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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.

Background & Aims: Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis., Methods: We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index <30 kg/m 2 were examined with the medium probe and those with a body mass index ≥30 kg/m 2 were examined with the extra-large probe. Linear regression models were conducted after adjusting for potential confounding factors of LSMs. We performed several sensitivity analyses., Results: We established LSM ranges for healthy individuals measured with both probes-these did not change significantly in sensitivity analyses of individuals with platelets ≥150,000/mm 3 and levels of alanine aminotransferase ≤33 IU/L in men or ≤25 IU/L in women. In multivariate analysis, factors that modified LSMs with statistical significance included diabetes, dyslipidemia, waist circumference, level of aspartate aminotransferase, and systolic blood pressure at examination time. Significant increases in LSMs were associated with the metabolic syndrome in individuals examined by either probe. Diabetes in obese individuals increased the risk of LSMs in the range associated with advanced fibrosis., Conclusions: In a systematic review and meta-analysis of data from individual participants, we established a comprehensive set of LSM ranges, measured by TE in large cohorts of healthy individuals and persons susceptible to hepatic fibrosis. Regression analyses identified factors associated with increased LSMs obtained by TE with the medium and extra-large probes., (Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.)

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.

Shear wave elastography (SWE) has been developed to non-invasively estimate liver stiffness. Different techniques are available and they are described in detail in the EFSUMB guidelines on elastography. However, there are only a few published studies investigating normal ranges in healthy subjects by comparing different equipment and analysing influencing factors. In the present review, we summarize the impact factors on liver stiffness measurement (LSM) using SWE, report its reproducibility, and define normal range tables of LSM in healthy subjects for clinical practice according to the published literature., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. The aim of our study was to evaluate a population of diabetic patients regarding the severity of liver steatosis and liver fibrosis., Methods: The study included 392 type 2 diabetic patients prospectively randomized, evaluated in the same session by transabdominal ultrasound to assess steatosis and by liver elastography to assess fibrosis (Transient Elastography - TE, FibroScan, EchoSens). Steatosis severity was graded using a semi-quantitative scale (S0-no steatosis; S1-mild steatosis; S2-moderate steatosis; S3-severe steatosis). For differentiation between stages of liver fibrosis, the following cut-off values were used (Wong et al., 2010): F2-F3: 7-10.2kPa, F4>/=10.3 kPa., Results: Reliable elastographic measurements were obtained in 76% (298/392) patients. By using the proposed cut-off values, significant fibrosis (F2-F3) was found in 18.8% (56) patients with steatosis, while 13.8% (41) had cirrhosis (F4). Significant fibrosis (F2-F3) was found in 20.4% (20/98) of the patients with S1, in 18.6% (22/118) of those with S2 and in 31.8% (14/44) of those with S3, while cirrhosis (F4) was diagnosed in 7.1% (7/98) patients with S1, in 20.3% (24/118) of those with S2 and in 22.7% (10/44) of those with S3., Conclusions: Liver steatosis diagnosed by ultrasound is very frequently found in type 2 diabetes mellitus patients, more than half of them having moderate/severe steatosis. A significant liver stiffness increase was found in more than 30% of these patients. Liver stiffness assessment in type 2 diabetic patients should be performed systematically to identify those with significant liver fibrosis.

