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Vibration-controlled transient elastography (VCTE) was the first non-invasive method used for assessing liver fibrosis in patients with chronic liver disease. Over the years, many studies have evaluated its performance. It is now used globally, and, in some countries, it represents the primary step in evaluating liver fibrosis. The aim of this study is to assess the feasibility of VCTE and highlight the prevalence of liver fibrosis stages assessed by VCTE in a large cohort of patients at a single study center. We also aimed to observe the trends in liver stiffness (LS) values over the years according to each type of hepatopathy. A retrospective study was conducted over a period of 13 years (2007–2019) and included patients who presented to our clinic for LS measurements (LSMs), either with known liver diseases or with suspected liver pathology who were undergoing fibrosis screening. The database contained a total of 23,420 measurements. Valid LSMs were obtained in 90.91% (21,291/23,420) of the cases, while 2129 (9.09%) of the measurements were either failed or unreliable. In untreated patients with chronic viral hepatitis, LS values tended to increase during the years, while in patients undergoing antiviral therapy LS values significantly decreased. Our comprehensive study, one of the largest of its kind spanning 13 years, emphasizes the reliability and significance of VCTE in real-world clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: A renal biopsy represents the gold standard in the diagnosis, prognosis, and management of patients with glomerulonephritis. So far, non-invasive elastographic techniques have not confirmed their utility in replacing a biopsy; however, the new and improved software from Hologic Supersonic Mach 30 is a promising method for assessing the renal tissue's stiffness and viscosity. We investigated whether this elastography technique could reveal renal tissue fibrosis in patients with chronic glomerulonephritis. Materials and methods: Two-dimensional-shear wave elastography (SWE) PLUS and viscosity plane-wave ultrasound (Vi PLUS) assessments were performed in 40 patients with chronic glomerulopathies before being referred for a renal biopsy. For each kidney, the mean values of five stiffness and viscosity measures were compared with the demographic, biological, and histopathological parameters of the patients. Results: In total, 26 men and 14 women with a mean age of 52.35 ± 15.54 years, a mean estimated glomerular filtration rate (eGFR) of 53.8 ± 35.49 mL/min/1.73m2, and a mean proteinuria of 6.39 ± 7.42 g/24 h were included after providing their informed consent. Out of 40 kidney biopsies, 2 were uninterpretable with inappropriate material and were divided into four subgroups based on their fibrosis percentage. Even though these elastography techniques were unable to differentiate between separate fibrosis stages, when predicting between the fibrosis and no-fibrosis group, we found a cut-off value of <20.77 kPa with the area under the curve (AUC) of 0.860, a p < 0.001 with 88.89% sensitivity, and a 75% specificity for the 2D SWE PLUS measures and a cut-off value of <2.8 Pa.s with an AUC of 0.792, a p < 0.001 with 94% sensitivity, and a 60% specificity for the Vi PLUS measures. We also found a cut-off value of <19.75 kPa for the 2D SWE PLUS measures (with an AUC of 0.789, p = 0.0001 with 100% sensitivity, and a 74.29% specificity) and a cut-off value of <1.28 Pa.s for the Vi PLUS measures (with an AUC 0.829, p = 0.0019 with 60% sensitivity, and a 94.29% specificity) differentiating between patients with over 40% fibrosis and those with under 40%. We also discovered a positive correlation between the glomerular filtration rate (eGFR) and 2D-SWE PLUS values (r = 0.7065, p < 0.0001) and Vi PLUS values (r = 0.3637, p < 0.0211). C reactive protein (CRP) correlates with the Vi PLUS measures (r = −0.3695, p = 0.0189) but not with the 2D SWE PLUS measures (r = −0.2431, p = 0.1306). Conclusion: Our findings indicate that this novel elastography method can distinguish between individuals with different stages of renal fibrosis, correlate with the renal function and inflammation, and are easy to use and reproducible, but further research is needed for them to be employed routinely in clinical practice. [ABSTRACT FROM AUTHOR]

Featured Application: In this review we present and discuss the published literature on the use of ultrasound-based liver elastography in children. The published data show that all the available shear wave elastography techniques are feasible and accurate for the assessment of liver fibrosis in children with diffuse liver disease due to several etiologies. For the assessment of focal liver lesions evidences are limited and no conclusion can be drawn so far. Studies performed using transient elastography (TE), point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) have shown that these techniques are all feasible and accurate in children for the evaluation of liver fibrosis due to several etiologies. However, for some specific pediatric pathologies, such as biliary atresia, the evidence is still limited. As shown in adults, inflammation is a confounding factor when assessing fibrosis severity and care should be taken when interpreting the results. Due to the scarce comparative data between serological tests and elastography techniques in children, a definite conclusion regarding which is the best cannot be drawn. Neither non-invasive elastographic techniques nor laboratory scores allow determination of the presence and the degree of inflammation, necrosis, iron or copper deposits. [ABSTRACT FROM AUTHOR]

