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In the current literature, there is only a small number of studies that have evaluated the utility of point share wave elastography for pancreatic assessment. Objective: To assess the feasibility of Virtual Touch Quantification (VTQ) elastography for pancreas assessment, as well as the mean pancreatic stiffness values in healthy subjects. Material and method: We included 70 subjects (52.8% women, 47.2% men, average BMI=25.9±4.9 kg/m2, average age 46.8±18.4 years) with a normal pancreatic ultrasound aspect and with no history of pancreatic disease or diabetes, in whom elastography measurements were performed with a Siemens Acuson S2000 Virtual Touch ultrasound system (Siemens AG, Erlangen, Germany) using a 4CI transducer. For each patient, 10 valid VTQ measurements of the pancreatic parenchyma were performed under fasting conditions. Reliable measurements were defined as a median value of ten pancreas stiffness measurements with a success rate ≥60% and an interquartile range interval <30%. Results: Out of 70 subjects, reliable measurements were acquired in 61 subjects (87.1%) by means of VTQ elastography. The mean pancreas stiffness values in healthy subjects was 1.26 m/s ± 0.1 m/s, CI 95% (1.24-1.28). There were no significant differences between the mean pancreas stiffness in men vs. women 1.25 m/s ± 0.09 m/s, CI 95% (1.21-1.28) vs. 1.28 m/s ± 0.1 m/s CI 95% (1.25-1.31) (p=0.103). Conclusion: VTQ can be a useful tool for pancreas quantification characterized by a good feasibility (87.1%) in healthy subjects. The mean pancreas stiffness values in healthy individuals was 1.26 m/s ± 0.1m/s. [ABSTRACT FROM AUTHOR]

Background and Aim: While the manufacturer recommended the use of 10 liver stiffness measurements (LSM) to quantify liver stiffness by 2D-SWE.GE, it has been demonstrated that 5 LSM are enough to quantify LS by 2D-SWE.GE [1]. The aim of this study was to evaluate the reliability of 3 vs 5 measurements in a cohort of patients with or without chronic liver disease. Material and method: 333 consecutive patients with or without chronic hepatopathies, in whom LS was evaluated by 2D-SWE, using LOGIQ E9 (GE Healthcare), were included in the study. The mean, median, standard deviation (SD) and interquartile range (IQR) of 3 and 5 were collected for each patient and compared to each other. Reliable LSM were defined as the median value of 5 or 3 measurements acquired in a homogenous area of liver parenchyma and an interquartile range/median(IQR/MED) <0.30. Results: Reliable LSM were obtained in 92.5% (308/333) of patients using 5 LSM and in 94.9% (316/33) using 3 LSM (p= 0.26). The mean kPascal (kPa) value of the median, mean, SD and IQR for 5 and 3 measurements were 10.26, 10.30, 1.49, 1.56 and 10.37, 10.75, 2.96, 1.25 respectively. No significant statistical differences were found between 3 LSM and 5 LSM regarding the median, mean and SD (all p > 0.05). Statistical difference was observed only regarding IQR (p= 0.0026). Conclusion: 3 LSM using 2D-SWE.GE seem to be reliable for LS evaluation with an increased feasibility of the method. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate how many measurements are needed for the non-invasive assessment of fibrosis by the new elastography technique THED and also to define the normal liver stiffness(LS) values in healthy subjects. Material and Method: We evaluated by THED and transient elastography(TE) a group of 183 patients: 44-healthy subjects(normal abdominal ultrasound, without any known liver disease and with a TE value <6.5kPa) and the rest with chronic hepatopathies. In all patients, 10 valid LS measurements were obtained in the same day, both with THED and with TE, using IQR/M<30% as a quality criterion. The following TE cut-off values were used to stage fibrosis in the chronic