Lyu G, Qin R. Liver stiffness measurement as a quantitative method for liver fibrosis in children with non-alcoholic fatty liver disease: A meta-analysis. J Paediatr Child Health 2022; 58:481-490. [PMID: 34554611 DOI: 10.1111/jpc.15751] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 12/13/2022]
Abstract
AIM This study assessed the diagnostic performance of liver stiffness measurement (LSM) in detecting liver fibrosis in paediatric patients with non-alcoholic fatty liver disease (NAFLD) through meta-analysis. METHODS Online database searches of PubMed, EMBASE, the Cochrane Library and the Web of Science were conducted for studies that evaluated the performance of LSM for diagnosing liver fibrosis in paediatric patients with NAFLD until 1 January 2021. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of the included studies. Three measures were used to assess the performance of LSM for detecting liver fibrosis in paediatric patients with NAFLD, including the summary sensitivities and specificities, the summary area under the receiver operating characteristic curves and the summary diagnostic odds ratios. RESULTS Our final data included seven studies with a total of 436 paediatric patients with NAFLD for meta-analysis. The overall prevalence of mild fibrosis, significant fibrosis, advanced fibrosis and cirrhosis was 66.3, 31.5, 14.9 and 1.2%, respectively. The summary sensitivity, specificity and area under the receiver operating characteristic values of LSM were 80, 92 and 0.94 for the prediction of mild fibrosis; 91, 97 and 0.98 for the prediction of significant fibrosis; and 89, 93 and 0.96 for the prediction of advanced fibrosis, respectively. CONCLUSION Liver stiffness measurement exhibited good diagnostic performance in predicting liver fibrosis and can be used as a non-invasive tool in the management of paediatric patients with non-alcoholic fatty liver disease.
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Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yuping Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
| | - Ran Qin
- Department of Ultrasound, The Chenggong Hospital, Xiamen University, Xiamen, China
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Chen Y, Duan H, Huang L, Jiang Z, Huang H. Supersonic shear wave imaging of the tibial nerve for diagnosis of diabetic peripheral neuropathy: A meta-analysis. Front Endocrinol (Lausanne) 2022; 13:934749. [PMID: 36120458 PMCID: PMC9478111 DOI: 10.3389/fendo.2022.934749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is the most common diabetes-associated complication and imposes a significant burden to healthcare systems. Thus, early diagnosis of DPN is extremely critical for management and outcome of diabetic patients. Supersonic Shear Wave Imaging (SSI) enables the noninvasive measurement of nerve stiffness. However, previous studies on SSI in the diagnosis of DPN were limited in sample sizes and reported various results. In this meta-analysis, we aimed to obtain comprehensive evidence on the value of tibial nerve stiffness measurement by SSI in the diagnosis of DPN. METHODS A comprehensive literature search in English and Chinese electronic database was conducted for studies (published until January 25, 2022) that investigated the diagnostic performance of tibial nerve stiffness measurement by SSI for detecting DPN. Summary receiver operating characteristics (SROC) modelling was constructed to conduct the meta-analysis of diagnostic accuracy of SSI for detecting DPN. RESULTS Finally, a total of 12 eligible studies with 1325 subjects were included for evaluation, and a meta-analysis was conducted to evaluate the diagnostic performance of tibial nerve stiffness measurement by SSI for detecting DPN. For tibial nerve stiffness measurement by SSI, the summary sensitivity and specificity for the diagnosis of DPN were 80% (95% confidence interval [CI]: 73%-86%) and 86% (95% CI: 82%-89%), respectively. The summary area under the ROC curve (AUROC) value of the SROC was 0.90 (95% CI: 0.87-0.92), for diagnosing DPN. A subgroup analysis of 11 SSI studies from China revealed similar diagnostic performance, with a summary sensitivity of 79% (95% CI: 72%-85%), specificity of 86% (95% CI: 82%-89%) and summary AUROC value of the SROC of 0.90 (95% CI: 0.87-0.92) for diagnosing DPN. CONCLUSIONS Our meta-analysis suggests that a tibial nerve stiffness measurement by SSI shows good performance in diagnosing DPN and has considerable potential as a noninvasive tool for detecting DPN.
