The aim of this study was to prospectively evaluate the diagnostic performance of strain elastography for the assessment of liver fibrosis in patients with chronic liver disease using Ishak (0–6) histology stage as a reference standard. Ninety-eight consecutive patients with suspected chronic liver disease scheduled for liver biopsy (n = 78) or histologically confirmed cirrhosis (n = 20) were enrolled. Liver fibrosis Index (LF Index) calculated by strain elastography, liver stiffness by transient elastography and serum fibrosis markers (aspartate aminotransferase-to-platelet ratio index and King’s Score) were measured. Spearman’s correlation coefficient between the LF Index, liver stiffness, serum fibrosis markers and fibrosis stage were calculated and compared using areas under the receiver-operating characteristics (AUROCs) curves. Among 73 patients who underwent strain elastography, there was weak correlation between fibrosis stage and the LF Index (Spearman’s: ρ = 0.385 for Ishak score; P = 0.001). Among 52 patients who underwent strain elastography and transient elastography, the AUROC values using LF Index, transient elastography, aspartate aminotransferase-to-platelet ratio index and King’s Score for diagnosing significant fibrosis (Ishak score ≥ 3) were 0.79, 0.87, 0.86 and 0.85, respectively ( P < 0.0001) and for diagnosing severe fibrosis/cirrhosis (Ishak score ≥ 5) were 0.83, 0.94, 0.92 and 0.92, respectively ( P < 0.0001). When comparing the diagnostic performance using LF Index, transient elastography, aspartate aminotransferase-to-platelet ratio index and King’s Score, transient elastography shows a significantly higher AUROC value than LF Index in detecting severe fibrosis ( P = 0.0149). The diagnostic performance of LF Index calculated by strain elastography was not statistically significantly different to the other noninvasive tests for the assessment of significant liver fibrosis but inferior to transient elastography for the assessment of severe fibrosis/cirrhosis.
Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. Cryoablation therapy, which uses rapid freeze and thaw cycles to destroy diseased tissue, is the standard nephron-sparing option for RCC treatment. This case report suggests cryoablation as an effective therapy for hematuria in RCC. A 52-year-old male patient with Stage IV RCC presented to the ED with hematuria and flank pain. He was catheterized, and several blood clots were removed from the bladder. Embolization was considered, however renal angiography failed to demonstrate a tumoral blush and no target for embolization was identified. In lieu of continued large volume hematuria, cryoablation of the tumor was offered as a potential therapy. We describe a case of successful treatment of clinically significant hematuria in a patient with RCC with cryoablation.
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