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Chen CC, Huang YK, Wang RC, Fu JT, Lee SW, Tsai HJ, Yang SS, Lee TY. Validating the Baveno Elastography Criteria of Advanced Liver Fibrosis in Two-Dimensional Shear Wave Elastography: A Prospective Pathology-Based Study. Dig Dis 2024:1-9. [PMID: 38697048 DOI: 10.1159/000539167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/29/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION The Baveno criteria for assessing advanced liver fibrosis were mainly determined by transient elastography (TE), and its pathology-based validation studies in two-dimensional shear wave elastography (2D-SWE) remain limited. We aimed to validate the Baveno criteria through use of 2D-SWE. METHOD Consecutive patients who underwent liver biopsies for various benign liver diseases were prospectively recruited. Liver stiffness measurement (LSM) was simultaneously evaluated by TE and 2D-SWE. The optimal cutoff value to predict advanced liver fibrosis was determined by the Youden Index, and the diagnostic performance was estimated using area under the receiver operating characteristic (AUROC) analysis. RESULTS A total of 101 patients were enrolled having a median age of 55.0 (IQR: 46.0-63.5) years, with 53 (52.48%) of them being male. Using <9 and >14 kPa as the optimal dual cutoffs, the AUROC values in TE and 2D-SWE were 0.92 (95% CI: 0.83-0.97) and 0.93 (95% CI: 0.84-0.98), respectively (p = 0.61). The sensitivity and specificity of LSM by TE/2D-SWE achieved rates of 94.44%/94.44% and 86.00%/88.00%, respectively. However, using the Baveno criteria, the AUROC values in TE and 2D-SWE could remain achieving 0.91 (95% CI: 0.82-0.97) and 0.93 (95% CI: 0.84-0.98), respectively (p = 0.36). The sensitivity and specificity in TE/2D-SWE were 88.24%/88.24% and 86.79%/90.57%, respectively. CONCLUSION This study establishes the compatibility of the Baveno dual cutoff criteria with 2D-SWE, positioning it as an easily used criteria in clinical practice and research.
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Affiliation(s)
- Chia-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yao-Kuang Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou, Taiwan
| | - Ren-Ching Wang
- Department of Pathology, China Medical University Hospital, Taichung, Taiwan
- Department of Nursing, College of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Jing-Tong Fu
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shou-Wu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Ju Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Teng-Yu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Seyrek S, Ayyildiz H, Bulakci M, Salmaslioglu A, Seyrek F, Gultekin B, Cavus B, Berker N, Buyuk M, Yuce S. Comparison of Fibroscan, Shear Wave Elastography, and Shear Wave Dispersion Measurements in Evaluating Fibrosis and Necroinflammation in Patients Who Underwent Liver Biopsy. Ultrasound Q 2024; 40:74-81. [PMID: 38345402 DOI: 10.1097/ruq.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Our aim was to predict these stages of hepatic fibrosis and necroinflammation using measurements from two-dimensional shear wave elastography (2D-SWE), transient elastography (Fibroscan, TE), and shear wave dispersion (SWD). MATERIALS AND METHODS In this prospectively designed study, chronic liver patients with nonspecific etiology whose biopsy was performed for up to 1 week were included. Two-dimensional SWE, SWD, and TE measurements were performed. The METAVIR and F-ISHAK classification was used for histopathological evaluation. RESULTS Two-dimensional SWE and TE were considered significant for detecting hepatic fibrosis. In distinguishing ≥F2, for 2D-SWE, area under the receiver operating characteristics (AUROC) was 0.86 (confidence interval [CI], 0.75-0.96) for the cutoff value