To evaluate liver stiffness measurements success rates (SR) by pSWE and 2D-SWE implemented on different ultrasound probes from different vendors and evaluate the input on the success rate of a new bariatric probe (DAX) in obese patients. A prospective study was conducted in which liver stiffness measurements (LSM) were performed in 201 consecutive subjects (60.1% men, average BMI = 28.7 ± 4.9 kg/m2, average age 59 ± 18.4 years, 38% obese) with or without chronic hepatopathies evaluated during the same session by point Shear Wave Elastography (pSWE), 2D Shear Wave Elastography (2D SWE), and Transient Elastography (TE) implemented on the following systems: Siemens ACUSON Sequoia (5C-1 convex transducer with pSWE and 2D SWE, Deep Abdominal Transducer (DAX) with pSWE and 2D SWE, 4V-1 linear transducer with pSWE), Aixplorer Mach 30 (C6-1X convex transducer with 2D SWE) and FibroScan Compact 530 (M and XL probes). Reliable LS measurements were defined as the median value of 10 measurements and an IQR/M<0.3. Valid LSM were obtained in 99%(199/201) using TE, 99%(199/201) using 2D SWE (C6-1X), 98.5% (198/201) using 2D SWE (5C-1), 99%(199/201) using 2D SWE (DAX), 97.5%(196/201) using pSWE (5C-1), 97.5%(196/201) using pSWE (DAX) and 91.5% (184/201) using pSWE (4V-1). No significant difference were found between the SR of TE, 2D SWE using C6-1X, 5C-1, DAX and pSWE using C5-1 and DAX (p>0.05. pSWE using the linear probe 4V-1 had significantly lower SR compared to the other probes (p< 0.001). 38% (77/201) of subjects were obese. Valid LSM were obtained in 100% of the obese (77/77) using 2D SWE DAX, in 98.7% (76/77) using TE, 2D SWE C6-1X, and pSWE DAX, in 97.4% (75/77) using pSWE and 2D SWE 5C-1 and in 83.1% (64/77) using pSWE 4V-1. No significant differences were found between the SR of TE, 2D SWE using C6-1X, 5C-1, DAX and pSWE using C5-1 and DAX in obese subjects (p>0.05). pSWE using the linear probe 4V-1 had significantly lower SR compared to the other probes in obese subjects (p<0.001). 2D SWE and pSWE implemented on convex ultrasound probes have very high success rates for liver stiffness measurements in general population and in obese, with no significant differences between them. pSWE implemented on 4V-1 linear ultrasound probe has a significantly lower success rate for liver stiffness measurements compared to pSWE and 2D SWE implemented on convex ultrasound probes. 2D SWE DAX probe had the highest SR (100%) in obese, with no significant differences compared to the other 2D SWE and pSWE implemented on convex ultrasound probes. [ABSTRACT FROM AUTHOR]

Abstract: We used supersonic shear imaging to determine the liver stiffness (LS) values of 82 patients without known liver pathology and studied the factors that influence these measurements. Five LS measurements were made in each subject, and the median value, expressed in kilopascals, was calculated. Reliable LS measurements were obtained in 84.5% of patients. Higher body mass index and older age were associated with failure to obtain reliable measurements. The mean value of LS measurements determined by SSI in our cohort of patients without known liver pathology was 6 ± 1.4 kPa. The mean LS measurements determined by SSI for men were significantly higher than those for women; body mass index did not significantly influence SSI measurements. Thus, 6 kPa is the mean SSI value in patients without known liver pathology, with higher values being obtained in men. [Copyright &y& Elsevier]

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. To assess the feasibility of Virtual Touch Quantification (VTQ) elastography for pancreas assessment, as well as the mean pancreatic stiffness values in healthy subjects. 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%. 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). 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]

Ultrasound elastography including transient elastography (TE), point shear wave elastography, (pSWE) and two (three)- dimensional shear wave elastography (2D-SWE) have been introduced mainly for the evaluation of the liver. All the techniques are also feasible for the examination of spleen, whereas pSWE and 2D-SWE can be used for the assessment of the pancreas, kidney, gastrointestinal tract and other organs. Strain elastography also plays a role for non-liver applications. The aim of the current report is to highlight unique features and techniques for the elastographic examinations in children and to report initial results in non-liver applications. [ABSTRACT FROM AUTHOR]

Non-invasive tests have been developed to determine the severity of liver disease in patients with alcohol use disorder (AUD). We aimed to assess the severity of liver steatosis and liver fibrosis (LF) in a cohort of patients with AUD using liver elastography and biological scores. Materials and methods: A prospective study was performed on 172 subjects, without previously known liver disease, with a positive AUDIT-C score, serum markers, and vibration-controlled transient elastography (VCTE) with Controlled Attenuation Parameter (CAP). Results: From 172 subjects with positive AUDIT-C test, VCTE diagnosed advanced fibrosis (F3) in 13.9% (24/172) of the subjects and liver cirrhosis (F4) in 17.5% (30/172). Moderate and severe steatosis was found in 18.6% (32/172), respectively 52.3% (90/172). Significant correlations were found between liver stiffness and APRI (r=0.33, p=0.001), FIB-4(r=0.31, p=0.0012) and the age-platelet index (r=0.25, p=0.008). FIB-4 (p=0.01) and age-platelet index (p=0.03) were independently associated with the presence of advanced fibrosis. Age-platelet index (AUC-0.82) performed significantly better than AST/ALT (AUC-0.55) and APRI (AUC-0.58) (p= 0.0001 and p= 0.0014, respectively), but no differences were found when compared to FIB-4 (AUC-0.77) (p=0.35) for predicting advanced fibrosis. Conclusion: In conclusion, in a cohort of patients with AUD, 70.9% presented moderate and severe liver steatosis and 17.5% were newly diagnosed with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-based elastography techniques became in the last years reliable tools to predict the severity of liver fibrosis in chronic hepatopathies. Usually, these techniques are integrated in high-end US machines but recently they became available in medium-range ones. To evaluate the performance of point Shear-Wave Elastography from Siemens, implemented on the new ACUSON Juniper Ultrasound System, for the non-invasive assessment of liver fibrosis, and to identify liver stiffness (LS) cut-off value for predicting advanced fibrosis, using Transient Elastography (TE) as the reference method. Material and method: We included 201 consecutive subjects (60% men, mean BMI = 28.7 ± 4.9 kg/m2, mean age 59 ± 18.4 years) with or without chronic hepatopathies in whom LS was evaluated in the same session by means of 2 elastography techniques: TE and p-SWE from Siemens. Reliable LS measurements were defined for TE as the median value of 10 measurements with an interquartile range/median (IQR/M) <30%, and for p-SWE as the median value of 10 measurements acquired in a homogenous area and an IQR/M <30%. A cut-off of ≥ 9.5 kPa by TE was used to define advanced fibrosis (F≥3) [1]. Valid liver stiffness measurements (LSM) were obtained in 97.5% of patients using both elastography methods. Therefore, 196 subjects were included in the final analysis (27.8% with TE ≥ 9.5 kPa). A moderate positive correlation was found between the LS values obtained by the 2 methods: r=0.68, p<0.0001 (Spearman correlation). LS values obtained by p-SWE were significantly lower than those obtained by TE: 8.3 kPa vs. 10.12kPa (p<0.0001). The best p-SWE cut-off value for advanced fibrosis (F≥3) was 7.4 kPa (AUC- 0.95; Se-81.5%; Sp-98%; PPV-95.7%; NPV-93.3%) Using the new US system, the best p-SWE cut-off value for predicting advanced fibrosis was 7.4 kPa. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the performance and optimal cut-off points for p-SWE and 2D-SWE for the non-invasive assessment of advanced liver fibrosis, using transient elastography as a reference method. Siemens ACUSON Sequoia (5C-1 convex transducer and Deep Abdominal Transducer-DAX) and FibroScan Compact M 530 (M and XL probes) were used. We included 198 consecutive patients with or without chronic liver disease that had all five LS values available. LS was evaluated in the same session by 3 elastographic techniques: TE, p-SWE and 2D-SWE. Reliable measurements were defined as the median value of 10 measurements and an IQR/M<0.3. For cACLD, the transient elastography cut-off point of 9.5 kPa was used [1]. From the 198 patients, 41.5% were women and 58.5% were men, mean age 54.8 ±13.8 years. The best cut-off values cACLD were: for 2D-SWE- 5C1 probe:>8.8 kPa, Se=97.7%, Sp=38.6%, AUC=0.84, p<0.0001;DAX probe:>7.6 kPa, Se= 40.9%, Sp=99.9%, AUC=0.84, p<0.0001; ForpSWE- 5C1 probe: >9.1 kPa, Se=54.5%, Sp=97.7%, AUC=0.86, p<0.0001; DAXprobe: > 8.8 kPa, Se=50%, Sp=98.5%, AUC=0.88, p<0.0001. The best cut-off value for predicting cACLD in pSWE range between 8.8 kPa and 9.1 kPa and for 2D-SWE raged between 7.6 kPa and 8.8 kPa. [ABSTRACT FROM AUTHOR]

