EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)

Dietrich, Christoph F.; Bamber, Jeffrey C.; Berzigotti, Annalisa; Bota, Simona; Cantisani, Vito; Castéra, Laurent; Cosgrove, David O.; Ferraioli, Giovanna; Friedrich‐Rust, Mireen; Gilja, Odd Helge; Goertz, Ruediger S.; Karlas, Thomas; Knegt, Robert J. de; Lédinghen, Victor de; Piscaglia, Fabio; Procopeţ, Bogdan; Săftoiu, Adrian; Sidhu, Paul S.; Sporea, Ioan; Thiele, Maja

doi:10.1055/s-0043-103952

Cited by 735 publications

(1,031 citation statements)

References 250 publications

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“…However, the direct comparison between different elastography technologies remains challenging as different dynamic stimulation frequencies are used. 33 The limitations of our study include the relatively low nnumbers and the heterogeneity of our study cohort, which could be the reason for the limited separation abilities between patients with no fibrosis and those with moderate fibrosis. In addition, the imbalance of different fibrosis stages with a high amount of F1 and F4 fibrosis in our study population is a possible limitation and probably due to selection bias.…”

Section: Discussionmentioning

confidence: 94%

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Heucke

Wuensch

Mohr

et al. 2019

J of Gastro and Hepatol

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Background and Aim Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure–function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13C‐methacetin Liver MAximum capacity (LiMAx) test and tissue‐structure related stiffness by 2D time‐harmonic elastography for the assessment of liver disease progression. Methods LiMAx test and time‐harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. Results LiMAx values correlated negatively with liver stiffness (r = −0.747), aminotransferase to platelet ratio index (r = −0.604), and fibrosis 4 (r = −0.573). Median (interquartile range) LiMAx values decreased with fibrosis progression from 395 μg/kg/h (371–460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126–309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52–1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54–1.67 m/s]) to severe fibrosis (1.85 m/s [1.76–1.92 m/s]). Conclusion Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

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Section: Discussionmentioning

confidence: 94%

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Heucke

Wuensch

Mohr

et al. 2019

J of Gastro and Hepatol

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“…Three valid SWE measurements were obtained, and the median value was calculated based on the European Federation of Societies for Ultrasound in Medicine and Biology Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography. 16 The SWE measurement was expressed in kilopascals (kPa). SWE measurements with an interquartile range/median value >30% were excluded because of invalid results, as recommended by the manufacturer and European Federation of Societies for Ultrasound in Medicine and Biology Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography.…”

Section: Fib-4 Indexmentioning

confidence: 99%

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Yamamura

Kawaguchi

Nakano

et al. 2019

Hepatology Research

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Aim Advanced hepatic fibrosis is seen in individuals with potential hepatocellular carcinoma and cardiovascular disease. Hepatic fibrosis can be assessed using a combination of the FIB‐4 index and imaging modalities, including shear wave elastography. We aimed to investigate the prevalence of advanced fibrosis in the general population and the profiles associated with advanced fibrosis using a data‐mining analysis. Methods We enrolled 1155 health checkup examinees (median age 53 years, 685 women, 470 male). Advanced fibrosis was defined by FIB‐4 index ≥1.3 and liver stiffness ≥8.07 kPa using shear wave elastography. Participants were classified as normal‐mild fibrosis (n = 1035) or advanced fibrosis (n = 120). Factors associated with advanced fibrosis were analyzed by logistic regression and decision‐tree analyses. Results Advanced fibrosis was observed in 10.4% of participants (120/1155). In the logistic regression analysis, independent factors for advanced fibrosis were age (≥75 years; OR 2.12, 95% CI 1.021–4.415; P = 0.0419) and the presence of metabolic syndrome (OR 2.51, 95% CI 1.416–4.462; P = 0.0017). The decision‐tree analysis showed two profiles associated with advanced fibrosis: profile 1 – individuals aged ≥65 years with metabolic syndrome and mild‐to‐moderate alcohol consumption (prevalence of advanced fibrosis 73.3%); and profile 2 – individuals without metabolic syndrome, aged ≥75 years, with no exercise habit (prevalence of advanced fibrosis 56.3%). Conclusions Advanced fibrosis was observed in 10.4% of health checkup examinees. Furthermore, we showed that aging, metabolic syndrome with mild‐to‐moderate alcohol consumption, and physical inactivity were associated with advanced fibrosis. Thus, prevention of metabolic syndrome and alcohol withdrawal, as well as exercise habits, might inhibit the progression of hepatic fibrosis.

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“…26,27 This is also stated in the most recent update of the EFSUMB guidelines on the use of elastography. 28 The differences might be explained by our small sample size of healthy subjects, but could also indicate that the performance of pSWE in determining the stiffness of NLT in healthy subjects is not as good as the first results showed.…”

Section: Patients With Fnh or Hcamentioning

confidence: 78%

Can point shear wave elastography differentiate focal nodular hyperplasia from hepatocellular adenoma

Taimr

Klompenhouwer

Thomeer

et al. 2018

J of Clinical Ultrasound

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PurposeFocal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are liver tumors that require different management. We assessed the potential of point shear wave elastography (pSWE) to differentiate FNH from HCA and the interobserver and intraobserver reliability of pSWE in the examination of these lesions and of native liver tissue (NLT).MethodsThe study included 88 patients (65 FNH, 23 HCA). pSWE was performed by two experienced liver sonographers (observers 1 [O1] and 2 [O2]) and acquired within the lesion of interest and NLT. Group differences, optimal cutoff for characterization and interobserver reliability was assessed with Mann‐Whitney‐U, area under the ROC curce (AUROC) and intraclass correlation coefficient (ICC). Intraobserver reliability in NLT was assessed in 20 healthy subjects using ICC.ResultsMedian stiffness was significantly higher in FNH than in HCA (7.01 kPa vs 4.98 kPa for O1 (P = 0.017) and 7.68 kPa vs 6.00 kPa for O2 (P = 0.031)). A cutoff point for differentiation between the two entities could not be determined with an AUROC of 0.67 (O1) and 0.69 (O2). Interobserver reliability was good for lesion‐ stiffness (ICC = 0.86) and poor for NLT stiffness (ICC = 0.09). In healthy subjects, intraobserver reliability for NLT‐stiffness was poor for O1 (ICC = 0.23) and moderate for O2 (ICC = 0.62).ConclusionThis study shows that pSWE cannot reliably differentiate FNH from HCA. Interobserver and intraobserver reliability for pSWE in NLT were insufficient. Interpretation of results gained with this method should be done with great caution.

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EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)

Cited by 735 publications

References 250 publications

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Can point shear wave elastography differentiate focal nodular hyperplasia from hepatocellular adenoma

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