Introduction: To identify liver stiffness (LS) cut-off values assessed by means of 2D-Shear Wave Elastography (2D-SWE) for predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method., Methods: Our prospective study included 383 consecutive subjects, with or without hepatopathies, in which LS was evaluated by means of TE and 2D-SWE. To discriminate between various stages of fibrosis by TE we used the following LS cut-offs (kPa): F1-6, F2-7.2, F3-9.6 and F4-14.5., Results: The rate of reliable LS measurements was similar for TE and 2D-SWE: 73.9% vs. 79.9%, p=0.06. Older age and higher BMI were associated for both TE and 2D-SWE with the impossibility to obtain reliable LS measurements. Reliable LS measurements by both elastographic methods were obtained in 65.2% of patients. A significant correlation was found between TE and 2D-SWE measurements (r=0.68). The best LS cut-off values assessed by 2D-SWE for predicting different stages of liver fibrosis were: F≥1: >7.1 kPa (AUROC=0.825); F≥2: >7.8 kPa (AUROC=0.859); F≥3: >8 kPa (AUROC=0.897) and for F=4: >11.5 kPa (AUROC=0.914)., Conclusions: 2D-SWE is a reliable method for the non-invasive evaluation of liver fibrosis, considering TE as the reference method. The accuracy of 2D-SWE measurements increased with the severity of liver fibrosis., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Acoustic Radiation Force Impulse (ARFI) elastography is a non-invasive technique for liver fibrosis assessment., Aim: To assess the feasibility of ARFI elastography in a large cohort of subjects and to identify factors associated with impossibility to obtain reliable liver stiffness (LS) measurements by means of this technique., Methods: Our retrospective study included 1031 adult subjects with or without chronic liver disease. In each subject LS was assessed by means of ARFI elastography. Failure of ARFI measurements was defined if no valid measurement was obtained after at least 10 shots and unreliable in the following situations: fewer than 10 valid shots; or median value of 10 valid measurements with a success rate (SR)<60% and/or an interquartile range interval (IQR) ≥ 30%., Results: Failure of LS measurements by means of ARFI was observed in 4 subjects (0.3%), unreliable measurements in 66 subjects (6.4%), so reliable measurements were obtained in 961 subjects (93.3%). In univariant analysis, the following risk factors were associated with failed and unreliable measurements: age over 58 years (OR=0.49; 95% CI 0.30-0.80, p=0.005), male gender (OR=0.58; 95% CI 0.34-0.94, p=0.04), BMI>27.7 kg/m(2) (OR=0.23, 95% CI 0.13-0.41, p<0.0001). In multivariate analysis all the factors mentioned above were independently associated with the risk of failed and unreliable measurements., Conclusions: Reliable LS measurements by means of ARFI elastography were obtained in 93.3% of cases. Older age, higher BMI and male gender were associated with the risk of failed and unreliable measurements, but their influence is limited as compared with Transient Elastography., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Our study compared three elastographic methods--transient elastography (TE), acoustic radiation force impulse (ARFI) imaging and supersonic shear imaging (SSI)--with respect to the feasibility of their use in liver fibrosis evaluation. We also compared the performance of ARFI imaging and SSI, with TE as the reference method. The study included 332 patients, with or without hepatopathies, in which liver stiffness was evaluated using TE, ARFI and SSI. Reliable measurements were defined as a median value of 10 (TE, ARFI imaging) or 5 (SSI) liver stiffness measurements with a success rate ≥60% and an interquartile range interval <30%. A significantly higher percentage of reliable measurements were obtained using ARFI than by using TE and SSI: 92.1% versus 72.2% (p < 0.0001) and 92.1% versus 71.3% (p < 0.0001). Higher body mass index and older age were significantly associated with inability to obtain reliable measurements of liver stiffness using TE and SSI. In 55.4% of patients, reliable liver stiffness measurements were obtained using all three elastographic methods, and ARFI imaging and TE were similarly accurate in diagnosing significant fibrosis and cirrhosis, with TE as the reference method., (Copyright © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background: Acoustic Radiation Force Impulse Elastography is a new method for non-invasive evaluation of liver fibrosis., Aim: To evaluate the impact of elevated alanine aminotransferase levels on liver stiffness assessment by Acoustic Radiation Force Impulse Elastography., Methods: A multicentre retrospective study including 1242 patients with chronic liver disease, who underwent liver biopsy and Acoustic Radiation Force Impulse. Transient Elastography was also performed in 512 patients., Results: The best Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis was 1.29 m/s in cases with normal alanine aminotransferase levels and 1.44 m/s in patients with alanine aminotransferase levels>5 × the upper limit of normal. The best cut-off for predicting liver cirrhosis were 1.59 and 1.75 m/s, respectively. Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis and cirrhosis were relatively similar in patients with normal alanine aminotransferase and in those with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal: 1.29 m/s vs. 1.36 m/s and 1.59 m/s vs. 1.57 m/s, respectively. For predicting cirrhosis, the Transient Elastography cut-offs were significantly higher in patients with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal compared to those with normal alanine aminotransferase: 12.3 kPa vs. 9.1 kPa., Conclusion: Liver stiffness values assessed by Acoustic Radiation Force Impulse and Transient Elastography are influenced by high aminotransferase levels. Transient Elastography was also influenced by moderately elevated aminotransferase levels., (Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Aims: This meta-analysis aims to compare the diagnostic performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis using liver biopsy (LB) as 'gold-standard'., Methods: PubMed, Medline, Lilacs, Scopus, Ovid, EMBASE, Cochrane and Medscape databases were searched for all studies published until 31 May 2012 that evaluated the liver stiffness by means of ARFI, TE and LB. Information abstracted from each study according to a fixed protocol included study design and methodological characteristics, patient characteristics, interventions, outcomes and missing outcome data., Results: Thirteen studies (11 full-length articles and 2 abstracts) including 1163 patients with chronic hepatopathies were included in the analysis. Inability to obtain reliable measurements was more than thrice as high for TE as that of ARFI (6.6% vs. 2.1%, P < 0.001). For detection of significant fibrosis, (F ≥ 2) the summary sensitivity (Se) was 0.74 (95% CI: 0.66-0.80) and specificity (Sp) was 0.83 (95% CI: 0.75-0.89) for ARFI, while for TE the Se was 0.78 (95% CI: 0.72-0.83) and Sp was 0.84 (95% CI: 0.75-0.90). For the diagnosis of cirrhosis, the summary Se was 0.87 (95% CI: 0.79-0.92) and Sp was 0.87 (95% CI: 0.81-0.91) for ARFI elastography, and, respectively, 0.89 (95% CI: 0.80-0.94) and 0.87 (95% CI: 0.82-0.91) for TE. The diagnostic odds ratio of ARFI and TE did not differ significantly in the detection of significant fibrosis [mean difference in rDOR = 0.27 (95% CI: 0.69-0.14)] and cirrhosis [mean difference in rDOR = 0.12 (95% CI: 0.29-0.52)]., Conclusion: Acoustic radiation force impulse elastography seems to be a good method for assessing liver fibrosis, and shows higher rate of reliable measurements and similar predictive value to TE for significant fibrosis and cirrhosis., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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 © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