Background: In chronic liver diseases, a correct estimation of the severity of liver fibrosis is important for recommendations regarding the treatment. Nowadays, evaluation of fibrosis is done by noninvasive methods such as biochemical scores and transient elastography instead of liver biopsy. The lack of sensitivity to detect fibrosis, because of its heterogeneity is a drawback of liver biopsy (LB). Objectives: To compare transient elastography (TE) and acoustic radiation force impulse (ARFI) for the evaluation of liver stiffness (LS), against percutaneous LB. Patients and Methods: Our study comprised of 223 subjects; 52 without fibrosis (38 volunteers and 14 patients with F0 on LB), 36 with F1, 40 with F2, 26 with F3 and 69 with liver cirrhosis (46 with LB and 23 with signs of cirrhosis). For each patient we performed in the same session 10 TE and 5 ARFI measurements. The median values were calculated. Results: A strong linear correlation (Spearman rho = 0.870) was found between TE and fibrosis (P < 0.0001); there was also a weaker correlation between ARFI and fibrosis (Spearman rho = 0.646; P < 0.0001). TE measurements were also correlated with ARFI measurements (Spearman rho = 0.733, P < 0.0001). The best test for predicting significant fibrosis (F ≥ 2) was TE with a cut-off value of 7.1 kPa (AUROC 0.953). For ARFI, the cut-off value was 1.27 m/s--area under ROC curve (AUROC): 0.890, sensitivity (Se) of 88.7%, specificity (Sp) of 67.5%, positive predictive value (PPV) of 64.5%, and negative predictive value (NPV) of 90% (P = 0.0044). For predicting cirrhosis (F = 4), the optimum cut-off values were 14.4 kPa for TE (AUROC: 0.985, Se: 95.6%, Sp: 94.7%, PPV: 89.2%, NPV: 98%) and 1.7 m/s for ARFI (AUROC: 0.931, Se: 93%, Sp: 86.7%, PPV: 73.6%, NPV: 96.9%) (P = 0.0102). Conclusions: LS evaluation by means of ARFI is not superior to TE for the assessment of liver fibrosis. ARFI is an accurate test for the diagnosis of cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Chronic viral hepatitis can be evaluated using invasive or noninvasive methods. Objectives: The aim of this study was to evaluate liver stiffness in inactive HBsAg carriers compared with normal subjects and determine if it is influenced by viral load in these patients. Patients and Methods: We prospectively evaluated 140 inactive HBsAg carriers and 152 normal subjects (without any signs or history of liver disease). In all subjects, liver stiffness was measured by 3 experienced physicians using a FibroScan® device (EchoSens, France) per standard procedures. We excluded patients for whom the SR of liver stiffness measurements was <60% and those who had measurements with an IQR>30%. Results: The mean liver stiffness in inactive HBsAg carriers was 5.6±2.1kPa, significantly higher than in normal subjects (4.8±1.2 kPa, p = 0.0002). In 16.4% (23) of inactive carriers, liver stiffness exceeded 7 kPa (the cutoff for significant fibrosis F > 2). In patients with undetectable viral loads, the mean liver stiffness was 4.9± 1.2 kPa, significantly lower than in those with detectable DNA (<2000 IU/ml)(6.7±2.7 kPa, p<0.001). Conclusions: Inactive HBsAg carriers have higher liver stiffness values compared with healthy individuals. Liver stiffness in inactive HBsAg carriers with detectable viral loads is higher than in those who are aviremic, suggesting that low viral loads promote fibrosis. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the severity of liver fibrosis and steatosis in a cohort of type 2 diabetic patients, using non-invasive Methods: Transient Elastography (TE) and Controlled Attenuation Parameter (CAP). Material and Method: The study included 704 type 2 diabetic patients prospectively randomized, evaluated in the same session by means of TE and CAP (FibroScan, EchoSens) to assess both liver fibrosis and steatosis. Reliable liver stiffness measurements (LSM) were defined as the median value of 10 LSM with an IQR/median < 30%. For TE and CAP, M and XL probes were used. A cut-off value of 10.1 kPa [1] was used to define severe fibrosis (F ≥ 3). For differentiation between stages of steatosis we used the following cut-off values recommended by the manufacturer: S1 (mild) < 230, S2 (moderate) 275-300 db/m, S3 (severe) > 300 db/m. Results: Out of 704 diabetics screened we excluded those with associated viral hepatitis, those with an AUDIT-C score ≥ 8 and those with unreliable LSM. The final analysis included 485 subjects (54.3% women, mean age 60 ± 9.5; mean BMI = 31.6 ± 6.1 kg/m2) with reliable LSM. 32.1% of patients had obesity grade I, 17.9 % had obesity grade II and 8.9% had obesity grade III (IMC ≥ 40 kg/m2). Mild, moderate and severe steatosis by means of CAP was found in 15.6%, 15.6 % and 59.3% cases, respectively. The median CAP values of patients with mild, moderate and severe steatosis were 260 db/m, 287.5 db/m and 354 db/m. Clinically relevant fibrosis was detected by means of TE in 19.6% (95/485) of subjects. Conclusion: In our group, 59.3% of diabetic patients had severe steatosis by means of CAP. Regarding the liver fibrosis, we found that 19.6% of them had severe fibrosis (TE ≥ 10.1kPa), suggesting the need for further assessment. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the feasibility of two elastographic methods, point Shear Wave Elastography (pSWE) and two dimensional Shear Wave Elastography (2D-SWE), integrated in the same ultrasound machine, for liver fibrosis (LF) assessment, using Transient Elastography (TE) as the reference method.Material and Methods: We included in the study 115 subjects 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 value of 10 measurements with interquartile range (IQR/M)≤30%,while 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 the reference method with the following cut-offs: F2≥7kPa, F3≥9.5kPa and F4≥12kPa.Results: Reliable measurements by TE were obtained in 98.2% of cases (113/115), by pSWE in 93.9% of cases (108/115) and by 2D-SWE in 92.1% of cases (106/115), so the final analysis included 101 patients. We divided the cohort into 3 groups: fibrosis 5.9 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%], while for 2D-SWE they were: 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 strong correlations 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), respectively. There were no significant differences between the mean values obtained by pSWE and 2D-SWE (p=0.96).Conclusion: The pSWE and 2D-SWE are feasible methods for assessing liver fibrosis, both techniques strongly correlating with TE results. [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]