of 8.05 kPa ( P = 0.003); for TE, AUROC was 0.79 (CI, 0.65-0.94) for the cutoff value of 10.4 kPa ( P < 0.001). No significance was found for TE in distinguishing ≥F3 ( P = 0.132). However, for 2D-SWE, a cutoff value of 10.45 kPa ( P < 0.001), with AUROC = 0.87 (CI, 0.78-0.97) was determined for ≥F3. Shear wave dispersion was able to determine the presence of necroinflammation ( P = 0.016) and a cutoff value of 15.25 (meter/second)/kiloHertz ([m/s]/kHz) ( P = 0.006) and AUROC of 0.71 (CI, 0.57-0.85) were calculated for distinguishing ≥A2. In addition, a cutoff value of 17.25 (m/s)/kHz ( P = 0.023) and AUROC = 0.72 (CI, 0.51-0.93) were found to detect severe necroinflammation. The cutoff value for SWD was 15.25 (m/s)/kHz ( P = 0.013) for detecting ≥A2 in the reversible stage of fibrosis (F0, F1, and F2), and AUROC = 0.72 (CI, 0.56-0.88). CONCLUSIONS Two-dimensional SWE and TE measurements were significant in detecting the irreversible stage and the stage that should be treated in hepatic fibrosis noninvasively. Shear wave dispersion measurements were significant in detecting necroinflammation noninvasively.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Servet Yuce
- Public Health Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Park HC, Joo Y, Lee OJ, Lee K, Song TK, Choi C, Choi MH, Yoon C. Automated classification of liver fibrosis stages using ultrasound imaging. BMC Med Imaging 2024; 24:36. [PMID: 38321373 PMCID: PMC10848434 DOI: 10.1186/s12880-024-01209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/21/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Ultrasound imaging is the most frequently performed for the patients with chronic hepatitis or liver cirrhosis. However, ultrasound imaging is highly operator dependent and interpretation of ultrasound images is subjective, thus well-trained radiologist is required for evaluation. Automated classification of liver fibrosis could alleviate the shortage of skilled radiologist especially in low-to-middle income countries. The purposed of this study is to evaluate deep convolutional neural networks (DCNNs) for classifying the degree of liver fibrosis according to the METAVIR score using US images. METHODS We used ultrasound (US) images from two tertiary university hospitals. A total of 7920 US images from 933 patients were used for training/validation of DCNNs. All patient were underwent liver biopsy or hepatectomy, and liver fibrosis was categorized based on pathology results using the METAVIR score. Five well-established DCNNs (VGGNet, ResNet, DenseNet, EfficientNet and ViT) was implemented to predict the METAVIR score. The performance of DCNNs for five-level (F0/F1/F2/F3/F4) classification was evaluated through area under the receiver operating characteristic curve (AUC) with 95% confidential interval, accuracy, sensitivity, specificity, positive and negative likelihood ratio. RESULTS Similar mean AUC values were achieved for five models; VGGNet (0.96), ResNet (0.96), DenseNet (0.95), EfficientNet (0.96), and ViT (0.95). The same mean accuracy (0.94) and specificity values (0.96) were yielded for all models. In terms of sensitivity, EffcientNet achieved highest mean value (0.85) while the other models produced slightly lower values range from 0.82 to 0.84. CONCLUSION In this study, we demonstrated that DCNNs can classify the staging of liver fibrosis according to METAVIR score with high performance using conventional B-mode images. Among them, EfficientNET that have fewer parameters and computation cost produced highest performance. From the results, we believe that DCNNs based classification of liver fibrosis may allow fast and accurate diagnosis of liver fibrosis without needs of additional equipment for add-on test and may be powerful tool for supporting radiologists in clinical practice.