The present study assessed the influence of food intake on acoustic radiation force impulse elastography (ARFI) measurements. Seventy-three healthy volunteers were included: 57 subjects in the study group (on whom ARFI measurements were performed first in fasting condition, followed by measurements made 1h and 3h after food intake); and 16 subjects in the control group (on whom ARFI measurements were performed 3 times during a 3-h interval without eating). All subjects included in the study group received the same standard solid meal. In the study group, the mean liver stiffness (LS) values by ARFI increased significantly 1 h after food intake (1.51 ± 0.40 m/s vs. 1.27 ± 0.23, p = 0.003), but 3 h after the meal the differences were no longer significant (1.46 ± 0.51 vs. 1.27 ± 0.23, p = 0.06). In the control group, the mean LS values were similar in all 3 measurements. In conclusion, food intake significantly increased the LS values, thus ARFI measurements should be performed in fasting conditions., (Copyright © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Aim: Liver biopsy (LB) is often essential for the diagnosis and staging of chronic viral hepatitis. The aim of our paper was to establish if the size of the biopsy needle influences the number of portal tracts obtained through LB., Material and Methods: We conducted a retrospective study on 596 echoassisted percutaneous LBs performed in the Department of Gastroenterology and Hepatology Timisoara during a 4 years period. We included only those biopsy results that had mentioned both the type of needle and the number of portal tracts. All LBs were echoassisted and performed with Menghini modified needles 1.4 and 1.6 mm in diameter (technique with two passages into the liver). The liver fragments were analyzed by a senior pathologist and Knodell score was used to describe necroinflammatory activity as well as fibrosis. We compared the number of portal tracts obtained with 1.4 vs. 1.6 Menghini needles., Results: Type 1.4 mm Menghini needles were used for 80 LBs, while 1.6 mm type were used in 516 LBs. Liver fragments obtained with 1.6 mm Menghini needles had a significantly higher mean number of portal tracts as compared to those obtained with 1.4 needles (24.5 ± 10.6 vs. 20.8 ± 8.6, p = 0.003)., Conclusion: The 1.6 mm Menghini needles provide better liver biopsy specimens, with higher number of portal tracts, as compared to 1.4 mm Menghini needles.

Aim: To establish an algorithm which includes the liver stiffness (LS) and/or spleen stiffness (SS) assessed by ARFI for the prediction of significant esophageal varices-EV (at least grade 2)., Material and Methods: Our study included 145 newly diagnosed cirrhotic patients admitted in our Department between September 2009-August 2011. 62 patients (42.7%) had significant EV. We performed 10 ARFI measurements in each patient, both in the liver and in the spleen; median values were calculated, expressed in meters/second. In 24 consecutive newly diagnosed cirrhotic patients admitted between September 2011-December 2011, we prospectively analyzed the value of the new score for predicting significant EV., Results: The LS and SS assessed by ARFI elastography, and the percentage of patients with ascites were stastically significant higher in patients with significant EV as compared with those without EV or grade 1 EV. By multiple regression analysis we obtained the following formula for predicting significant EV: prediction of significant EV (Pred EV(2-3)) score: -0.572 + 0.041 x LS (m/s) + 0.122 x SS (m/s) + 0.325 x ascites (1-absent, 2-present). The best Pred EV(2-3) cut-off value for predicting significant EV was > 0.395 (AUROC = 0.721, accuracy = 69.6%). The accuracy in the group of patients in which the value of this score was prospectively analyzed was similar with that obtained in the first cohort of patients (70.8 vs. 69.6%). In conclusion, the proposed Pred EV(2-3) score had a enough good value for predicting significant EV.

