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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: Many of the patients presenting with metabolic syndrome (MetS) also have liver steatosis (NAFLD) and some of them could develop liver fibrosis. Purpose: To develop a simple score that could rule out fibrosis, especially significant fibrosis (F≥ 2) and could be used in daily practice in patients with MetS, in order to identify patients at risk. Patients and Methods: A total of 204 patients with MetS were prospectively enrolled. Evaluation of liver fibrosis was made using Vibration Controlled Transient Elastography while evaluation of steatosis was achieved using ultrasound (US). Results: Out of 204 patients with MetS, 179 patients (87.7%) had reliable liver stiffness measurements and 22.9% (41/179) had F ≥ 2. To formulate the fibrosis predicting score, all clinical variables associated with F ≥ 2 in the univariate analysis were considered in a multivariate regression model. According to the power of correlation, by consensus, we attributed 1 point for BMI > 31.4 kg/m2, 1 point for female gender, 1 point for HDLc < 47mg/dL, 1 point for mild steatosis at US, 1.5 point for moderate and 2 points for severe steatosis. Conclusion: At an optimal cut-off value of < 3.5, our score could be used to rule-out the risk for developing at least significant fibrosis with a high negative predictive value (NPV 89.2%) in patients with MetS. [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]

Abstract: 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 1.29m/s in cases with normal alanine aminotransferase levels and 1.44m/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 1.75m/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: 1.29m/s vs. 1.36m/s and 1.59m/s vs. 1.57m/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: 12.3kPa vs. 9.1kPa. 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 &y& Elsevier]

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. [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]

Abstract: Our aim was to compare liver stiffness (LS) measurements by means of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in patients with chronic hepatitis B and C, according to the severity of fibrosis. We also compared the correlation strength of ARFI and TE measurements with liver fibrosis. We included 53 patients with hepatitis B and 107 with hepatitis C in which liver biopsy, ARFI and TE measurements were performed in the same session. The mean LS values measured with ARFI were similar in patients with chronic hepatitis B and C and depended on the stage of fibrosis. The correlation strength of LS measurements by ARFI and by TE with fibrosis was similar in chronic hepatitis B and C patients. In conclusion, for the same stage of fibrosis, the mean LS values by ARFI were similar in patients with chronic hepatitis B and C. ARFI had similar predictive value with TE in both chronic viral hepatitis. [Copyright &y& Elsevier]

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: Type 2 diabetes mellitus (T2DM), obesity, hyperlipidemia, and hypertension are considered risk factors for developing non-alcoholic fatty liver disease (NAFLD). This study aims to assess steatosis and fibrosis severity in a cohort of T2DM patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP). Material and method: We performed a prospective study in which, in each patient, we aimed for 10 valid CAP and liver stiffness measurements (LSM). To discriminate between fibrosis stages, we used the following VCTE cut-offs: F ≥ 2–8.2 kPa, F ≥ 3–9.7 kPa, and F4 - 13.6 kPa. To discriminate between steatosis stages, we used the following CAP cut-offs: S1 (mild) – 274 dB/m, S2 (moderate) – 290dB/m, S3 (severe) – 302dB/m. Results: During the study period, we screened 776 patients; 60.3% had severe steatosis, while 19.4% had advanced fibrosis. Female gender, BMI, waist circumference, elevated levels of AST, total cholesterol, triglycerides, blood glucose, and high LSM were associated with severe steatosis (all p-value < 0.05). BMI, waist circumference, elevated levels of AST, HbA1c, and CAP were associated with advanced fibrosis (all p-values < 0.05). Conclusion: Higher BMI (obesity) comprises a higher risk of developing severe steatosis and fibrosis. Individualized screening strategies should be established for NAFLD according to different BMI. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Noninvasive assessment of liver fibrosis with the aspartate transaminase to platelet ratio index (APRI): Usefulness in patients with chronic liver disease," by Y. Yilmaz and colleagues in the 2011 issue.