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Grants
- NTIS Number: 9991007146 the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety
- HI21C0940110021 the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- No. 2022-0-00101 the Institute of Information & communications Technology Planning & Evaluation (IITP) grant funded by the Korea government (MSIT)
- the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety
- the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- the Institute of Information & communications Technology Planning & Evaluation (IITP) grant funded by the Korea government (MSIT)
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Affiliation(s)
- Hyun-Cheol Park
- Division of Industrial Mathematics, National Institute for Mathematical Sciences, 70, Yuseong-daero, Yuseong-gu, 34047, Daejeon, Republic of Korea
| | - YunSang Joo
- Department of Computer Engineering, Gachon University, 1342, Seongnam-daero, Sujeong-gu, 13120, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - O-Joun Lee
- Department of Artificial Intelligence, The Catholic University of Korea, 43, Jibong-ro, 14662, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Kunkyu Lee
- Department of Electronic Engineering, Sogang University, 35 Baekbeom-ro, 04107, Seoul, Republic of Korea
| | - Tai-Kyong Song
- Department of Electronic Engineering, Sogang University, 35 Baekbeom-ro, 04107, Seoul, Republic of Korea
| | - Chang Choi
- Department of Computer Engineering, Gachon University, 1342, Seongnam-daero, Sujeong-gu, 13120, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Republic of Korea.
| | - Changhan Yoon
- Department of Biomedical Engineering, Department of Nanoscience and Engineering, Inje University, Inje-ro 197, 50834, Gimhae, Gyeongnam, Republic of Korea.
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Wang K, Zhang S, Zhou W, Wen L, Zhang S, Yu D. Clinical Application of Shear Wave Elastography With Shear Wave Dispersion Imaging in the Preoperative Evaluation of Hepatic Parenchyma in Patients With Liver Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:797-807. [PMID: 35730210 DOI: 10.1002/jum.16029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic parenchyma in patients with liver tumors before resection. METHODS A total of 174 patients with liver tumors were prospectively enrolled. SWE and SWD examinations were performed. Fibrosis stage and necroinflammatory activity were determined histopathologically according to the Scheuer standard. We compared the diagnostic accuracy of SWE and SWD. RESULTS Both SWE and SWD values of the liver were highly correlated with liver fibrosis stage (P < .05, respectively). Both SWE and SWD values of the liver were moderately correlated with necroinflammatory activity (P < .05, respectively). Both SWE and SWD values of the liver were not correlated with steatosis (P > .05, respectively). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (P < .001, respectively). The area under the receiver operating characteristic (ROC) curve of SWE value was 0.982, 0.977, 0.969, and 0.984 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWE values were 6.9, 7.9, 8.7, and 10.6 kPa for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The area under the ROC curve of SWD value was 0.967, 0.960, 0.925, and 0.954 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWD values were 11.2, 12.0, 13.2, and 16.0 m/s/kHz for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. CONCLUSIONS SWE and SWD could be noninvasive and accurate for predicting the stage of liver fibrosis in patients with liver tumors before surgery. SWE was more accurate than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4).
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Affiliation(s)
- Kun Wang
- Department of Ultrasound, The Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Shuchen Zhang
- Department of Ultrasound, Yancheng City, No. 1 People' s Hospital, Yancheng, China
| | - Wenyan Zhou
- Department of Ultrasound, Yancheng City, No. 1 People' s Hospital, Yancheng, China
| | - Li Wen
- Function, The Special Care Hospital of Hebei Province, Shijiazhuang, China
| | - Shanshan Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Yu
- Department of Ultrasound, North China Medical Treatment Health Group, Fengfeng General Hospital, Handan, China