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.

Aim: To assess the values of liver stiffness (LS) in patients with hepatitis B virus (HBV) chronic hepatitis and to compare them with those in patients with hepatitis C virus (HCV) chronic hepatitis., Methods: The study included 140 patients with HBV chronic hepatitis, and 317 patients with HCV chronic hepatitis, in which LS was measured (FibroScan®-Echosens®) and liver biopsy was performed in the same session (assessed according to the Metavir score)., Results: According to the Metavir score of the 140 HBV patients: one had F0, 32 had F1, 67 had F2, 33 had F3 and 7 had F4. Of the 317 HCV patients: 5 had F0, 34 had F1, 146 had F2, 93 had F3 and 39 had F4. For the same severity of fibrosis, the mean values of LS in HBV patients were similar to those in HCV patients: F1, 6.5 ± 1.9 kPa vs 5.8 ± 2.1 kPa (P = 0.0889); F2, 7.1 ± 2 kPa vs 6.9 ± 2.5 kPa (P = 0.3369); F3, 9.1 ± 3.6 kPa vs 9.9 ± 5 kPa (P = 0.7038); F4, 19.8 ± 8.6 kPa vs 17.3 ± 6.1 kPa (P = 0.6574). A significant direct correlation between LS measurements and fibrosis was found in HCV patients (Spearman's r = 0.578, P < 0.0001), as well as in HBV patients (r = 0.408, P < 0.0001). The correlation was more significant in HCV than in HBV patients (Fisher's Z-test, Z = 2.210, P = 0.0271)., Conclusion: In our group, the mean values of LS in patients with chronic B hepatitis were similar to those in patients with chronic HCV hepatitis, for the same stage of fibrosis. Also, LS was correlated with the severity of fibrosis both in HBV and HCV chronic hepatitis patients.

Background and Aim: Chronic liver diseases are investigated through invasive (liver biopsy) or non-invasive (FibroScan or FibroTest) methods. Recently the non-invasive methods have become more and more popular. The aim of this paper is to evaluate the liver stiffness (LS) measured by transient elastography in individuals without known hepatic pathology ("normal" subjects) and to see if it is influenced by age., Material and Method: We examined a group of "normal" subjects by means of a FibroScan device (EchoSens, France). In each patient we performed 10 valid measurements and a median value was calculated by the device. The subjects were individuals without known hepatic pathology: healthy volunteers or patients from departments other than Gastroenterology in our hospital., Results: We evaluated 152 "normal" subjects (87 women and 65 men, mean age 45.3 + or - 17.6 years). The mean value of LS in "normal" subjects was 4.8 + or - 1.3 kPa, ranging from 2.3 to 8.8 kPa. The mean values of LS in age subgroups were: 18-29 years - 5 + or - 1.3 kPa; 30-39 years - 4.5 + or - 1.2kPa; 40-49 years - 5 = or - 1.1kPa; 50-59 years - 4.7 + or - 1.2kPa; 60-69 years - 5 + or - 1.3kPa; >70 years - 4.7 + or - 1.4kPa. There were no statistically significant differences between the mean values of LS in various age subgroups (p=0.5263)., Conclusions: The mean value of LS measured by transient elastography in "normal" subjects was lower than 5 kPa. Age does not modify the LS.

