1
|
Renard AS, Paisant A, Cartier V, Calès P, Goyet-Prelipcean M, Geagea E, Tasu JP, Silvain C, Wagner M, Cleach AL, Vilgrain V, Castera L, Bricault I, Decaens T, Savoye-Collet C, Montialoux H, Correas JM, Vallet-Pichard A, Boursier J, Aubé C. Validation of a screening algorithm for hepatic fibrosis by Doppler ultrasound and elastography in a general population. Acta Radiol 2023; 64:1730-1737. [PMID: 36617943 DOI: 10.1177/02841851221138519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early detection can prevent the initial stages of fibrosis from progressing to cirrhosis. PURPOSE To evaluate an algorithm combining three echographic indicators and elastographic measurements to screen for hepatic fibrosis in an unselected population. MATERIAL AND METHODS From May 2017 to June 2018, all patients with no history and no known chronic liver disease who were referred for an ultrasound (US) were prospectively included in eight hospitals. The indicators being sought were liver surface irregularity, demodulation of hepatic veins, and spleen length >110 mm. Patients presenting at least one of these underwent elastography measurements with virtual touch quantification (VTQ) or supersonic shear imaging (SSI). If elastography was positive, patients were referred to hepatologist for fibrosis evaluation. Reference standard was obtained by FibroMeterVCTE or biopsy. A FibroMeterVCTE result >0.384 indicated a "necessary referral" to a hepatologist. RESULTS Of the 1501 patients included, 504 (33.6%) were positive for at least one US indicator. All of them underwent US elastography, with 85 being positive. Of the patients, 58 (3.6%) had a consultation with a liver specialist: 21 had positive FibroMeterVCTE and nine had an indication of biopsy for suspicion of fibrosis. This screening algorithm made it possible to diagnose 1.6% of patients in our population with unknown fibrosis. Of the patients, 50% referred to the liver specialist were "necessary referrals." CONCLUSION Our study suggests that three simple US indicators with no systematic elastographic measurement could be applied in day-to-day practice to look for hepatic fibrosis in an unsuspected population allowing relevant referrals to a hepatologist.
Collapse
Affiliation(s)
| | - Anita Paisant
- Department of Radiology, Angers University Hospital, Angers, France.,HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France
| | - Victoire Cartier
- Department of Radiology, Angers University Hospital, Angers, France
| | - Paul Calès
- HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France.,Department of Hepatology, Angers University Hospital, Angers, France
| | | | - Edmond Geagea
- Department of Hepatology, Cholet Hospital, Cholet, France
| | | | | | - Mathilde Wagner
- UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | - Aline Le Cleach
- UPMC, Department of Hepatology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France.,University Paris Diderot. Sorbonne Paris Cité, INSERM U1149, CRI, Paris, France
| | - Laurent Castera
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Ivan Bricault
- Department of Radiology and Medical Imaging, University Hospital, Grenoble, France.,Laboratory of Techniques for Biomedical Engineering and Complexity Management, University Grenoble Alpes / National Center for Scientific Research, Grenoble, France.,Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research / Research Department, University Hospital, Grenoble, France
| | - Thomas Decaens
- Université Grenoble Alpes, Grenoble, France.,Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, La Tronche, France.,Department of Hepatology, Pôle Digidune, CHU Grenoble Alpes, La Tronche, France
| | - Céline Savoye-Collet
- Department of Radiology, Rouen University Hospital, Normandie Univ, UNIROUEN, Quantif-LITIS EA 4108, Rouen cedex, France
| | - Hélène Montialoux
- Department of Hepatology, Rouen University Hospital, Rouen cedex, France
| | - Jean-Michel Correas
- Department of Adult Radiology, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Anaïs Vallet-Pichard
- Department of Hepatology, AP-HP, université Paris Descartes, Sorbonne Paris Cité, groupe hospitalier Cochin Port Royal, Paris, France.,Institut Pasteur, U.1223, Inserm, Paris, France
| | - Jérôme Boursier
- HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France.,Department of Hepatology, Angers University Hospital, Angers, France
| | - Christophe Aubé
- Department of Radiology, Angers University Hospital, Angers, France.,HIFIH Laboratory, EA 3859, UNIV Angers, Angers, France
| |
Collapse
|
2
|
Allaire M, Goumard C, Lim C, Le Cleach A, Wagner M, Scatton O. New frontiers in liver resection for hepatocellular carcinoma. JHEP Rep 2020; 2:100134. [PMID: 32695968 PMCID: PMC7360891 DOI: 10.1016/j.jhepr.2020.100134] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 02/08/2023] Open
Abstract
Liver resection is one of the main curative options for early hepatocellular carcinoma (HCC) in patients with cirrhosis and is the treatment of choice in non-cirrhotic patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit on long-term outcomes. In the last decades, improved surgical techniques and perioperative management, as well as better patient selection, have enabled the indications for liver resection to be expanded. In this review, we aim to describe the main indications for liver resection in the management of HCC, its role compared to percutaneous ablation and liver transplantation in the therapeutic algorithm, as well as the recent advances in liver surgery that could be used to improve the prognosis of patients with HCC.
Collapse
Key Words
- ALPPS, associating liver partition and portal vein ligation for staged hepatectomy
- BCLC, Barcelona Clinic liver cancer
- CSPH, clinically significant portal hypertension
- DFS, disease-free survival
- GSA, galactosyl serum albumin
- HCC
- HCC, hepatocellular carcinoma
- HVGP, hepatic venous pression gradient
- ICG, indocyanine green
- ICG-R15, hepatic clearance of ICG 15 minutes after its intravenous administration
- IL-6, interleukin 6
- LR, liver resection
- LSM, liver stiffness measurement
- Laparoscopy
- Liver resection
- MELD, model for end-stage liver disease
- NAFLD, non-alcoholic fatty liver disease
- OS, overall survival
- PVL, portal vein ligation
- PVTT, tumour-related portal vein thrombosis
- RFA, radiofrequency ablation
- SSM, spleen stiffness measurement
- Surgery
- TACE, transarterial chemoembolisation
Collapse
Affiliation(s)
- Manon Allaire
- Sorbonne Université, Service d'Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
- Inserm U1149, Centre de Recherche sur l'Inflammation, France Faculté de Médecine Xavier Bichat, Université Paris Diderot, Paris, France
| | - Claire Goumard
- Sorbonne Université, CRSA, Service de chirurgie digestive, hépato-biliaire et transplantation hépatique, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Chetana Lim
- Sorbonne Université, CRSA, Service de chirurgie digestive, hépato-biliaire et transplantation hépatique, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Aline Le Cleach
- Sorbonne Université, Service d'Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Mathilde Wagner
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Service de Radiologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Olivier Scatton
- Sorbonne Université, CRSA, Service de chirurgie digestive, hépato-biliaire et transplantation hépatique, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| |
Collapse
|