hepatopathies group: F1≥6.5kPa, F2≥7kPa, F3≥9.5kPa, F4≥12kPa(1). Results: Reliable LS measurements were obtained in all 183 patients (54.6% male, mean age 56.5±12.4 years) by means of both methods. According to TE, fibrosis severity was:F4-24.5%(45/183p),F3-6%(11/183p),F2-14.7%(27/183p),F1-12%(22/183p), F0-42.6% (78/183). There were no differences between the mean LSM obtained with 5 THED measurements vs. with 10 THED measurements: 1.66±0.26m/s vs. 1.65±0.24m/s, p=0.48. In the subgroup of 44 healthy volunteers (48.8% men, mean age: 37.7±2.38, average BMI=25.6 kg/m2), the mean LS value was 1.49±0.01 m/s. There were no significant differences between the mean LS values in healthy men vs. healthy women, 1.52±0.06m/s vs. 1.47±0.01m/s (p=0.1). Conclusion: Five valid measurements may be enough to quantify the liver fibrosis THED elastography, without significant loss of accuracy, thus reducing the examination time. The mean liver stiffness values by THED in healthy subjects was 1.49±0.01m/s. [ABSTRACT FROM AUTHOR]

Objective: to highlight the prevalence of liver fibrosis stages assessed by transient elastography (TE) in a large cohort of patients in a single study center. Material and method: 22400 liver stiffness(LS) assessments by mean of TE have been performed in our Department during an 11 years period(2007-2018). The study included patients with chronic liver diseases of various etiology. In each patient, 10 valid LS measurements were obtained either with M probe or with XL probe. If no valid LS measurements could be obtained, the evaluation was declared as failure. Reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M)≤30%, and a Success Rate (SR)≥60%. To discriminate between LS stages by TE we used the following cut-offs[1]: F2-7 kPa; F3-9.5 kPa and F4-12 kPa. Results: The feasibility in our cohort was 90.1%, 2238 of 22400 measurements(9.9%) were failed or unreliable. The etiology of chronic liver diseases evaluated by TE was: hepatitis C virus infection:35%(7838 patients), hepatitis B virus infection:20.5%(4601), dual hepatitis virus infection:1.5%(332), alcoholic liver disease:5.2%(1172), Non-Alcoholic Steatohepatitis (NASH):6.8%(1518), Both Alcoholic and Non-Alcoholic Steatohepatitis(BASH):0.3%(72) and other etiologies:30.7%(6867). Based on TE cut-off values, the severity of liver fibrosis in our group was as follows:F<2:9783 patients(48.5%); F2:3132 patients(15.6%); F3:1714 patients(8.5%) and F4:5533 patients(27.4%). Conclusion: Transient elastography had a feasibility of 90.1% in this large cohort, almost half of the patients(48.5%) having at most mild fibrosis, and approximately one quarter having cirrhosis (27.4%). [ABSTRACT FROM AUTHOR]

Objective: to evaluate the liver stiffness(LS) values after DAA(Direct-acting antivirals) therapy, in patients with compensated HCV cirrhosis, with sustained virologic response(SVR) and to highlight how many LS values become lower than the values for cirrhosis. Material and method: We examined 167 patients who had LS>12 kPa at baseline, who underwent 12 weeks DAA therapy and had SVR. 56 of them were followed up by TE 24 and 48 weeks after EOT (end of treatment). A subgroup of 28 patients were followed up 96 weeks after EOT(SVR96). LS values were assessed by means of TE at the start of treatment (ST), at SVR12 (12 weeks from EOT), SVR24, SVR48 and SVR96, respectively. In each session, 10 LS measurements (LSM) were obtained. Reliable LSM were defined as median value of 10 measurements with Interquartile range/median≤30%. Results: LS mean values at SVR12 were significantly lower as compared to ST(16.6±6.87vs 21.3±8.8 kPa p=0.002). As compared to SVR12, at SVR24 the mean LS values remained stable (16.6±6.87vs16.9±6.87kPa p=0.81) and at SVR48 the values continued to decrease, but without statistical significance (14.6±5.3vs16.6±6.87kPa p=0.08). LS was<12 kPa in 14% of patients at SVR12, in 16% at SVR24 and in 27% at SVR48. In the subgroup of 28 evaluated at SVR96, the LS decreased significantly as compared to SVR12(11.6±4.6vs15.5±6.2kPa p=0.009), and 46% had LS<12 kPa. Conclusion:In compensated HCV cirrhotic patients, the mean LS values significantly decreased at SVR12, remained stable at SVR24 and decreased at SVR48. In the subgroup of patients followed up at SVR96, almost half had LS values lower than 12 kPa. [ABSTRACT FROM AUTHOR]

