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Background Percutaneous biopsy is a widely-accepted technique for acquiring histologic samples of the liver. When there is concern for bleeding, plugged percutaneous biopsy (PPB) may be performed, which involves embolization of the biopsy tract. Purpose To evaluate the efficacy and safety of PPB of the liver in patients suspected to have graft rejection after living-donor liver transplantation (LDLT). Material and Methods During January 2007 and December 2013, 51 patients who underwent PPB of the liver under the suspicion of post-LDLT graft rejection were retrospectively analyzed. A total of 73 biopsies were performed. Biopsy was performed with a 17-gauge core needle and 18-gauge cutting needle. The needle tract was embolized using gelatin sponge (n = 44) or N-butyl cyanoacrylate (NBCA) (n = 29). The specimens were reviewed to determine their adequacy for histologic diagnosis. We reviewed all medical records after PPB. Results Specimens were successfully acquired in all procedures (100%). They were adequate for diagnosis in 70 cases (95.9%) and inadequate in three (1.3%). Average of 9.8 complete portal tracts was counted per specimen. One minor complication (1.4%) occurred where the patient had transient fever after the procedure. Conclusion PPB is easy and safe to perform in LDLT recipients and provides high diagnostic yield.

The purpose of the present study is to compare the diagnostic accuracy of the splenic arterial resistive index (SARI) with that of liver stiffness measurement (LSM) for identifying patients with clinically significant portal hypertension (CSPH). We included 47 patients (M:F = 37:10) who underwent Doppler ultrasonography, LSM and hepatic venous pressure gradient (HVPG) on the same day. We investigated whether the SARI and LSM were correlated with the HVPG, and compared area under the curve (AUC) values for the abilities of SARI and LSM to diagnose CSPH. We also performed a sub-group analysis. The SARI and LSM were all moderately correlated with HVPG overall in patients. The AUC of SARI and LSM were 0.873 and 0.745, respectively. In patients without splenomegaly, SARI was strongly correlated with HVPG (r = 0.830), but LSM was moderately correlated with HVPG (r = 0.601). The AUC was also higher for SARI than for LSM. Therefore, SARI is potentially an excellent non-invasive measurement method for diagnosing CSPH, especially those without splenomegaly., (Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background & Aims: To assess the correlation between liver stiffness measurement (LSM) by real-time shear wave elastography (SWE) and hepatic venous pressure gradient (HVPG) and to investigate the diagnostic performance of SWE for predicting clinically significant and severe portal hypertension (CSPH and SPH)., Methods: Clinical data of 115 cirrhotic patients with haemodynamic measurement were consecutively collected. Liver stiffness (LS) was measured using SWE by repeated performance five times per patient, and the median value and interquartile range of the parameters on the same day of HVPG measurement was calculated. CSPH and SPH were defined as a HVPG ≥10 mmHg and ≥12 mmHg respectively., Results: A total of 92 patients (male, 63; mean age, 53 ± 11.9 years) were eligible for analysis. CSPH and SPH were detected in 77 patients (83.7%) and 66 patients (71.5%) respectively. HVPG were significantly correlated with LSM in the overall, CSPH, and SPH patients (r = 0.646, 0.574 and 0.424 respectively; all P < 0.001). With ascites, the correlation coefficient did not decrease (r = 0.587). The AUROCs of LSM was 0.819 (95% CI, 0.725-0.892) for CSPH and 0.867 (95% CI, 0.780-0.928) for SPH. The cut-off values for determining CSPH and SPH were 15.2 kPa (Sensitivity, 85.7%; Specificity, 80.0%) and 21.6 kPa (Sensitivity, 83.3%; Specificity, 80.8%) respectively., Conclusion: In cirrhotic patients, LSM by SWE is highly correlated with HVPG value regardless of ascites. SWE is a new reliable non-invasive diagnostic tool to predict CSPH and SPH, even in cirrhotic patients with ascites., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of this study was to investigate the value of liver stiffness in patients without liver disease using shear wave elastography and to determine the liver stiffness threshold value for identifying patients with chronic liver diseases., Methods: A total of 150 patients who underwent liver sonography coupled with shear wave elastography were enrolled. On the basis of clinical and pathologic criteria, they were assigned to 1 of 2 groups: nondiseased liver (n = 97) and noncirrhotic chronic liver disease (n = 53). Liver stiffness was measured in the right liver, and the median value of 10 measurements was calculated. Both mean and median values in the nondiseased liver group were compared with those in the noncirrhotic chronic liver disease group. To validate this comparison, liver stiffness of the patients who underwent liver biopsy revealing either no fibrosis (fibrosis score F0; n = 5) or substantial fibrosis (F2; n = 14) was also investigated and compared. To determine the optimal threshold value for determining chronic liver disease, a receiver operating characteristic curve analysis was performed., Results: The mean liver stiffness value in the nondiseased liver group was 5.4 kPa. In the noncirrhotic chronic liver disease group, the mean value was 8.1 kPa. Differences between the nondiseased liver and both noncirrhotic chronic liver disease groups were statistically significant (P < .001). The optimal liver stiffness threshold value for discriminating nondiseased liver from noncirrhotic chronic liver disease was 6.9 kPa. The sensitivity using this threshold was 94%. In the biopsy-proven patients, the mean liver stiffness values were 6.0 kPa in the F0 group and 9.9 kPa in the F2 group., Conclusions: The range of liver stiffness in patients with nondiseased liver and the optimal threshold value for discriminating these patients from those with chronic liver disease were identified.