Aims: Non-invasive methods to assess the severity of chronic liver diseases have become more and more popular. The aim of our study was to evaluate the correlation of four Shear Waves Elastographic methods in a cohort of patients with chronic liver diseases of mixed etiologies and to compare their performances for liver fibrosis evaluation.Material and Methods:  A prospective study was conducted on 127 consecutive patients with chronic liver diseases of mixed etiologies. LS measurements were performed in all subjects, in one session, during the same day, by means of 4 elastographic methods: Transient Elastography (TE), Virtual Touch Quantification (VTQ), ElastPQ and 2D-SWE.SSI. The diagnosis accuracies of VTQ, ElastPQ, 2D-SWE.SSI were then compared using TE as reference method.Results: Valid LS measurements by all four shear waves ultrasound elastographic methods were obtained in 116/127 subjects with VTQ, in 108/127 subjects with 2D-SWE.SSI, in 111/127 with TE and in 109/127 with ElastPQ, so the final analysis included 82/127 subjects (64.5%). A good and significant correlation was found between all 4 elastographic methods. The diagnostic accuracy of VTQ, 2D-SWE.SSI and ElastPQ for the diagnosis of significant and severe fibrosis (F2/F3), and liver cirrhosis were similar for all elastographic techniques: VTQ vs 2D-SWE.SSI vs ElastPQ: 84.1% vs 85.3% vs. 84% (p>0.05); 93.9% vs 94% vs 94% (p>0.05).Conclusion: considering TE as the reference method for liver fibrosis evaluation, VTQ, ElastPQ, and 2D-SWE.SSI obtained similar accuracies for diagnosing at least significant fibrosis (F≥2) and liver cirrhosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the normal ranges of liver stiffness measurements (LSMs) in participants with healthy livers, using General Electric 2-D shear wave elastography (2-D-SWE-GE) compared with transient elastography (TE). We included 80 participants with healthy livers and without known liver disease, in whom liver stiffness was evaluated in the same session using two elastographic methods, TE and 2-D-SWE-GE. Reliable LSMs were defined for TE as the median of 10 measurements with a success rate of ≥60% and an interquartile range (IQR) < 30%, and for 2-D-SWE-GE, as the median of 10 measurements acquired in a homogenous area and an IQR < 30%. Participants with LSMs > 6.5 kPa by TE were excluded. Reliable LSMs were obtained in 79 participants (98.7%) by means of 2-D-SWE-GE and in 80 participants (100%) by means of TE (p = 0.9). The mean LSM obtained by 2-D-SWE-GE in our cohort of participants with healthy livers was 5.1 ± 1.3 kPa, which was significantly higher than the LSM assessed by TE (4.3 ± 0.9 kPa, p < 0.0001). In 2-D SWE-GE, mean LSMs were significantly higher for men than for women, 5.9 ± 1.2 kPa versus 4.7 ± 1.2 kPa (p = 0.0005). In conclusion, 2-D-SWE-GE has very good feasibility (98.7%) in healthy persons. The mean LSM determined by 2-D-SWE-GE in healthy participants was 5.1 ± 1.3 kPa. LSMs obtained by means of 2-D-SWE-GE were higher than those obtained by TE in participants with healthy livers. [ABSTRACT FROM AUTHOR]