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Kovatsch A, Honcharova-Biletska H, Segna D, Steigmiller K, Blümel S, Deibel RA, Kühlewindt T, Leinenkugel G, Müller S, Furrer E, Schawkat K, Reiner CS, Weber A, Müllhaupt B, Scharl M, Gubler C, Jüngst C. Performance of two-dimensional shear wave elastography and transient elastography compared to liver biopsy for staging of liver fibrosis. Eur J Clin Invest 2023:e13980. [PMID: 36880934 DOI: 10.1111/eci.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/12/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Staging of liver fibrosis traditionally relied on liver histology; however, transient elastography (TE) and more recently two-dimensional shear wave elastography (2D-SWE) evolved to noninvasive alternatives. Hence, we evaluated the diagnostic accuracy of 2D-SWE assessed by the Canon Aplio i800 ultrasound system using liver biopsy as reference and compared the performance to TE. METHODS In total, 108 adult patients with chronic liver disease undergoing liver biopsy, 2D-SWE and TE were enrolled prospectively at the University Hospital Zurich. Diagnostic accuracies were evaluated using the area under the receiver operating characteristic (AUROC) analysis, and optimal cut-off values by Youden's index. RESULTS Diagnostic accuracy of 2D-SWE was good for significant (≥F2; AUROC 85.2%, 95% confidence interval (95%CI):76.2-91.2%) as well as severe fibrosis (≥F3; AUROC 86.8%, 95%CI: 78.1-92.4%) and excellent for cirrhosis (AUROC 95.6%, 95%CI: 89.9-98.1%), compared to histology. TE performed equally well (significant fibrosis: 87.5%, 95%CI: 77.7-93.3%; severe fibrosis: 89.7%, 95%CI: 82.0-94.3%; cirrhosis: 96%, 95%CI: 90.4-98.4%), and accuracy was not statistically different to 2D-SWE. 2D-SWE optimal cut-off values were 6.5, 9.8 and 13.1 kPa for significant fibrosis, severe fibrosis and cirrhosis, respectively. CONCLUSIONS Performance of 2D-SWE was good to excellent and well comparable with TE, supporting the application of this 2D-SWE system in the diagnostic workup of chronic liver disease.
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Affiliation(s)
- Audrey Kovatsch
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel Segna
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klaus Steigmiller
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Sena Blümel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf A Deibel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Tobias Kühlewindt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Georg Leinenkugel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Sandra Müller
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Eva Furrer
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Khoschy Schawkat
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Cäcilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Achim Weber
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Division of Gastroenterology &Hepatology, Triemli Hospital, Zurich, Switzerland
| | - Christoph Jüngst
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Wang K, Dong Y, Han H, Cao J, Bao J, Wang WP. Clinical application of two dimensional shear wave elastography with a propagation map in evaluating liver fibrosis in patients with liver tumors. Clin Hemorheol Microcirc 2023; 85:93-104. [PMID: 35723093 DOI: 10.3233/ch-221511] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) with a propagation map in evaluating the degree of hepatic fibrosis in patients with liver tumors before resection. METHODS AND MATERIALS From January 2020 to April 2021, 128 patients with liver tumors were prospectively enrolled, including 20 benign liver tumors and 108 malignant liver tumors. 2D-SWE with a propagation map technology was used to measure the stiffness of liver parenchyma 2 cm away from the tumor. The median value of five measurements was used in this study. The stage of hepatic fibrosis was graded in accordance with Scheuer standard. Spearman correlation was used to analyze the correlation between liver fibrosis stage and the liver stiffness. Univariate and multivariate linear regression analyses were used to determine significant affecting factors for liver stiffness value. The diagnostic performance of 2D-SWE with a propagation map in predicting fibrosis stage was evaluated by receiver operating characteristic curve analysis. RESULTS The median liver stiffness value in patients with benign liver tumors was lower than that in patients with malignant liver tumors (6.0 kPa vs. 9.4 kPa, p < 0.05). The median liver stiffness values in patients with primary liver cancer were higher than that in patients with benign liver tumors and other types of malignant liver tumors (9.6 kPa vs. 6.0 kPa, p < 0.05). The liver stiffness measured by 2D-SWE was highly correlated with the fibrosis stage confirmed by postoperative pathology (r = 0.834, p < 0.05). For the liver stiffness value, PLT,TB,ALB and fibrosis stage are significantly associated with liver stiffness. The median liver stiffness values in stages S0-S4 of fibrosis were 6.0, 7.2, 8.0, 9.4, and 12.6 kPa, respectively. The areas under the ROC curve of S≥1, S≥2, S≥3, and S = 4 as predicted by SWE were 0.932, 0.945, 0.945, and 0.916, respectively. According to the Youden index, the optimal critical values for predicting fibrosis S≥1, S≥2, S≥3, and S = 4 were 6.8 (sensitivity of 89.69% and specificity of 93.55%), 7.5 (sensitivity of 87.50 % and specificity of 95.00 %), 8.3 (sensitivity of 87.14 % and specificity of 87.93 %) and 9.8 (sensitivity of 79.55 % and specificity of 86.90 %) kPa. CONCLUSION 2D-SWE with a propagation map could noninvasively and accurately predict the staging of liver fibrosis in patients with liver tumors before resection.