Unlabelled: The AIM of our study was to evaluate the results of transient elastography assessment of liver stiffness (LS) in various categories of patients., Material and Method: We performed transient elastography in 986 patients. We evaluated: the percentage of cases in which valid measurements could be obtained; the values of LS in 40 patients with no history of chronic liver disease ("normal" patients); 44 inactive HBsAg carriers; 173 patients with proven liver cirrhosis; and the correlation between liver biopsy results and LS in 93 patients with chronic HCV hepatitis., Results: We obtained valid measurements of LS in 94.6% of the 986 cases. Male gender, younger age and low BMI were positive predictive factors for obtaining valid measurements. The mean values of LS were: 5.2+/-1.3 kPa in "normal" patients, 5.8+/-2.6 kPa in inactive HBsAg carriers, 37.2+/-20.9 kPa in patients with liver cirrhosis. In patients with chronic HCV hepatitis, we found that the mean value of LS in those with METAVIR F>=2 was 8.5+/-4.2 kPa, higher than in those with F<2: 5.3+/-1.4 kPa (p=0.0017). In patients with F>=3, the mean value of LS was 11.1+/-4.3 kPa, significantly higher than in patients with F<3: 6.1+/-2.5 kPa (p<0.0001)., Conclusions: Liver stiffness, as a marker of fibrosis, can be evaluated by means of transient elastography in a great majority of patients. It is a useful method for the exclusion of significant liver fibrosis and for predicting liver cirrhosis. As compared to liver biopsy, transient elastography can discern significant fibrosis from no or mild fibrosis.

Aim: To compare the liver stiffness (LS) measurement by transient elastography (TE) to the liver biopsy (LB)-considered the "gold standard" in the evaluation of patients with chronic hepatitis C., Methods: During a period of 12 mo, we evaluated 199 consecutive patients with chronic hepatitis due to hepatitis C virus (HCV), in which LB and LS assessments (by means of TE) were performed during the same session., Results: Out of 199 patients, a valid measurement of the LS could not be obtained in 8. The mean value of LS in the cohort of 191 valid measurements was 8.45 +/- 4.96 kPa, ranging from 2.3 to 38 kPa. The mean value of LS in patients with significant fibrosis at biopsy (161 patients with F >= 2 according to Metavir) was 9.02 +/- 5.15 kPa, significantly higher than in patients with no or mild fibrosis (30 patients with F < 2 Metavir): 5.39 +/- 1.81 kPa (P < 0.0001). For a cut-off value of 6.8 kPa, the LS had a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6% and a specificity of 93.3% for the presence of significant fibrosis (at least F2 Metavir), with a diagnostic performance of 77.3% (AUROC 0.773). Using this cut-off value, we reached the best discrimination between absence of fibrosis/mild fibrosis (F < 2 Metavir) and the presence of moderate to severe fibrosis (F >= 2 Metavir)., Conclusion: In patients with chronic hepatitis due to HCV, a cut-off value of 6.8 kPa measured by TE can differentiate between significant fibrosis and absent or mild fibrosis, with a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6%, a specificity of 93.3%, and a diagnostic performance of 77.3%.

Chronic viral hepatitis is a common disease in the general population. During chronic hepatitis, the prognosis and clinical management are highly dependent on the extent of liver fibrosis. The fibrosis evaluation can be performed by FibroTest (using serological markers), by Elastography or FibroScan (a noninvasive percutaneous technique using the elastic properties of the hepatic tissue) and by liver biopsy (LB), considered to be the "gold standard". Currently, there are three techniques for performing LB: percutaneous, transjugular and laparoscopic. The percutaneous LB can be performed blind, ultrasound (US) guided or US assisted. There are two main categories of specialists who perform LB: gastroenterologists (hepatologists) and radiologists, and the specialty of the individual who performs the LB determines if the LB is performed under ultrasound guidance or not. There are two types of biopsy needles used for LB: cutting needles (Tru-Cut, Vim-Silverman) and suction needles (Menghini, Klatzkin, Jamshidi). The rate of major complications after percutaneous LB ranges from 0.09% to 2.3%, but the echo-guided percutaneous liver biopsy is a safe method for the diagnosis of chronic diffuse hepatitis (cost-effective as compared to blind biopsy) and the rate of complications seems to be related to the experience of the physician and the type of the needle used (Menghini type needle seems to be safer). Maybe, in a few years we will use non-invasive markers of fibrosis, but at this time, most authorities in the field consider that the LB is useful and necessary for the evaluation of chronic hepatopathies, despite the fact that it is not a perfect test.