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]

Abstract: 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>27.7kg/m2 (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 &y& Elsevier]

Abstract: Our study tried to identify the factors associated with discordance between liver stiffness values assessed by acoustic radiation force impulse (ARFI) elastography and histologic fibrosis in 106 chronic hepatitis C patients. Liver biopsy (LB) and ARFI measurements were performed in the same session. A discordance of at least two stages of fibrosis in the Metavir scoring system between ARFI results and LB was defined as significant. The performance of ARFI elastography was assessed using the following cut-offs: F1-1.19 m/s, F2-1.34 m/s, F3-1.55 m/s and F4-1.80 m/s. Discordance of at least two stages of fibrosis between ARFI results and histologic assessment were observed in 31.7% of the patients. In an univariate analysis, female sex (p = 0.004), interquartile range interval (IQR) ≥30% (p = 0.04), high alanine aminotransferases (p = 0.008) and high aspartate aminotransferases levels (p = 0.003) were associated with discordances. In a multivariate analysis, the female sex (p = 0.006) and IQR ≥30% (p = 0.004) were associated with discordances. Therefore, IQR parameter should be used for ARFI measurements. [Copyright &y& Elsevier]

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]

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]

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]

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]

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]

Alcoholic liver disease (ALD) and Non-alcoholic fatty liver disease (NAFLD) are becoming the most common causes of chronic liver diseases and the leading causes of liver transplantation. Developing non-invasive methods for liver fibrosis and steatosis assessment are needed in these patients. In addition to Transient Elastography (TE), new methods were developed. to evaluate and compare the performance of two point shear wave elastography techniques (pSWE and Auto pSWE) for the assessment of fibrosis and of Ultrasound Derived Fat Fraction (UDFF) for the assessment of steatosis, in patients with NAFLD and ALD using TE with Controlled Attenuation Parameter (CAP) as a reference methods. A prospective study was conducted in which 166 consecutive patients with previously diagnosed ALD and NAFLD were included. All were evaluated in the same session by pSWE, Auto pSWE and UDFF, implemented in a Siemens ACUSON Sequoia system, using a Deep Abdominal Transducer (DAX), and by TE with CAP, implemented in a FibroScan Compact M 530 system (M and XL probes). Reliable measurements were defined as the median value of 10 measurements with an IQR/M<0.3. The following TE cut-off values were used: for significant fibrosis (F≥2) - 9 kPa for ALD and 8.2 kPa for NAFLD [1,2]. For mild (S1) steatosis, the following CAP cut-off values were used: 268 dB/m for ALD and 294 dB/m for NAFLD [3]. Fibrosis distribution was the following: in the ALD group F≥2 -10% (5/48) patients and F4 -25% (12/48) patients; in the NAFLD group, F≥2 -4.2% (5/118) patients and F4- 6% (7/118) patients. In the ALD group 50% (24/48) had severe steatosis and in the NAFLD- 39% (46/118), with no significant differences between the two groups, p-values >0.05. The best cut-off values for identifying significant fibrosis (F≥2) with p-SWE and Auto pSWE in ALD patients were: >7 kPa, with AUCs (0.94 and 0.90), Se (83.3% and 41.6%), Sp (83.3% and 100%); in NAFLD patients: >5.2 kPa, AUCs (0.71 and 0.75), Se (40% and 60%), Sp (100% and 96.2%). For the presence of at least mild steatosis, UDFF cut-off value in ALD patients was >5%, AUC=0.94, Se=96.6%, Sp=83.3% and in NAFLD patients was >12%, AUC=0.87, Se=78.5%, Sp=84.2%. The cut-off values by pSWE and Auto pSWE for identifying significant fibrosis were >7 kPa in ALD patients and > 5.2 kPa in NAFLD patients. The cut-off values for UDFF in diagnosing at least mild steatosis were >5% in ALD patients and >12% in NAFLD patients. [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 elastography assessment currently requires five to ten acquisitions per patient, which sometimes is difficult and time consuming. Auto Shear Waves Elastography (Auto pSWE) and Ultrasound derived fat fraction (UDFF) are new techniques that quantify liver fibrosis and steatosis. The aim of this study was to evaluate which is the smallest number of acquisitions needed in order to accurately quantify liver steatosis and fibrosis. 345 consecutive subjects with or without chronic hepatopathies were included in the study, in whom liver stiffness (LS) was evaluated by Auto pSWE and liver steatosis by UDFF. Both methods are implemented on the ACUSON Sequoia system [Siemens ACUSON Sequoia (Deep Abdominal Transducer-DAX)]. Using the automated technique, 15 measurements are made during a single acquisition, in less than 5 seconds, both for steatosis and fibrosis. Patients were evaluated with one acquisition, five acquisitions and ten acquisitions. ANOVA test and Kruskal-Wallis test were used to compare the three groups, depending on their distribution. The correlation between the results form one acquisition, five acquisitions and ten acquisitions were almost perfect, all correlation coefficients (r) > 0.97. We found no significant differences between the mean LS measurements among three groups (mean ±SD: 5.25 ± 1.2 kPa vs. 5.23 ± 1.3 kPa vs 5.25 ± 1.3 kPa, p=0.99), nor for steatosis [median (IQR): 9 (12.5) vs 10 (11.7) vs 9 (11), p=0.89]. One acquisition for both Auto pSWE and UDFF may be enough to quantify the liver fibrosis and liver steatosis without significant loss of accuracy. [ABSTRACT FROM AUTHOR]