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Affiliation(s)
- Kun Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Ultrasound Medicine and Engineering, Fudan University, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hong Han
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jiaying Cao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jingwen Bao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Ultrasound Medicine and Engineering, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
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Jang JK, Lee ES, Seo JW, Kim YR, Kim SY, Cho YY, Lee DH. Two-dimensional Shear-Wave Elastography and US Attenuation Imaging for Nonalcoholic Steatohepatitis Diagnosis: A Cross-sectional, Multicenter Study. Radiology 2022; 305:118-126. [PMID: 35727151 DOI: 10.1148/radiol.220220] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Multiparametric US examination may have potential in the comprehensive evaluation of nonalcoholic fatty liver disease (NAFLD), but multicenter studies are lacking. Purpose To evaluate the diagnostic performance of multiparametric US with the attenuation coefficient (AC) from attenuation imaging (ATI) and liver stiffness (LS) and dispersion slope (DS) from two-dimensional (2D) shear-wave elastography (SWE) in a multicenter study of patients with NAFLD. Materials and Methods This prospective study enrolled consecutive participants between December 2019 and June 2021 with suspected nonalcoholic steatohepatitis (NASH) who were scheduled to undergo liver biopsy in five tertiary hospitals. Before the procedure, all participants underwent US with ATI and 2D SWE according to the study protocol. Multivariable linear regression analyses were performed to determine the significant determinant factors for AC, LS, and DS. Diagnostic performance was decided based on the areas under the receiver operating characteristic curve (AUCs). Results A total of 132 participants (median age, 38 years; IQR, 27-54 years; 69 women) were evaluated. Among the participant characteristics, including pathologic findings, demographic characteristics, body mass index, and serum markers, hepatic steatosis for AC (P < .001), lobular inflammatory activity for DS (P = .007), and both fibrosis (P = .01) and lobular inflammatory activity (P = .04) for LS were significant determinant factors. At histopathologic examination, 53 of the 132 participants (40.2%) had NASH. The risk score system obtained using unweighted sum of scores from AC and DS showed the best diagnostic performance in the detection of NASH (AUC = 0.94; 95% CI: 0.89, 0.98; P < .05 for all), as compared with serum markers or other US parameters alone (AUC ≤ 0.88). Conclusion US attenuation imaging and two-dimensional shear-wave elastography were useful for assessing hepatic steatosis, lobular inflammation, and fibrosis. The risk score system obtained using the attenuation coefficient and dispersion slope showed the best diagnostic performance fo r nonalcoholic steatohepatitis. cris.nih.go.kr no. KCT0004326 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Jong Keon Jang
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Eun Sun Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Jung Wook Seo
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Youe Ree Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - So Yeon Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Young Youn Cho
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Dong Ho Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
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8
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Puccinelli C, Pelligra T, Briganti A, Citi S. Two-dimensional shear wave elastography of liver in healthy dogs: anaesthesia as a source of variability. Int J Vet Sci Med 2022; 10:46-51. [PMID: 35677323 PMCID: PMC9132446 DOI: 10.1080/23144599.2022.2073138] [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] [Indexed: 11/28/2022] Open
Abstract
