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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]

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]

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]

Abstract: Our study assessed acoustic radiation force impulse (ARFI) reproducibility and the factors influencing it. The intra- and interoperator reproducibility were studied in 33 and 58 patients, respectively. Intraclass correlation coefficient (ICC) was used to assess ARFI reproducibility. The overall intraoperator agreement was better than the interoperator one: ICC 0.90 vs. ICC 0.81. The correlation of repeated ARFI measurements was higher, but not significantly so, in cases in which intraoperator reproducibility was assessed compared with the ones in which interoperator reproducibility was studied: r = 0.848 vs. r = 0.694 (p = 0.08). For both intra- and interoperator reproducibility, the ICCs were smaller in women vs. men (0.88 vs. 0.91 and 0.67 vs. 0.86, respectively), in patients with high body mass index (BMI) ≥25 kg/m² vs. <25 kg/m² (0.88 vs. 0.91 and 0.79 vs. 0.82, respectively), in patients with ascites vs. no ascites (0.80 vs. 0.93 and 0.78 vs. 0.84, respectively) and in noncirrhotic vs. cirrhotic patients (0.77 vs. 0.82 and 0.70 vs. 0.83, respectively). [Copyright &y& Elsevier]

Aim: The updated Baveno VI guidelines recommend that screening for high-risk varices (HRV) by esophago-gastro-duodenoscopy (EGD) can be avoided in patients with compensated advanced chronic liver disease (cACLD) who have liver stiffness LSM<20 kPa and platelet count PLT>150,000/L. The aims of this study were to validate extended Baveno VI criteria in patients with chronic liver disease and to establish cut-off values for our cohort.Materials and Methods: This retrospective study included 839 patients with liver cirrhosis evaluated by Transient Elastography (TE), biological tests, and upper endos-copy, all within one year. The Baveno VI criteria were validated on a sub-group of 728 patients (Cohort 1, randomly selected from the study sample) and tailored cut-off points were determined. The remaining 111 patients comprised the validating set (Cohort 2) for these specific cut-off values.Results: In Cohort 1, Baveno VI criteria had 86.2% accuracy. The calculated cut-offs to rule-in HRV were PLT<150,000/mm3 and LSM >35.3 kPa; while to rule-out HRV they were PLT >150.000/mm3 and LSM <19.6 kPa. In patients in the "grey-zone", by multivariate analysis, albumin was independently associated with HRV at a cut-off of ˂3.4 g/dl. In the validation cohort, the calculated rule out cut-offs had 100% accuracy.Conclusions: The Baveno VI criteria had a good accuracy for exclusion of HRV in this large cohort of cirrhotic patients. Adding an albumin-related threshold increased performance and broadened applicability. Using the calculated rule-out criteria for HRV, all unnecessary EGD could be excluded. [ABSTRACT FROM AUTHOR]

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

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

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

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

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: The aim of our study was to assess the influence of liver residual mass in cirrhotic patients on the liver stiffness (LS), measured by ARFI elastography. Methods: Two hundreds eleven cirrhotic patients were enrolled. To evaluate the liver residual mass, the Child-Pugh and MELD scores were used and 10 valid ARFI measurements were performed. The correlation between Child-Pugh, MELD scores and the LS were evaluated. Results: Valid ARFI measurements were not obtained in 3 patients. A direct, very low correlation between the LS values and the Child-Pugh (r=0.264, p<0.001) and MELD scores (r=0.194, p=0.005) was found. A direct, low correlation between LS measurements and total bilirubin (r=0.271, p<0.001) and an inverse, low correlation with albumin (r=-0.270, p<0.001), prothrombin time (r=-0.196, p=0.006), cholinesterase (r=-0.241, p=0.003) was obtained. The LS mean values were statistically significant higher in patients with Child-Pugh class B vs. A (p=0.002) and in Child-Pugh C vs. A (p<0.001). The values were not significantly different in patients with Child-Pugh B vs. C (p=0.06). Conclusions: Higher values of LS measurements by means of ARFI could be an indicator of decreased liver functional reserve, evaluated by means of Child Pugh or Meld scores. [ABSTRACT FROM AUTHOR]

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

Aim: To establish the values of spleen stiffness (SS) assessed by Acoustic Radiation Force Impulse (ARFI) in healthy subjects and in cirrhotic patients, and to evaluate its predictive value for the presence of cirrhosis and for the presence and severity of esophageal varices (EV). Patients and Methods: Our study included 82 subjects (15 healthy volunteers, 57 cirrhotic patients, 10 with various grade of liver fibrosis), 38 women and 44 men. Of these, 42 cirrhotic patients had varices, 30 had significant EV and 11 had a history of variceal bleeding. We performed 10 measurements in each patient expressed in meters/second (m/s) and a median value was obtained. Results: The mean SS values (m/s) were: 2.04+/-0.28 in healthy subjects and 3.10+/-0.55 in cirrhotic patients (p<0.001). For a cut-off value of >2.51 m/s of SS, ARFI had 85.2% Se, 91.7% Sp, 95.8% PPV, 73.3% NPV, 87.1% accuracy (AUROC=0.91) for predincting liver cirrhosis. No significant differences regarding SS were observed between patients with and without EV, also between those with and without a history of variceal bleeding. Conclusion: SS evaluated by means of ARFI had a very good predictive value for the presence of cirrhosis (AUROC=0.91, accuracy=87.1%), but could not predict the presence or severity of EV, also the risk of variceal bleeding. [ABSTRACT FROM AUTHOR]

Aim: to assess the accuracy of transient elastography (TE) and Acoustic Radiation Force Impulse (ARFI) for liver fibrosis assessment, as compared to percutaneous liver biopsy (LB) in patients with chronic hepatitis. Patients and Methods: Our study included 71 patients (P) (54 with HCV and 17 with HBV chronic hepatitis) in which we compared TE and ARFI to the LB (evaluated according to the Metavir scoring system). Results: On LB, from the 71P, 6P (8.4%) had F1, 25P (35.2%) had F2, 24P (33.8%) had F3 and 16P (22.5%) had F4. A direct, strong, linear correlation (Spearman r=0.707) was found between TE measurements and fibrosis (p<0.0001) and a weaker one, between ARFI and fibrosis (rho=0.469; p<0.0001). TE measurements were also correlated with ARFI measurements r=0.532, p<0.0001. By comparing the AUROC curves, TE and ARFI had similar predictive values for the presence of significant fibrosis (F greater or equal to 2 Metavir): AUROC ARFI=0.649, AUROC TE=0.731 (p=0.476); and cirrhosis (F=4 Metavir): AUROC ARFI=0.868, AUROC TE= 0.936 (p=0.294) Conclusion: LS measurements assessed by means of TE correlate better than those assessed by means of ARFI to the histological fibrosis in patients with HBV and HCV chronic hepatitis. Both methods have excellent predictive values for the presence of cirrhosis. [ABSTRACT FROM AUTHOR]

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

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