Non-invasive ultrasound-based techniques for liver stiffness assessment (LS) were developed as an alternative to liver biopsy. Transient Elastography (TE) is the first method validated by several guidelines and other new methods were developed recently. The aim of this study was to evaluate the performance of two point Shear Waves Elastography (pSWE) techniques implemented in the same ultrasound system for liver stiffness assessment, using TE as reference. A prospective study was conducted, in which 271 consecutive patients with or without previously diagnosed liver disease were included. LS was evaluated by point Shear Wave Elastography (pSWE and Auto pSWE) implemented on Siemens ACUSON Sequoia system (Deep Abdominal Transducer-DAX) and by TE using FibroScan Compact M 530 system (M and XL probes).For Auto pSWE, 15 measurements/values are automatically obtained in a single evaluation and the median and IQR are calculated. For p-SWE and TE, reliable measurements were defined as the median value of 10 measurements with IQR/M<0.3 for all probes. For significant fibrosis, a cut-off value by TE of 7 kPa was used, and for liver cirrhosis 12 kPa [1]. Valid LSM were obtained in all 271 (100%) patients using both elastographic methods. A very good positive correlation was found between the LS values obtained by TE and both Auto pSWE and pSWE: r=0.78, p<0.0001; and between Auto pSWE and p-SWE: r=0.92, p<0.0001. The best pSWE and Auto pSWE cut-off value for significant fibrosis (F≥2) was 5.1 kPa (p-SWE: AUC- 0.81; Se-58.3%; Sp-94.6%; PPV-83.1%; NPV-83.5%; Auto pSWE: AUC- 0.82; Se-63.1%; Sp-90.4%; PPV-76.8%; NPV-84.4%) and for liver cirrhosis (F4) was 6.7 kPa (p-SWE: AUC- 0.92; Se-73.8%; Sp-94.3%; PPV-83.8%; NPV-95.3%; Auto pSWE: AUC- 0.93; Se-78.5%; Sp-97.8%; PPV-86.8%; NPV-96.1%). The two techniques, pSWE and Auto pSWE have very good correlations with TE and similar performance for predicting significant fibrosis and liver cirrhosis in a mixed cohort of patients. [ABSTRACT FROM AUTHOR]

Ultrasound-based liver elastography techniques are non-invasive methods used for the assessment of liver stiffness (LS). In addition to Transient Elastography (TE), new methods were developed. to compare the performance of 2D-SWE technique implemented on two different ultrasound probes from different vendors for the assessment of liver stiffness measurements (LSM) using transient elastography (TE) as reference method. A prospective study was conducted in which LSM were performed in 201 consecutive patients with or without chronic liver disease, evaluated in the same session by 2D-SWE and TE implemented on the following systems: Siemens ACUSON Sequoia (5C-1 convex transducer and Deep Abdominal Transducer-DAX), Aixplorer Mach 30 (C2-1X convex transducer) and FibroScan Compact M 530 (M and XL probes). Reliable measurements were defined as the median value of 10 measurements and an IQR/M<0.3. For significant fibrosis a cut-off value for TE of 7 kPa was used, for advanced fibrosis 9.5 kPa and for liver cirrhosis 12 kPa [1] From 201 patients, 198 patients had reliable measurements in all techniques and were included in the final analysis, mean age 54.8±13.3 years, mean BMI28.8 ± 5.0, 58% (116/198)men. 58.5% were without or with mild fibrosis, 14.1% had significant fibrosis, 6.2% had advanced fibrosis and 21.2% had liver cirrhosis. For significant fibrosis the performance was slightly better for 2D-SWE.SSI (AUROC=0.89, p<0.0001, >7.3 kPa, Se=85.1%, Sp=87.9%) followed by 2D-SWE.5C1 (AUROC=0.79, p<0.0001, >6.9 kPa, Se=33.7%, Sp=96.7%) and 2D-SWE.DAX (AUROC=0.78, p<0.0001, >6.3 kPa, Se= 36.4%, Sp=96.7%), p=0.01. For advanced fibrosis the best performance was slightly better by 2D-SWE.SSI (AUROC=0.92, p<0.0001, >8.8 kPa, Se=92.5%, Sp=91.9%), and by 2D-SWE.DAX (AUROC=0.86, p<0.0001, >7.6 kPa, Se= 38.8%, Sp=99.3%), followed by 2D-SWE.5C1 (AUROC=0.84, p<0.0001, >8.6 kPa, Se=38.8%, Sp=96.5%), p=0.02. For liver cirrhosis the performances were similar: 2D-SWE.SSI (AUROC=0.91, p<0.0001, >10.3 kPa, Se=92.8%, Sp=90.3%), followed by 2D-SWE.DAX (AUROC=0.90, p<0.0001, >10 kPa, Se= 23.8%, Sp=98.7%) and 2D-SWE.5C1 (AUROC=0.84, p<0.0001, >9.9 kPa, Se=33.3%, Sp=96.7%), p=0.10.The cut off values for predicting different stages of fibrosis ranged from 6.3-7.3 kPa for F2, 7.6-8.8 kPa for F3 and 9.9-10.3 for F4. The performance of the evaluated 2D SWE techniques for liver fibrosis assessment was similar. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the accuracy of quantitative ultrasonic measurements of renal allograft elasticity and viscosity using shear wave elastography (SWE) Aixplorer Mach 30 ultrasound system (Supersonic Imagine, Aix-en-Provence, France). 2D-SWE was performed on 35 kidney transplanted patients (13 women, 22 men) with a mean age of 48.45±13.33 years and mean estimated glomerular filtration rate(eGFR) 52.19±22.28ml/min/1.73m2. One nephrologist took 5 quantitative measures of renal cortical elasticity and viscosity, in 5 different frames, which were represented in terms of Young's modulus (kPa) respectively Viscosity Plane-wave Ultra-Sound (Vi-Plus) in Pa.s. The intraclass correlation coefficient, as well as intraobserver reproducibility (Bland-Altman plot with multiple measures per subject), were evaluated. We obtained 5 valid measurements in every studied patient, with a mean measurement stability index (SI) tool accuracy of 92.5%±1.95%. We found no correlation between median depth of measurements and median SI, or between kidney length (cm) and median SI, but we found a positive correlation between body mass index (BMI) and mean depth of measurements (r=0.7029, P<0.0001, 95% CI for r 0.4739 to 0.8428). Our study shows a good intraclass correlation coefficient for mean values of transplanted renal cortical elasticity with average measures of 0.9551, 95% CI 0.926 to 0.974 as well as for Vi-Plus with average measures of 0.8338, 95% CI 0.728 to 0.907. The Bland-Altman plot with multiple measures per subject displays a mean of 23.2±1.96 with a lower limit of 8.5 and an upper limit of 37.8. 2D-SWE with Aixplorer Mach 30 system shows a good intraclass correlation coefficient as well as good intraobserver reproducibility for both measures in renal cortical elasticity and viscosity. This can prove to be a low-cost way to provide additional diagnostic information in kidney transplanted patients. Further studies are required for this method to be introduced routinely into clinical practice. [ABSTRACT FROM AUTHOR]