Two-dimensional shear wave elastography (2D-SWE) is a non-invasive method to quantitatively evaluate the liver stiffness (LS), allowing the detection of hepatic pathological changes in both dogs and humans. In dogs, some factors such as patient movement and respiration can cause artefacts and potential errors of measurements. Therefore, anaesthesia has been suggested to reduce the effect of the movement on 2D-SWE in dogs. This study was performed to evaluate the influence of an anaesthetic protocol on 2D-SWE measurements for assessment of LS in healthy dogs. Forty-five dogs were included and subjected to anaesthesia: in 11 dogs, the 2D-SWE was performed both before and under anaesthesia, in 19 dogs, the 2D-SWE was performed only when they were awake and in 15 dogs, the examination was carried out only under anaesthesia. The anaesthetic protocol was composed of intramuscular injection of a combination of dexmedetomidine, methadone and ketamine and intravenous administration of propofol for induction and isoflurane for maintenance. The variability of 2D-SWE values according to anaesthesia was evaluated. Median 2D-SWE values were significantly higher in anesthetized dogs compared to awake dogs either by considering separately the dogs in which the examination was performed both awake and under anaesthesia and by considering all dogs included. According to our study, anaesthesia helped to avoid challenges related to patient movement and respiration; however, it was a source of variability on 2D-SWE values, and this factor should be considered before performing 2D-SWE under anaesthesia.
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Affiliation(s)
| | - Tina Pelligra
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Simonetta Citi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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Chen Y, Li J, Zhou Q, Lyu G, Li S. Detection of liver and spleen stiffness in rats with portal hypertension by two-dimensional shear wave elastography. BMC Med Imaging 2022; 22:68. [PMID: 35418033 PMCID: PMC9006581 DOI: 10.1186/s12880-022-00786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The measurement of liver stiffness (LS) and spleen stiffness (SS) based on ultrasound elastography can be used for non-invasive assessment of portal hypertension (PH). However, there are few studies on the corresponding mechanism of increased spleen stiffness. Our aim was to use two-dimensional shear wave elastrography (2D-SWE) to evaluate the relationship between LS and SS and the severity of PH in rats. And explore the mechanism of the increase of LS and SS in PH. METHODS Sixty male Sprague-Dawley rats were randomly divided into portal hypertension (PH group, n = 45) and normal control (NC group, n = 15). At 12 weeks, LS and SS was detected by 2D-SWE in vivo. Related hemodynamic parameters and portal vein pressure (PVP) was measured. Spleen and liver 2D-SWE detection was performed again after sacrifice. Pathological changes were observed. RESULTS The SS and LS were increased in PH group (P < 0.05). The SS decreased after sacrifice, and what's more the magnitude of SS decline significantly higher in PH group than in NC group (P < 0.05). The correlation between SS and PVP is stronger than LS (r = 0.624, P < 0.001). SS has positive correlation with indexes of hyperdynamic circulation, but LS was weakly. The correlation between SS and the pathological grade (r = 0.633, P < 0.001) was lower than that in LS (r = 0.905, P < 0.001). Multiple linear regression analysis revealed that SS, portal vein inner diameter (PVD) and splenic vein blood flow velocity (SVV) were significantly associated with PH. CONCLUSIONS Spleen and liver measurement by 2D-SWE may be helpful in evaluating PVP. The correlation between SS and PVP is stronger than LS in rats measured by 2D-SWE. Hemodynamic circulation are important in the elevation of SS with portal hypertension. Pathological changes also have a degree of influence, but have more significance for the elevation of LS. SS may be a more effective noninvasive predictor of PH than LS.