Introduction: While most ultrasound elastography methods employ transient stimulation methods, the new time-harmonic elastography diagnostic system (THED) relies on time-harmonic vibrations in the same manner as MRI elastography (1). The aim of our study was to assess the performance of THED to diagnose different stages of fibrosis, considering transient elastography (TE) as reference method. Material and methods: We evaluated by THED a group of 160 patients: (69 female and 91 male, mean age 56,5±12,4 years, mean BMI 27,9±5,2kg/m2). The following TE cut-off values were used to stage fibrosis: F1≥6kPa, F2≥7kPa, F3≥9,5kPa, F4≥12 kPa(2). In all patients, 10 valid LS measurements were obtained in the same day, by THED and TE, with the results expressed in kPa. Quality criteria:SR≥60%, IQR<30% have been used for each subject. Results: The feasibility was 100% in both TE and THED. The best cut-off value for different fibrosis stages were: F1 >1.5m/s(6.7kPa), AUROC=0.84, 95%CI(0.78-0.90), P<0.0001, Se=95.1%, Sp=21.5%, PPV=75.4%, NPV=83.3%; F2 >1.6 m/s(7.6kPa), AUROC=0.89, 95%CI (0.83-0.93), P<0.0001, Se=80.7%, Sp=81.8%, PPV=81.7%, NPV=80.5%; F3 >1.69m/s(8.5kPa). AUROC=0.87, 95%CI (0.81-0.92), P<0.0001, Se=75%, Sp=89.4%, PPV=79.2%, NPV=86.9%; F4 >1.75 m/s(9.1kPa) AUROC=0.92, 95%CI (0.87-0.95), P<0.0001, Se=80%, Sp=93%, PPV=81.8%, NPV=92.2%. There was a direct, positive and strong correlation between THED and TE: r=0.82, p<0.001. Conclusion: The new THED system has good performance for predicting liver cirrhosis with a cut off value of >1.75 m/s(9.1kPa). There is a strong correlation between liver fibrosis measurements performed by THED and TE. [ABSTRACT FROM AUTHOR]

Background and Aim: Liver stiffness (LS) measurement by elastographic methods is a noninvasive technique for the evaluation of liver fibrosis, which could also be used for predicting the presence of esophageal varices (EV) in patients with liver cirrhosis. The aim of this study was to evaluate two ultrasound based elastographic methods as non-invasive markers for predicting the presence of EV, in a cohort of alcoholic liver cirrhosis patients. Material and method: The study included 77 patients diagnosed with compensated alcoholic liver cirrhosis, who underwent both upper endoscopy and LS assessment by: Transient Elastography(TE) (Fibroscan/EchoSens) and pSWE-Virtual Touch Tissue Quantification(VTQ) (Siemens Acuson S2000). Reliable LS measurements were defined for both methods as the median values of 10 measurements with IQR/ M<30%. We used TE as the reference method to diagnose liver cirrhosis (LS ≥12 kPa) [1]. Patients with ascites were excluded due to the impossibility to perform TE. Results: 56 patients out of 77 had valid measurements by both elastographic methods and were included in the final analysis, 40/56 patients with EV. The best cut-off values to rule out the presence of EV in our cohort, with a NPV of 100% were: ≤20.1 kPa for TE(AUROC 0.9; Se100%; Sp 28%; PPV 56%; NPV 100%, Lr- 0, LR+1.38) and ≤2.1 m/s for VTQ(AUROC 0.85; Se100%; Sp 18%; PPV- 52%; NPV- 100%, Lr- 0, LR+1.21). Conclusion: Using for TE the cut-off value ≤20.1 kPa and for VTQ≤2.1 m/s we can rule out quite accurately the presence of EV in patients with alcoholic liver cirrhosis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to evaluate the inter-and intraobserver