Background & Aims: Ombitasvir/Paritaprevir/ritonavir/Dasabuvir (OBV/PTV/r+DSV) is one of the elective direct-acting antivirals (DAAs) recommended by international guidelines and the only one covered by the National Insurance System in Romania until November 2016. Our aim was to present the first prospective Romanian cohort evaluating the effectiveness and safety in clinical practice of this 3DAA combination in patients with HCV genotype-1b Child A liver cirrhosis. Methods: 681 patients received OBV/PTV/r+DSV+RBV for 12 weeks and were assessed clinically and biologically at baseline, week 4, 8, 12 (end of treatment, EOT), and 12 weeks after therapy (sustained viral response, SVR). Results: Per protocol, EOT virological response was 99.8% and SVR12 rate was 99.4%. Adverse events were present in 36.4% of patients. Permanent discontinuation of 3DAA regimen due to side effects was reported in 11 patients (1.6%). In 47.6% (185/389) of patients, Transient Elastography values were >20kPa (defined as clinically significant portal hypertension, CSPH) at baseline. Independent variables associated with CSPH were: baseline cholesterol level (p=0.003), platelet count <120,000/mm? (p=0.02), MELD score (p=0.01). Liver stiffness measurement has significantly improved between baseline (26.6±12.7kPa) and SVR12 (21.6±11.8kPa) (p<0.0001). The same was true for APRI score (2.66±0.15 at baseline vs 0.85±0.02 at SVR12, p<0.0001) and FIB4 score (5.53±0.28 vs 3.24±0.08, p<0.0001), but not for Lok score (0.57±0.01 vs 0.63±0.01, p<0.0001). Conclusions: We report a high efficacy of the 3DAA regimen in a homogeneous compensated HCV genotype- 1b liver cirrhosis population, in a real-life setting. Noninvasive fibrosis scores significantly improved at SVR12. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the performance of 2D shear-wave elastography from General Electric (2D-SWE.GE) for the noninvasiveassessment of liver fibrosis and to identify liver stiffness (LS) cut-off values for predicting different stages of fibrosisusing Transient Elastography (TE) as the reference method.Material and Method: We included 331 consecutive subjectswith or without chronic hepatopathies in whom LS was evaluated in the same session by means of 2 elastographic techniques:TE and 2D-SWE.GE. Reliable LS measurements were defined for TE as the median value of 10 measurements with a successrate of ≥60% and an interquartile range (IQR)<30% and for 2D-SWE.GE as the median value of 10 measurements acquiredin a homogenous area and an IQR<30%. To discriminate between TE fibrosis stages we used the following cut-offs: F2- 7;F3- 9.5 and F4- 12kPa.Results: Reliable LS measurements were obtained in 95.8% subjects by 2D-SWE.GE, and 94.2%by TE (p=0.44). Based on TE cut-off values we divided our cohort into four groups: F<2: 30.1%; F=2: 10.2%; F=3: 12.2%;F=4: 47.5%. A strong correlation was found between the LS values obtained by the 2 methods: r=0.83, p<0.0001.LS valuesobtained by 2D-SWE.GE were significantly lower than those obtained by TE: 10.14±4.24 kPa vs. 16.72±13.4 kPa (p<0.0001).The best cut-off value for F≥2, F≥3 and for F=4 were 6.7, 8.2 and 9.3 kPa.Conclusions: The best 2D-SWE.GE cut-off valuesfor predicting F≥2, F≥3 and F=4 were 6.7, 8.2 and 9.3kPa. [ABSTRACT FROM AUTHOR]

Aim: Reliable liver stiffness measurements (RLSM) using Transient Elastography (TE) with the standard M probe are difficult to obtain in overweight (BMI≥25kg/m2) and obese (BMI>30kg/m2) patients. The aim of our paper was to assess the feasibility of TE in daily practice using both M and XL probes. Material and Method: We studied retrospectively 3235 patients with chronic liver disease assessed by TE first by the M probe (standard probe – transducer frequency 3.5 MHz), and if the measurements were unreliable, with the XL probe (transducer frequency 2.5 MHz). Reliable measurements were defined as the median of 10 valid measurements with a success rate ≥ 60% and an interquartile range < 30%. Results of liver elasticity were expressed in kilo Pascals (kPa). Results: RLSM by M probe were obtained in 62.2% (2015/3235) patients, and by XL probe in 1011/1220 (80%) of patients with unreliable measurements by M probe; thus we obtained RLSM in 93.5% of 3235 cases. In overweight patients we obtained RLSM in 89.9% (1039/1156) cases: in 63.1% (729) by M probe and in 26.8% (310) by XL probe. In obese patients we obtained RLSM in 83.8% (746/890): in 18.4% (164) by M probe and in 65.4% (582) by XL probe. Thus, by using both probes, RLSM were obtained in 1785 (87.2%) of overweight and obese patients. Conclusion: The feasibility of the M probe was 62.2% in our Department. Reliable measurements using M or XL probe allowed the evaluation of liver stiffness in 93.5% of cases. By using both M and XL probes, reliable LSM by TE can be obtained in the majority of obese and overweight patients (87.2%). [ABSTRACT FROM AUTHOR]