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Affiliation(s)
- YongJian Chen
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
| | - JingYun Li
- Maternal and Child Health Service Application Technology Collaborative Innovation Center, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Qin Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
| | - GuoRong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China. .,Maternal and Child Health Service Application Technology Collaborative Innovation Center, Quanzhou Medical College, Quanzhou, Fujian, China.
| | - ShiLin Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
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10
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Gu JH, He C, Zhao QY, Jiang TA. Usefulness of new shear wave elastography in early predicting the efficacy of neoadjuvant chemotherapy for patients with breast cancer: where and when to measure is optimal? Breast Cancer 2022; 29:478-486. [PMID: 35038129 DOI: 10.1007/s12282-021-01327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND The aim of this study was to investigate the diagnosis performance of new shear wave elastography (sound touch elastography, STE) in the prediction of neoadjuvant chemotherapy (NAC) response at an early stage in breast cancer patients and to determine the optimal measurement locations around the lesion in different ranges. METHODS One hundred and eight patients were analyzed in this prospective study from November 2018 to December 2020. All patients completed NAC treatment and underwent STE examination at three time points [the day before NAC (t0); the day before the second course (t1); the day before third course (t2)]. The stiffness of the whole lesion (G), 1-mm shell (S1) and 2-mm shell (S2) around the lesion was expressed by STE parameters. The relative changes (∆stiffness) of STE parameters after the first and second course of NAC were calculated and shown as the variables [Δ(t1) and Δ(t2)]. The diagnostic accuracy of STE was evaluated by means of receiver operating characteristic curve analysis. RESULTS The ∆stiffness (%) including ∆Gmean(t2), ∆S1mean(t2) and ∆S2mean(t2) all showed significant differences between pathological complete response (pCR) and non-pCR groups. ∆S2mean(t2) displayed the best predictive performance for pCR (AUC = 0.842) with an ideal ∆stiffness threshold value - 26%. CONCLUSIONS Measuring the relative changes in the stiffness of surrounding tissue or entire lesion with STE holds promise for effectively predicting the response to NAC at its early stage for breast cancer patients and ∆stiffness of shell 2 mm after the second course of NAC may be a potential prediction parameter.
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Affiliation(s)
- Jiong-Hui Gu
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Chang He
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Qi-Yu Zhao
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Tian-An Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
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11
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Dong B, Lyu G, Chen Y, Lin G, Wang H, Qin R, Gu J. Comparison of two-dimensional shear wave elastography, magnetic resonance elastography, and three serum markers for diagnosing fibrosis in patients with chronic hepatitis B: a meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:1077-1089. [PMID: 33487039 DOI: 10.1080/17474124.2021.1880894] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Two-dimensional shear wave elastography (2D-SWE), magnetic resonance elastography (MRE), aspartate transaminase-to-platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and King's score have been proposed for diagnosing fibrosis. METHODS Literature databases were searched until October 1st, 2020. The summary area under the receiver operating characteristic curve (AUROC), the summary diagnostic odds ratios, and the summary sensitivities and specificities were used to assess the performance of these noninvasive methods for staging fibrosis. RESULTS Our final data contained 72 studies. The prevalence of significant fibrosis, advanced fibrosis, and cirrhosis was 58.3%, 36.2%, and 20.5%, respectively, in chronic hepatitis B (CHB). For 2D-SWE and MRE, the summary AUROCs were 0.89 and 0.97, 0.95 and 0.97, and 0.94 and 0.97 for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. The summary AUROCs using APRI and FIB-4 for detecting significant fibrosis, advanced fibrosis, and cirrhosis were 0.76 and 0.75, 0.74 and 0.77, and 0.77 and 0.82, respectively. The summary AUROCs of King's score for detecting significant fibrosis and cirrhosis were 0.77 and 0.83, respectively. CONCLUSION MRE and 2D-SWE may show the best diagnostic accuracy for predicting fibrosis in CHB. Among the three serum markers, King's score may be more useful for diagnosing fibrosis.
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Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian Province, China
| | - Yuping Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Guofu Lin
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Respirology Medicine Centre of Fujian Province, Quanzhou, Fujian Province, China
| | - Huaming Wang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Ran Qin
- Department of Ultrasound, The Chenggong Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Jionghui Gu
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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12
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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.
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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.)
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