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Affiliation(s)
- Yuping Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Honghong Duan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Lichun Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhengrong Jiang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Huibin Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- *Correspondence: Huibin Huang,
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Saito Y, Matsumoto N, Aizawa Y, Fukamachi D, Kitano D, Toyama K, Fujito H, Sezai A, Okumura Y. Prognostic Value of Liver Stiffness Measured by Two-Dimensional Elastography in Acute Decompensated Heart Failure with Preserved Ejection Fraction. Int Heart J 2021; 62:821-828. [PMID: 34276020 DOI: 10.1536/ihj.21-025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Liver stiffness (LS) assessed by ultrasound elastography reflects right-sided filling pressure and offers additional prognostic information in patients with acute decompensated heart failure (ADHF). However, the prognostic value of LS in heart failure (HF) with preserved ejection fraction (HFpEF) remains unclear. This study aimed to investigate the prognostic value of LS measured by two-dimensional shear wave elastography (2D-SWE) in patients with HFpEF.We prospectively enrolled 80 patients hospitalized for decompensated HFpEF between September 2019 and June 2020. Patients were categorized into three groups based on the tertile values of LS at discharge.The third tertile LS group had an older age; more advanced New York Heart Association functional class; higher total bilirubin, γ-glutamyl transferase (GGT), N-terminal pro-B type natriuretic peptide (NT pro-BNP), and Fibrosis-4 index; a larger right ventricle diastolic diameter, higher tricuspid regurgitation pressure gradient, and a larger maximal inferior vena cava diameter. During a median [interquartile range] follow-up period of 212 (82-275) days, 25 (31.2%) patients suffered composite end points (all-cause mortality and rehospitalization for worsening HF). The third tertile LS group had a significantly higher rate of composite end points (log-rank P = 0.002). A higher LS and the third tertile LS were significantly associated with the composite end points, even after adjusting for a conventional validated HF risk score and other previously reported prognostic risk factors.Increased LS measured by 2D-SWE reflects the severity of liver impairment by liver congestion and fibrosis, underlying right HF, and provides additional information for the prediction of poor outcomes in HFpEF.
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Affiliation(s)
- Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Naoki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine
| | - Yoshihiro Aizawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kazuto Toyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Hidesato Fujito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Wei H, Song B. Elastography for Longitudinal Assessment of Liver Fibrosis after Antiviral Therapy: A Review. J Clin Transl Hepatol 2020; 8:445-453. [PMID: 33447528 PMCID: PMC7782123 DOI: 10.14218/jcth.2020.00033] [Citation(s) in RCA: 4] [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: 04/18/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023] Open
Abstract
Chronic hepatitis B or C viral infection is a common cause of liver cirrhosis and hepatocellular carcinoma. Fibrosis regression can be achieved after long-term antiviral therapy (AVT). Monitoring of dynamic changes in liver fibrosis after treatment is essential for establishing prognosis and formulation of a follow-up surveillance program. Routine surveillance of fibrosis after AVT by liver biopsy, the gold standard for fibrosis assessment, is hindered by its invasive nature, sampling error and observer variability. Elastography is a noninvasive quantitative alternative that has been widely used and validated for the staging of liver fibrosis prior to treatment. Recently, increasing research interest has been focused on the role of elastography in longitudinal assessment of liver fibrosis after AVT. In this review, the basic principles, acquisition techniques, diagnostic performances, and strengths and limitations of ultrasound elastography and magnetic resonance elastography are presented. Emerging evidence regarding the use of elastography techniques for the monitoring of liver fibrosis after AVT is summarized. Current challenges and future directions are also discussed, designed to optimize the application of these techniques in clinical practice.
