In diffuse liver disease, it is extremely important to make an accurate diagnosis of liver fibrosis prior to determining indications for therapy or predicting treatment outcome and malignant potential. Although liver biopsy has long been the gold standard in the diagnosis of liver fibrosis, it is still an invasive method. In addition, the sampling error is an intrinsic problem of liver biopsy. Non-invasive serological methods for the diagnosis of liver fibrosis can be affected by factors unrelated to the liver. Recently, after the introduction of FibroScan, it became possible to measure liver fibrosis directly and non-invasively by elastography, which has attracted attention as a non-invasive imaging diagnostic tool for liver fibrosis. In addition, real-time tissue elastography is currently being used to conduct clinical trials at many institutions. Moreover, virtual touch quantification enables the observation of liver stiffness at any location by simply observing B-mode images. Furthermore, the recently developed ShearWave elastography visualizes liver stiffness on a color map. Elastography is thought to be useful for all types of diffuse liver diseases. Because of its association with portal hypertension and liver carcinogenesis, elastography is expected to function as a novel prognostic tool for liver disease. Although various elastographic devices have been developed by multiple companies, each device has its own measurement principle, method, and outcome, creating confusion in clinical settings. Therefore, it is extremely important to understand the characteristics of each device in advance. The objective of this guideline, which describes the characteristics of each device based on the latest knowledge, is for all users to be able to make the correct diagnosis of hepatic fibrosis by ultrasound elastography.

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.

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nuclear farnesoid X receptor (FXR) in the terminal ileum. On the other side FGF19 suppresses hepatic bile acid biosynthesis. We hypothesized that patients with Crohn's disease (CD) show lower FGF19 levels as compared to patients with ulcerative colitis (UC). Patients and Methods: In total, we recruited 12 CD patients after ileocecal resection (ICR), 12 nonoperated CD patients and 12 UC patients as controls in remission. Serum FGF19 levels were determined by ELISA after 10 hrs of overnight fasting. All individuals received orally 1g fat (Calo-gen®) per kg body weight, and FGF19 levels were measured after 2, 4 and 6 hrs. Serum concentrations of BA and 7α-OHcholesterol levels, which is a valid marker of BA biosynthesis, were determined by GC-MS after 2, 4 and 6 hrs. Results: Basal FGF19 levels are significantly lower in CD patients (± ICR) as compared to UC patients. The increase of FGF19 levels 2, 4 und 6 hrs after the oral fat load differs between UC and CD (ICR+) patients, with highest levels after 4 hrs in UC patients (p<0.05). CD (ICR+) patients display the lowest FGF19 levels at all time points. Fasting and postprandial levels of BA are not significantly different between CD and UC patients. However at all time points, serum 7α-OH-cholesterol levels are significantly higher in CD (ICR+) in comparison to UC patients. In the whole study cohort basal FGF19 and basal 7α-OH-cholesterol levels are inversely correlated (r=0.397, p=0.017). Conclusions: Low FGF19 levels in CD (± ICR) patients could be the consequence of persistent inflammation and impaired bile acid signaling in the ileum. CD (ICR+) patients display lowest FGF19 levels, consistent with highest 7α-OH-cholesterol levels and lack of repression of BA synthesis. We speculate that this observation results from insufficient intestinal FXR activity in CD.