Ultrasound (US) based elastographic techniques have become in the last years reliable tools for predicting the severity of liver fibrosis in chronic hepatopathies. Usually, they are integrated with high-end US machines but recently they also became available in medium-range ones. The aim of this study was to present the normal liver stiffness (LS) values obtained using 2 different ultrasound machines (one high-end and one medium-range) as well as 3 different probes We evaluated LS using shear wave elastography (SWE) methods, both point SWE (p-SWE) and 2DSWE, integrated with 2 ultrasound machines: Siemens Sequoia, using the 5C1, DAX and 4V1 probes and Siemens Juniper using 5C1 probe. Patients without known liver pathology, with a normal US examination aged 26 – 76 years were included. All patients underwent conventional ultrasound examination, and transient elastography (TE) measurements were performed as a reference method for fibrosis severity assessment. Patients with LS values higher than 7kPa were excluded (considered to have at least significant fibrosis). We made 10 measurements by each probe, using each elastography technique available and median values were calculated Conventional US and TE were performed in 66 patients without known liver pathology. After applying the exclusion criteria, 50 patients remained (mean age – 50.88 years, mean BMI - 29.09 kg/m2). The mean LS value by p-SWE using Siemens Juniper with the 5C1 probe was 3.02 ± 0.84 kPa, significantly lower than TE 4.84 ± 1.08kPa (p < 0.005). The mean value using p-SWE Siemens Sequoia with the 5C1, DAX and 4V1 probes were 3.29 ± 0.74 kPa, 2.96 ± 0.6kPa and 3.09 ± 0.71 kPa, all significantly lower than TE (p < 0.005). 2D SWE measurements were made using the Siemens Sequoia with the 5C1 probe and the DAX probe, with mean LS values of 2.66 ± 0.75 kPa and 2.8 ± 0.99 kPa, these values were also significantly lower than those obtained by TE. A comparison was made between all the probes both using 2DSWE and p-SWE, no significant differences were found (p > 0.05). In healthy individuals, average liver stiffness values by Siemens Juniper point SWE (5C1 probe) as well as by Siemens Sequoia using 2DSWE (5C1, DAX probes) and point SWE (5C1, DAX and 4V1 probes) ranged between 2.66 kPa and 3.09 kPa and were significantly lower as compared to TE. No significant differences were found when comparing point and 2DSWE measurements with the two systems among different probes. [ABSTRACT FROM AUTHOR]

Liver fibrosis is a progressive process leading to liver cirrhosis. Several non-invasive elastography techniques were developed in order to perform liver stiffness measurements (LS). The aim of this study was to evaluate the performance and feasibility of 2D-Shear Wave Elastography (2D-SWE) for liver fibrosis (LF) assessment using Transient Elastography (TE) as the reference method. 67 subjects were included, 65% (44/67) male, mean age 55.6 ± 13.2, in which LS was evaluated in the same session by TE (FibroScan Compact M 530) and 2D-SWE (Samsung-Medison RS85). Reliable LS measurements were defined for TE the median value of 10 measurements with an IQR/M≤30%, while for 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 cut-off value ≥ 7 kPa for at least significant liver fibrosis [1]. Reliable measurements by TE and 2D-SWE were obtained in all 67 cases. A strong correlation was found between 2D-SWE and TE, r=0.83. The best cut-off value for 2D-SWE in identifying at least significant fibrosis (F≥2) was >7 kPa [AUROC=0.91, 95% CI (0.82;0.97), p<0.0001, Se=81.8%, Sp=80.0%, PPV=66.7%, NPV=90.0%]. 2D-SWE is a feasible method for assessing liver fibrosis, that strongly correlates with TE results. [ABSTRACT FROM AUTHOR]

Liver steatosis can progress to nonalcoholic steatohepatitis and liver cirrhosis, becoming one of the leading indications for liver transplantation. Therefore, early detection and staging of steatosis is very important. In addition to Transient Elastography (TE) with Controlled Attenuation Parameter (CAP), several methods were developed for steatosis assessment. The aim of our study was to evaluate the feasibility of two new quantitative ultrasound (QUS) parameters, TSI (tissue scatter-distribution imaging) and TAI (tissue attenuation imaging) for steatosis diagnosis considering CAP as reference. A prospective study was conducted in which liver steatosis was assessed in 67 patients (65.7% men, mean age 55.6 ± 13.2 years), evaluated in the same session by QUS and CAP implemented on the following systems: Samsung Medison RS85 (CA1-7A probe) and FibroScan Compact M 530 (M and XL probes), respectively. For CAP, reliable measurements were defined as the median value of 10 measurements with IQR/M<0.3. For QUS, five consecutive measurements of TAI and TSI were acquired by a color-coded map overlaid on B-mode ultrasound. Attenuation coefficient and scatter-distribution coefficient were automatically calculated and reliable measurements were defined as an reliability index, R2 over 0.6. The cut-off value by CAP for identifying the presence of at least mild steatosis was 248 dB/m [1]. Reliable measurements by CAP and TAI/TSI were obtained in 100% of cases. Moderate correlations between steatosis assessment methods were observed: TAI vs. CAP r=0.67, TSI vs. CAP r=0.53, TSI vs. TAI, r=0.63. The best cut-off value for TAI to identify at least mild steatosis was > 0.66 (AUROC=0.87, p<0.0001, Se=81.2%, Sp=84.2%, PPV=92.9%, NPV=64%). The best cut-off value for TSI for identifying at least mild steatosis was > 96.2 (AUROC=0.81, p<0.0001, Se=81.2%, Sp=84.2%, PPV=88.6%, NPV=64%). TAI and TSI are feasible methods for assessing liver steatosis, which moderately correlate with CAP measurements. [ABSTRACT FROM AUTHOR]