Abstract: 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 &y& Elsevier]

Abstract: 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 &y& Elsevier]

Abstract: Aim: The aim of this international multicenter study was to evaluate the reliability of Acoustic Radiation Force Impulse (ARFI) elastography for predicting fibrosis severity, in patients with chronic hepatitis C. Patients and methods: We compared ARFI to liver biopsy (LB) in 914 patients (10 centers, 5 countries) with chronic hepatitis C. In each patient LB (evaluated according to the METAVIR score) and ARFI measurements were performed (median of 5–10 valid measurements, expressed in meters/second – m/s). In 400 from the 914 patients, transient elastography (TE) was also performed (median of 6–10 valid measurements, expressed in kiloPascals – kPa). Results: Valid ARFI measurements were obtained in 911 (99.6%) of 914 cases. On LB 61 cases (6.7%) had F0, 241 (26.4%) had F1, 202 (22.1%) had F2, 187 (20.4%) had F3, and 223 (24.4%) had F4 fibrosis. A highly significant correlation (r =0.654) was found between ARFI measurements and fibrosis (p <0.0001). The predictive values of ARFI for various stages of fibrosis were: F ≥1 – cut-off>1.19m/s (AUROC=0.779), F ≥2 – cut-off>1.33m/s (AUROC=0.792), F ≥3 – cut-off>1.43m/s (AUROC=0.829), F =4 – cut-off>1.55m/s (AUROC=0.842). The correlation with histological fibrosis was not significantly different for TE in comparison with ARFI elastography: r =0.728 vs. 0.689, p =0.28. TE was better than ARFI for predicting the presence of liver cirrhosis (p =0.01) and fibrosis (F ≥1, METAVIR) (p =0.01). Conclusion: ARFI elastography is a reliable method for predicting fibrosis severity in chronic hepatitis C patients. [Copyright &y& Elsevier]

Aim: To establish the influence of different factors on the correlation between liver stiffness (LS) measurements by ARFI and liver fibrosis, evaluated by liver biopsy (LB). We assessed the following factors: the success rate (SR) and interquartile range (IQR) interval, the place where ARFI was performed, liver steatosis, the quality of the specimen obtained by LB. Methods: We studied 471 patients: 82 with LB, 82 healthy volunteers and 307 with cirrhosis. We performed 10 valid ARFI measurements, a median value was calculated, expressed in meters/second. Results: Valid measurements were not obtained in 11 patients. There was a direct, strong, correlation (r=0.694) between ARFI and fibrosis (p<0.0001). There were no statistically significant differences between the mean ARFI values obtained in segments V vs. VIII (p=0.89). Considering the IQR and SR, the correlation of ARFI with fibrosis was: for IQR<30% and SR ≥ 60%: r=0.722 and for IQR>30% and/or SR ≤ 60%: r=0.268 (p=0.0001). The quality of the liver specimen (2-3 cm long vs. >3 cm) did not influence the correlation of ARFI with fibrosis. Conclusions: To obtain the best correlation between ARFI and fibrosis, IQR must be <30% and SR ≥ 60%. These technical parameters must be introduced to improve the ARFI value for LS evaluation. [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]

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]

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]