Unlabelled: The aim of our paper was to assess the quality of the liver fragment obtained by liver biopsy for staging chronic hepatitis., Material and Method: We analyzed retrospectively 250 echoassisted percutaneous liver biopsies (LB) concerning the length of the fragment and the mean number of portal spaces. We used Menghini modified needles 1.4 and 1.6 mm in diameter and the LBs were performed by the same senior hepatologist., Results: The indications for the LB were represented by: chronic hepatitis C in 69 % (172 cases), chronic hepatitis B in 17 % (43 cases), chronic hepatocytolysis in 10% (25 cases), primary billiary cirrhosis in 1.5% (4 cases), chronic B+C hepatitis in 3 cases, autoimmune chronic hepatitis in 2 cases and Wilson's disease in 1 case. From the 250 LBs, in 87% of cases (217 patients) the liver sample had 8-10 portal spaces ("good fragment") and in 69% of cases (173 patients) the liver sample had at least 11 portal spaces ("very good fragment"). In 13% of the cases (33 liver biopsies) the histological sample was suboptimal, less than 8 portal spaces. In 1.6% of the cases (4 biopsies), the liver sample was not adequate for the diagnosis (less than 4 portal spaces), so that we had to perform a second biopsy (in another session). In 88% cases (219 subjects), the length of the liver fragment obtained was longer than 2 cm and only in 12% of cases (31 patients) the fragment was smaller than 2 cm. The median length of the fragment obtained by LB in our department was 30.8 +/- 8.7 mm, and the mean number of portal spaces was 14.9 +/- 7.09., Conclusion: In experienced hands, percutaneous liver biopsy can obtain "good" histological material in the vast majority of cases.

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]

Background: Multiparametric ultrasound (MPUS) is a concept whereby the examiner is encouraged to use the latest features of an ultrasound machine. The aim of this study was to reanalyze inconclusive focal liver lesions (FLLs) that had been analyzed via contrast enhanced ultrasound (CEUS) using the MPUS approach with the help of a tree-based decision classifier. Materials and methods: We retrospectively analyzed FLLs that were inconclusive upon CEUS examination in our department, focusing our attention on samples taken over a period of two years (2017−2018). MPUS reanalysis followed a three-step algorithm, taking into account the liver stiffness measurement (LSM), time–intensity curve analysis (TIC), and parametric imaging (PI). After processing all steps of the algorithm, a binary decision tree classifier (BDTC) was used to achieve a software-assisted decision. Results: Area was the only TIC-CEUS parameter that showed a significant difference between malign and benign lesions with a cutoff of >−19.3 dB for washout phenomena (AUROC = 0.58, Se = 74.0%, Sp = 45.7%). Using the binary decision tree classifier (BDTC) algorithm, we correctly classified 71 out of 91 lesions according to their malignant or benignant status, with an accuracy of 78.0% (sensitivity = 62%, specificity = 45%, and precision = 80%). Conclusions: By reevaluating inconclusive FLLs that had been analyzed via CEUS using MPUS, we managed to determine that 78% of the lesions were malignant and, in 28% of them, we established the lesion type. [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]

Aim: To evaluate the range of liver stiffness (LS) cut-off values for predicting different stages of liver fibrosis (LF) for 2D-SWE-GE implemented on three different systems from General Electric Healthcare (LOGIQ E9, LOGIQ S8, LOGIQ P9).Material and Method: We performed a comparative study evaluating the performance of 2D-SWE-GE (LOGIQ E9, S8, P9) for predicting different stages of LF using Transient Elastography (TE) as the reference method. All patients (with or without chronic hepatopathies) were evaluated by TE, 331 patients were included in the LOGIQ E9 study, 179 in the LOGIQ S8 study and 234 in the LOGIQ P9 study. Reliable liver stiffness measurements (LSM) were defined for TE as the median value of 10 measurements with an interquartile range/median ratio (IQR/M)≤0.30 and for 2D-SWE-GE as the median value of 10 measurements and IQR/M≤0.30.Results: Reliable LSM was obtained by both methods in 91.5% subjects of the LOGIQ E9 group, in 95.5% subjects from the LOGIQ S8 group and in 87.6% subjects in the LOGIQ P9 group. The performance of 2DSWE-GE for predicting F≥2 with LOGIQ E9, LOGIQ S8 and LOGIQ P9 systems were: cut-offs 6.7 kPa, 6.9 kPa and 6.8 kPa; AUCs 0.95, 0.92 and 0.93. For predicting F≥3, the performances were: cut-offs - 8.2 kPa, 8.2 kPa and 7.6 kPa; AUCs - 0.97, 0.93 and 0.94. For predicting F4, the performances were: cut-offs - 9.3 kPa, 9.3 kPa and 9.3 kPa; AUCs - 0.96, 0.91 and 0.91.Conclusion: The LS cut-off values for 2D-SWE-GE implemented on different systems for predicting F≥2, F≥3 and F=4 are not significantly different. [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]

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]

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 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]

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]