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Affiliation(s)
- Hong Wei
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Correspondence to: Bin Song, Department of Radiology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China. Tel: +86-28-85423680, Fax: +86-28-85582499, E-mail:
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Zheng Y, Xia S, Ren X, Zhan W, Zheng Z, Chen Z. A study of spleen shear-wave elastography in indirect prediction of liver fibrosis in patients with chronic hepatitis B. Clin Hemorheol Microcirc 2020; 76:63-72. [PMID: 32538828 DOI: 10.3233/ch-200869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the value of spleen shear-wave elastography (sound touch elastography [STE], sound touch quantification [STQ]) in indirect prediction of liver fibrosis in patients with chronic hepatitis B (CHB). METHODS The Young's modulus (kPa) of spleen STE, STQ and liver FibroScan were measured in 112 patients with CHB. The final diagnosis was according to histological results from liver biopsy based on Scheure G/S scoring system and liver FibroScan was considered as a reference index of prediction efficiency. Grouped by the stage of liver fibrosis, data were analyzed by Spearman correlation analysis, Mann-Whitney test and receiver operating characteristic curve (ROC). RESULTS Spleen STE was positively correlated with the degree of liver fibrosis, but spleen STQ was not. STEmean and STEmax of spleen were statistically different between the groups categorized by S = 2, S = 3 and S = 4 (all p < 0.05), respectively. Spleen STEmean had the best predicting performance on staging liver fibrosis. The areas under the ROC (AUC) for spleen STEmean were 0.66 (95% confidence interval [CI], 0.56-0.76) for stage S = 2 or higher, 0.72 (95% CI, 0.60-0.83) for S = 3 or higher, 0.83 (95% CI, 0.74-0.92) for S = 4 (all P < 0.01). The differences between the AUC for spleen STEmean and liver FibroScan in liver fibrosis staging were not statistically significant when the groups categorized by S = 2 and S = 4 (P = 0.146 and P = 0.052). But when categorized by S = 3, the evaluating performance of liver FibroScan was better (P = 0.004). CONCLUSION STEmean of spleen is applicable in indirect predicting fibrosis stage in patients with CHB.
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Affiliation(s)
- Yi Zheng
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Shujun Xia
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xinping Ren
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.,Department of Ultrasound, Wuxi Branch of Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Wuxi, Jiangsu, China
| | - Weiwei Zhan
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Zhan Zheng
- School of Systems Engineering, National University of Defense Technology, Changsha, Hunan, China
| | - Zhijie Chen
- Shenzhen Mindary Biomedical Electronics Co., Ltd. Shenzhen, Guang Dong, China
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Chen S, Jiang T. Preoperative noninvasive assessment for liver fibrosis in hepatocellular carcinoma patients with chronic hepatitis B: Comparison of two-dimensional shear-wave elastography with serum liver fibrosis models. Eur J Radiol 2020; 133:109386. [PMID: 33160197 DOI: 10.1016/j.ejrad.2020.109386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the diagnostic performance of two-dimensional shear-wave elastography (2D-SWE) in hepatocellular carcinoma patients with chronic hepatitis B adapted to hepatectomy comparing to serum liver fibrosis models. METHOD 100 patients with chronic hepatitis B who first diagnosed with hepatocellular carcinoma and had undergone 2D-SWE measurements before the hepatectomy were included. The performance of 2D-SWE and serum models in the diagnosis of liver fibrosis was assessed using receiver operating characteristic (ROC) analyses. RESULTS The areas under ROC (AUCs) for 2D-SWE, Forns score, aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis 4 Score (FIB-4) were 0.983, 0.757, 0.745, 0.710 in the diagnosis of significant fibrosis (F ≥ 2) respectively, and 0.896, 0.718, 0.626, 0.575 in the diagnosis of cirrhosis (F = 4) respectively. The AUCs for 2D-SWE in the diagnosis of significant fibrosis and cirrhosis were significantly higher than those for the serum fibrosis models (p < 0.05). The AUCs of Forns in the diagnosis of significant fibrosis (F ≥ 2) showed no statistical differences (p > 0.05) with those of APRI and FIB-4 while in the diagnosis of cirrhosis (F = 4), they are significantly higher (p < 0.05). CONCLUSIONS 2D-SWE is a reliable method for preoperative noninvasive assessment of liver fibrosis in HCC patients with CHB, with notably higher diagnostic accuracy than serum liver fibrosis models.
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Affiliation(s)
- Shuochun Chen
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
| | - Tian'an Jiang
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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