Mirella Fraquelli

Bio: Mirella Fraquelli is an academic researcher from Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. The author has contributed to research in topics: Cirrhosis & Transient elastography. The author has an hindex of 43, co-authored 189 publications receiving 7865 citations. Previous affiliations of Mirella Fraquelli include Cochrane Collaboration & University of Milan.

Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease

Abstract: Objective. Transient elastography (TE) is gaining popularity as a non-invasive method for predicting liver fibrosis, but intra- and interobserver agreement and factors influencing TE reproducibility have not been adequately assessed. This study addresses these aspects. Setting. Tertiary referral Liver Unit. Patients. Over a four month period, 200 patients with chronic liver disease (CLD) of different etiologies, consecutively underwent TE and liver biopsy. Interventions. TE was performed twice by two different operators either concomitantly or within three days of the bioptic procedure (Metavir classification). Main outcome measures. Intra- and interobserver agreement was analyzed using the intraclass correlation coefficient (ICC) and correlated with different patient and liver disease-related covariates. Results. 800 TE examinations were performed with an indeterminate result rate of 2.4%. The overall inter-observer agreement ICC was 0.98(95% CI:0.977-0.987). Increased BMI(>28Kg/m2), steatosis, and low staging grades ( 7.9 for ≥F2, >10.3 for ≥F3 and >11.9 for F=4. TE values by the 2 raters fell within the same cut-off of fibrosis in 88% of the cases for F≥2, in 92% for F≥3 and 91% for F=4. Conclusions. TE is a highly reproducible and user-friendly technique for assessing liver fibrosis in patients with CLD. However, since TE reproducibility is significantly reduced in patients with steatosis, increased BMI and lower degrees of hepatic fibrosis, caution is warranted in the clinical use of TE as a surrogate for liver biopsy.

The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis

Abstract: Background Contrast-enhanced ultrasound (CE-US), contrast CT scan and gadolinium dynamic MRI are recommended for the characterisation of liver nodules detected during surveillance of patients with cirrhosis with US. Aim To assess the sensitivity, specificity, diagnostic accuracy and economic impact of all possible sequential combinations of contrast imaging techniques in patients with cirrhosis with 1–2 cm liver nodules undergoing US surveillance. Patients/methods 64 patients with 67 de novo liver nodules (55 with a size of 1–2 cm) were consecutively examined by CE-US, CT, MRI, and a fine-needle biopsy (FNB) as diagnostic standard. Undiagnosed nodules were re-biopsied; non-malignant nodules underwent enhanced imaging follow-up. The typical radiological feature of hepatocellular carcinoma (HCC) was arterial phase hypervascularisation followed by portal/venous phase washout. Results HCC was diagnosed in 44 (66%) nodules (2, 2 cm). The sensitivity of CE-US, CT and MRI for 1–2 cm HCC was 26, 44 and 44%, with 100% specificity, the typical vascular pattern of HCC being identified in 22 (65%) by a single technique versus 12 (35%) by at least two techniques carried out at the same time point (p=0.028). Compared with the cheapest dual examination (CE-US+CT), the cheapest single technique of stepwise imaging diagnosis of HCC was equally expensive (€26 440 vs €28 667), but led to a 23% reduction of FNB procedures (p=0.031). Conclusions In patients with cirrhosis with a 1–2 cm nodule detected during surveillance, a single imaging technique showing a typical contrast pattern confidently permits the diagnosis of HCC, thereby reducing the need for FNB examinations.

Severe Liver Fibrosis or Cirrhosis: Accuracy of US for Detection—Analysis of 300 Cases

Abstract: PURPOSE: To determine the accuracy of various ultrasonographic (US) signs for assessment of the degree of liver fibrosis, with histologic results as reference standard. MATERIALS AND METHODS: Three hundred consecutive asymptomatic patients with at least 6 months of increased levels of aspartate aminotransferase and/or alanine aminotransferase underwent liver US and biopsy. The estimated pretest probability of severe fibrosis or cirrhosis was 35%. Three US parameters were investigated: liver surface nodularity, caudate lobe hypertrophy, and pattern of hepatic venous blood flow. US results were compared with histologic results obtained after liver biopsy, which constituted the reference standard for diagnosis of severe fibrosis or cirrhosis. The degree of fibrosis was graded according to METAVIR criteria, with stages 3 and 4 considered together. Data were analyzed with κ and χ2 statistics. Sensitivity, specificity, positive and negative likelihood ratios, and posttest probability were calculated for each US...

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

Abstract: Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.