reproducibility of the new time-harmonic elastography diagnostic system (THED) (1) and the impact of ultrasound (US) experience in acquiring reliable measurements, since no official recommendations are available for this system. Material and methods: Elastographic measurements (EM) were obtained in 27 consecutive subjects using THED. Three examiners with different levels of experience in US and US-based elastography, performed 10 valid EM on each subject. We defined their experience as follows: E1- no experience in elastography and less than 50 ultrasound (US) examinations, E2: more than one year elastographic experience and more than 500 US examinations and E3: more than 1000 US examinations, without any experience in elastography. We used the intraclass correlation coefficient (ICC), inter-rater agreement (Kappa coefficient) and concordance correlation coefficient to assess the inter- and intraobserver reproducibility. Results: We did not find significant differences between the means of EM obtained by the examiners overall and across study group [1.66 (E1) vs 1.66 (E2) vs 1.65 (E3), p=0.76]. The overall agreement between examiners was excellent: 0.94 (95% CI: 0.89-0.97). There was at least a good agreement between examiners (E1 vs. E3: k=0.80, 95% CI:0.67-0.94; E1 vs. E2: k=0.81, 95% CI:0.69-0.94), and good to excellent in E2 vs. E3: k=0.89, 95% CI:0.82-0.96. The intraobserver reproducibility for each of the examiners was excellent, however the ICCs were higher in more experienced examiners in US: E1- 0.92, (95% CI:0.82-0.96) vs. E3-0.94 (95% CI:0.87-0.97) vs. E2-0.97 (95% CI:0.95-0.99). The concordance correlation coefficients were similar: E1 vs. E3-0.84, E1 vs. E2-0.89 and E3 vs. E2-0.89. Conclusions: The good ICCs and Kappa coefficients for the mean values show that THED is a reproducible method. Ultrasound experience did not significantly influence the results. [ABSTRACT FROM AUTHOR]

Introduction: Acute pancreatitis is an entity of notable importance due to its high incidence and mortality. Conventional ultrasonography (US) is curently the first-line imaging modality used in clinical practice for assessing acute pancreatitis, as a non-invasive, easy and safe procedure. The aim of the current retrospective study was to investigate the value of conventional ultrasonography and contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis, using contrast enhanced CT/MRI as the reference method. Material and methods: We conducted a retrospective study of 187 patients with acute pancreatitis who were admitted in our Department from January 2017 to February 2019. US was performed in all patients and CEUS in a subgroup in whom the pancreas was visible by US. CEUS enhancement pattern of the lesions was described according to the current EFSUMB guidelines. All patients had CT/MRI as reference method. Results: 187 patients were included (117 men -62.6%; mean age 56,1 years; range 19-90) from which 47 were with recurent pancreatitis. In most cases the etiology was biliary 43.3% (81), followed by alcohol abuse 26.2% (49) and 7.5% (14) patients were with hipertriglyceridemia. Regarding the etiology in 13.4% (25) the cause of acute pancreatitis was unknown. From the study group 64 (35.1%) were mild, 96 (51.3%) moderate and 22 (11.7%) severe forms of acute pancretitis. US diagnosed free intraperitonel fluid and collections in 84.7% (n=100). CEUS was performed in 23 cases (19.4%) and pancreatic necrosis was diagnosed in 8 patients. CEUS missed the presence of necrosis only in 1 patient as compared to CT/MRI. Conclusion: Standard ultrasonography is a good method for assessment in acute pancreatitis, with a good detection of free intraperitoneal fluid and collections but with limited value to detect pancreatic necrosis. CEUS is comparable to CT/MRI but limited by the acoustic window of the patient. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the enhancement pattern of cholangiocellular carcinoma (CCC) on contrast enhanced ultrasound (CEUS). Methods: This observational retrospective study included 50 patients diagnosed with CCC between 2010-2018. The final diagnosis of CCC was established by an imaging method (contrast enhanced CT or MRI) or biopsy. All 50 patients with CCC were examined by CEUS (22 men, 38 women, mean age 64.3±10.9 years); only 5 patients had liver cirrhosis and 2 patients with chronic hepatopathy with severe fibrosis. CEUS was considered conclusive for CCC if a typical pattern was present (EFSUMB criteria). Results: In the arterial phase the enhancement patters were: a) Rim-like enhancement: irregular peripheral hyper-enhancement and nonenhancing regions 18/50 cases (36%); b) Homogeneous hyperenhancement in 11/50 cases (22%); c) Heterogeneous hyperenhancementmixed irregular hyper-enhancement in both the peripheral and central parts of the lesion and nonenhancing regions in 12/50 cases (24%); d) Isoenhancement in 2/50 cases (4%); e) Hypoenhancement in 7/50 cases (14%). In the portal phase washout was observed in 34/50 (68%) cases, isoenhancement in 7/50 cases (14%), hypoenhacement in 7/50 cases (14%) and hyperenhancing pattern in 2/50 (4%) cases. In the late phase washout was observed in 40/50 (80%) cases, hypoenhacement in 8/50 cases (16%), isoenhancement in 1/50 cases (2%) and hyperenhancing pattern in 1/50 cases (2%). In 44% (22/50 cases) CEUS was conclusive for the diagnosis of CCC, 25 lesions were inconclusive on CEUS and 3 (6%) lesions were misdiagnosed. After CEUS examination all 25 inconclusive lesions were classified as malignant. Conclusions: 60% of CCC cases had rim-like and heterogeneous enhancement in the arterial phase. Washout was present in the late vascular phase in 80% of cases. After CEUS examination a conclusive result for the diagnosis of CCC was obtained in 44% cases. All inconclusive lesions on CEUS were classified as malignant. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility of two novel elastographic methods, pSWE and 2D-SWE, integrated in the same ultrasound machine, for liver fibrosis (LF) assessment using Transient Elastography (TE) as the reference method. Material and methods: 115 subjects were included, in which LF was evaluated in the same session by TE (Fibroscan, EchoSens), pSWE and 2D-SWE (Samsung-Medison RS85). Reliable liver stiffness (LS) measurements were defined: for TE the median values of 10 measurements with a success rate ≥60% and IQR/M<30%; for pSWE and 2D-SWE the median value of 10 measurements, with a reliability measurement index (RMI)>0.5 and IQR/M<30%; for classification of LF severity we used TE as reference method with the following cut-offs: F2≥7kPa, F3≥9.5kPa and F4≥12kPa [1]. Results: Reliable measurements by TE were obtained in 98.2%(113/115), by pSWE in 93.9%(108/115) and by 2D-SWE in 92.1%(106/115) subjects, so the final analysis included 101 patients. We divided the cohort into 3 groups: fibrosis5.9 kPa [AUROC=0.95, 95% CI (0.89;0.98),p<0.0001,Se=94.1%,Sp=89.5%,PPV= 82.1%,NPV=96.8%] F4 LS>8 kPa (AUROC=0.98, 95% CI (0.94;0.99),p<0.0001,Se=94.4%,Sp=95.1%,PPV=81%,NPV=98.7%), and for 2D-SWE: F≥2 LS>6.1 kPa[AUROC=0.93, 95% CI(0.86;0.97),p<0.0001,Se=91.1%, Sp=80.6%,PPV=70.5%,NPV=94.7%], F4 LS>7.6 kPa[AUROC=0.98, 95% CI(0.93;0.99), p<0.0001,Se=100%,Sp=91.5%,PPV=72%,NPV=100%]. We observed a strong correlation between LS values obtained by TE and 2D-SWE(r=0.85), between TE and pSWE(r=0.88) and between pSWE and 2D-SWE(r=0.90) (p=0.37). There were no significant differences between the mean values obtained by pSWE and 2D-SWE(p=0.96). Conclusion: The novel pSWE and 2D-SWE are feasible methods for assessing liver fibrosis, both techniques strongly correlating with TE results. [ABSTRACT FROM AUTHOR]