Unlabelled: The AIM of this paper is to establish the values of liver stiffness (LS) assessed by means of ARFI in patients without known liver pathology and considered healthy subjects. Material and Method: the study group was composed of 82 subjects without known liver pathology, healthy volunteers or patients from other departments of our hospital who did not have altered liver laboratory tests. 76 patients had ARFI valid measurements (47 women and 29 men, mean age 34.5 +/-14.3 years). In each subject abdominal ultrasound was performed (patients with steatosis or any other signs of chronic liver pathology were excluded) as well as ARFI (using Siemens Acuson S2000). The median value of 10 measurements was calculated, expressed in m/s; we considered valid only the measurements with IQR<30%, SR>60%, similar to transient elastography. Mean ARFI values and mean values according to age and gender were evaluated. Results: valid ARFI measurements were obtained in 76/82 patients (92.6%). The mean value of ARFI measurements in normal individuals was 1.15+/-0.21 m/s. There were no significant differences between the mean ARFI values in men vs. women (1.16+/-0.21 vs. 1.14+/-0.22m/s, p=0.67), also among different age groups (p>0.05). Conclusion: In our study the mean LS value obtained by ARFI in healthy subjects was 1.15 m/s. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility and usefulness of two novel elastographic methods, integrated in the same ultrasound machine (Samsung-Medison RS85), one pSWE and one 2D-SWE, for liver fibrosis (LF) assessment using Transient Elastography (TE) as the reference method. Our study included 115 subjects, with or without chronic liver disease, in which LF was evaluated in the same session by means of Transient Elastograpy (Fibroscan, EchoSens) and by pSWE and 2D-SWE techniques integrated in the same ultrasound machine (Samsung-Medison RS85 Ultrasound Machine). Reliable liver stiffness (LS) measurements were defined as follows: for TE as the median values of 10 measurements with a success rate of more than 60% and an interquartile range/median ratio (IQR/M)<30%; for pSWE as the median value of 10 measurements with a reliability measurement index (RMI)>0.5 and an IQR/M<30%; and for 2D-SWE as the median value of 10 measurements obtained in an homogenous area with the same quality criteria as for pSWE. For classification of liver fibrosis severity we used TE as reference method with the following cut-offs: F2≥7kPa, F3≥9.5 kPa and F4≥12 kPa. 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: fibrosis 5.9 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%) and for 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%). The best cut off values calculated for 2d-SWE are: for 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%), and for 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%). The novel pSWE and 2D-SWE are feasible methods for assessing liver fibrosis, both techniques strongly correlating with TE results. [ABSTRACT FROM AUTHOR]

The aim of the study was to highlight the prevalence of liver fibrosis stages assessed by means of transient elastography (TE) in large cohort of patients in a single study centre. 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. The feasibility in our cohort was 90.1%, 2238 of 22400 measurements (9.9%) were failed or unreliable. 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%). 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]

Liver stiffness (LS) measurements by Transient Elastography (TE) has been accepted as a tool for fibrosis assessment. The aim of the study was to evaluate what happens with liver stiffness values after DAA (Direct-acting antivirals) therapy, in patients with compensated HCV cirrhosis, who had sustained virologic response (SVR) and to highlight in how many LS values become lower than the accepted cut-off for cirrhosis. A number of 167 patients with compensated HCV cirrhosis who had LS > 12 kPa at baseline, underwent a 12 weeks DAA therapy (Viekirax/Exviera) and had SVR. 56 of them were followed up by TE 24 weeks after EOT (end of treatment) and also 48 weeks after EOT (SVR 48). A subgroup of 28 patients were followed up 96 weeks after EOT (SVR 96). LS values were assessed by means of TE (FibroScan, Echosens) at the start of treatment (ST), at SVR 12 (12 weeks from EOT), SVR 24, SVR 48 and SVR 96, respectively. In each session, 10 valid liver stiffness measurements (LSM) were obtained and reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M) ≤ 30%. LS mean values at SVR12 were significantly lower as compared to ST (16.6 ± 6.87 kPa vs 21.3 ± 8.8, p = 0.002). As compared to SVR12, at SVR24 the mean LS values remained stable (16.6 ± 6.87 vs 16.9 ± 6.87 kPa, p = 0.81) and at SVR48 the values continued to decrease, but without statistical significance (14.6 ± 5.3 vs 16.6 ± 6.87 kPa, p = 0.08). LS was < 12 kPa in 14% of patients at SVR12, in 16% of patients at SVR24 and in 27% patients at SVR48. In the subgroup of 28 patients evaluated at SVR96, the mean LS values decreased significantly as compared to SVR12 (11.6 ± 4.6 vs. 15.5 ± 6.2 kPa, p = 0.009), and 46% had LS < 12 kPa. In compensated HCV cirrhotic patients, the mean LS values significantly decreased at SVR12, remained stable at SVR24 and decreased at SVR48; 14 % patients had LS values < 12 kPa at SVR12, 16% at SVR 24 and 27% at SVR 48. In the subgroup of patients followed up at SVR96, almost half had LS values lower than 12 kPa. [ABSTRACT FROM AUTHOR]

While most ultrasound elastography methods employ transient stimulation methods, the new time harmonic elastography (THED) relies on time-harmonic vibrations in the same manner as magnetic resonance elastography. The aim of our study was to assess the performance of the THED system for ruling in/out liver cirrhosis (LC) considering transient elastography (TE) as the reference method, as well as and the correlation of THED values with TE. We evaluated by THED a group of 70 patients. Each subject has been fasting for more than 6 hours before evaluation. 10 valid LS measurements were performed in the same day, both by THED and by TE. We used the TE cut-off values published by Tsochatzis (1): significant fibrosis (F ≥ 2)- 7.0kPa and for LC (F = 4)- 12kPa as reference values. Quality criteria recommended by the manufacturer: SR ≥ 60%, IQR < 30% have been used for each subject. For a better work flow we transformed the measurement units also in KPa. From the 70 patients, 34 were women and 36 men. Mean age 55.2 ± 11.7, mean BMI 27.8 ± 6.2 kg/m2. Of the 70 patients, 15.8% (11/70) were F4, 25.7% (18/70) were F2-3, 58.5 % (41/70) were F0-1.We had 100% feasibility for all the patients that were previously evaluated by TE. The cut-off for ruling out LC by THED measurements on our study group was < 1.5 m/s (7.2 KPa) , AUROC = 0.83, 95%CI (0.73-0.91), P < 0.0001, Se = 100%, Sp = 35.1%, PPV = 31.4%, NPV = 100%. The cut-off for ruling in LC by THED measurements was > 2 m/s (11.9 kPa). AUROC = 0.83, 95%CI (0.73-0.91), P < 0.0001, Se = 18%, Sp = 100%, PPV = 100, NPV = 80.6%. There was a direct, positive and strong correlation between LS measurements by THED and TE evaluated with Pearson correlation coefficient, r = 0.73, p < 0.001. In our study, the cut-of values to rule-out and rule-in LC by LS measurements with THED system were < 7.2 KPa and > 11.9 kPa, respectively. There was a strong correlation between the LS values obtained by the two elastographic methods. [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]

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]