Journal ArticleDOI
Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B.
Hung Chan,Grace Lai-Hung Wong,P. C.-L. Choi,Anthony W.H. Chan,Angel Mei-Ling Chim,K. K.-L. Yiu,Francis K.L. Chan,Joseph J.Y. Sung,V. W.-S. Wong +8 more
TLDR
Transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis and can be avoided in 62% and 58% of patients with normal and elevated ALT respectively.Abstract:
The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1-4), bridging fibrosis (F0-2 vs F3-4) and liver cirrhosis (F0-3 vs F4) was 0.80 (95% CI: 0.68-0.92), 0.87 (95% CI: 0.82-0.93) and 0.93 (95% CI: 0.89-0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis.read more
Citations
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EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis.
TL;DR: Liver biopsy gives a snapshot and not an insight into the dynamic changes during the process of fibrogenesis, so immunohistochemical evaluation of cellular markers such as smooth muscle actin expression for hepatic stellate cell activation, cytokeratin 7 for labeling ductular proliferation or CD34 for visualization of sinusoidal endothelial capillarization can provide additional ‘‘functional’’ information.
Journal ArticleDOI
Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease
Vincent Wai-Sun Wong,Julien Vergniol,Grace Lai-Hung Wong,Juliette Foucher,Henry Lik-Yuen Chan,Brigitte Le Bail,Paul Cheung-Lung Choi,Mathurin Kowo,Anthony W.H. Chan,Wassil Merrouche,Joseph J.Y. Sung,Victor de Ledinghen +11 more
TL;DR: Transient elastography is accurate in most NAFLD patients and is useful as a screening test to exclude advanced fibrosis, and liver biopsy may be considered in patients with liver stiffness of at least 7.9 kPa.
Journal ArticleDOI
EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography.Part 2: Clinical Applications
David O. Cosgrove,Fabio Piscaglia,Jeffrey C. Bamber,Jörg Bojunga,Jean Michel Correas,Odd Helge Gilja,Andrea Klauser,Ioan Sporea,Fabrizio Calliada,Cantisani,Mirko D'Onofrio,E. E Drakonaki,Mathias Fink,Mireen Friedrich-Rust,Jeremie Fromageau,Roald Flesland Havre,Christian Jenssen,R Ohlinger,Adrian Saftoiu,F Schaefer,Christoph F. Dietrich +20 more
TL;DR: The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation.
Journal ArticleDOI
EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)
Christoph F. Dietrich,Jeffrey C. Bamber,Annalisa Berzigotti,Simona Bota,Vito Cantisani,Laurent Castera,David O. Cosgrove,Giovanna Ferraioli,Mireen Friedrich-Rust,Odd Helge Gilja,Ruediger S. Goertz,Thomas Karlas,Robert J. de Knegt,Victor de Ledinghen,Fabio Piscaglia,Bogdan Procopet,Adrian Saftoiu,Paul S. Sidhu,Ioan Sporea,Maja Thiele +19 more
TL;DR: The first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography is presented, focused on the assessment of diffuse liver disease.
Journal ArticleDOI
WFUMB Guidelines and Recommendations for Clinical Use of Ultrasound Elastography: Part 2: Breast
Richard G. Barr,Kazutaka Nakashima,Dominique Amy,David O. Cosgrove,André Farrokh,F. K. W. Schäfer,Jeffrey C. Bamber,Laurent Castera,Byung Ihn Choi,Yi-Hong Chou,Christoph F. Dietrich,Hong Ding,Giovanna Ferraioli,Carlo Filice,Mireen Friedrich-Rust,Timothy J. Hall,Kathryn R. Nightingale,Mark L. Palmeri,Tsuyoshi Shiina,Shinichi Suzuki,Ioan Sporea,Stephanie R. Wilson,Masatoshi Kudo +22 more
TL;DR: The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver disease, aimed at assessing the usefulness ofElastography in the management of liver diseases.
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Journal ArticleDOI
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