Hepatic Venous Congestion After Living Donor Liver Transplantation: Quantitative Assessment of Liver Stiffness Using Shear Wave Elastography—A Case Report

Wang, H.-K.; Lai, Yi‐Chen; Tseng, Hsiou-Shan; Lee, R.-C.; Loong, Che‐Chuan; Lin, Niang‐Cheng; Chou, Yi‐Hong; Chiou, Hong‐Jen; Chang, Chao-Sung

doi:10.1016/j.transproceed.2012.01.035

Cited by 18 publications

(11 citation statements)

References 14 publications

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“…However, several studies using transient elastography, acoustic radiation force impulse imaging, or SWE measurements have shown that necroinflammatory activity, jaundice, and/or congestion increase liver stiffness. 19,20,[26][27][28][29] In this study, we found that liver stiffness significantly decreased from EOT to SVR24 in chronic HCV patients with ALT levels ≤ 30 and FIB-4 index > 2.0. These patients were considered to have low levels of necroinflammatory activity.…”

Section: Discussionmentioning

confidence: 88%

“…In addition, based on a meta‐analysis of cohort studies, Singh et al reported that degree of liver stiffness was associated with risk of decompensated cirrhosis, HCC, and death in patients with chronic liver diseases. However, several studies using transient elastography, acoustic radiation force impulse imaging, or SWE measurements have shown that necroinflammatory activity, jaundice, and/or congestion increase liver stiffness …”

Section: Discussionmentioning

confidence: 99%

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Improvement of liver stiffness in patients with hepatitis C virus infection who received direct‐acting antiviral therapy and achieved sustained virological response

Tada

Kumada

Toyoda

et al. 2017

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Improvement of liver stiffness in patients with hepatitis C virus infection who received direct‐acting antiviral therapy and achieved sustained virological response

Tada

Kumada

Toyoda

et al. 2017

J of Gastro and Hepatol

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“…The group with significant liver fibrosis had significantly higher necroinflammatory activity grades compared with the group with non‐significant liver fibrosis. In several studies, influences of necroinflammatory activity, jaundice and/or congestion on TE, ARFI or SWE measurements have been found . Namely, liver stiffness is increased when inflammation, jaundice and/or congestion are present in the liver.…”

Section: Discussionmentioning

confidence: 99%

“…In several studies, influences of necroinflammatory activity, jaundice and/or congestion on TE, ARFI or SWE measurements have been found. [36][37][38][39][40][41] Namely, liver stiffness is increased when inflammation, jaundice and/or congestion are present in the liver. Further studies evaluating how to divide patients with varying degrees of liver fibrosis by necroinflammatory activity grades that involve a larger number of CHC patients are also warranted.…”

Section: Discussionmentioning

confidence: 99%

Utility of real‐time shear wave elastography for assessing liver fibrosis in patients with chronic hepatitis C infection without cirrhosis: Comparison of liver fibrosis indices

Tada¹,

Kumada²,

Toyoda³

et al. 2015

Hepatology Research

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Aim:To clarify the diagnostic impact of liver fibrosis except for cirrhosis identified using shear wave elastography (SWE) in chronic hepatitis C (CHC) patients, and to compare the performance in diagnosing liver fibrosis among SWE and liver fibrosis indices.Methods: A total of 55 CHC patients who underwent liver biopsy were analyzed. The diagnostic performance for identifying significant liver fibrosis (F2-F3) for SWE, FIB-4 index, aspartate aminotransferase-to-platelet ratio index (APRI) and Forns' index was assessed using receiver-operator curve (ROC) analysis. Results:The median SWE elasticity value, FIB-4 index, APRI and Forns' index in the F0-F1 and F2-F3 groups were 6.3 kPa and 13.1 kPa; 1.52 and 4.45; 0.41 and 1.43; and 7.69 and 8.85, respectively (P < 0.001 for all four methods). Multivariate analysis showed that SWE was independently associated with the presence of significant liver fibrosis (odds ratio, 2.52; 95% confidence interval, 1.49-4.28; P < 0.001). The area under the ROC curve for SWE in diagnosing significant liver fibrosis was 0.94, indicating high diagnostic value, compared with 0.86, 0.88 and 0.83, for the FIB-4 index, APRI and Forns' index, respectively, which corresponds to moderate diagnostic value. The accuracy of SWE, FIB-4 index, APRI and Forns' index for diagnosing significant liver fibrosis was 90.9%, 76.4%, 74.5% and 67.2%, respectively.Conclusion: SWE has excellent ability for diagnosing significant liver fibrosis in CHC even when patients with cirrhosis are excluded. The diagnostic performance of SWE is superior to that of three liver fibrosis indices.

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“…Serial measurements before and after treatment of venous stenosis either in the setting of an experimental murine model through partial ligation of the inferior vena cava [67] or in the setting of human liver transplantation have shown the potential confounding effect of hepatic venous congestion on liver stiffness [68]. …”

Section: Biologic Confoundersmentioning

confidence: 99%

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

Tang

Cloutier

Szeverenyi

et al. 2015

American Journal of Roentgenology

170

112

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OBJECTIVE-The purpose of the article is to review the diagnostic performance of ultrasound and MR elastography techniques for detection and staging of liver fibrosis, the main current clinical applications of elastography in the abdomen.CONCLUSION-Technical and instrument-related factors and biologic and patient-related factors may constitute potential confounders of stiffness measurements for assessment of liver fibrosis. Future developments may expand the scope of elastography for monitoring liver fibrosis and predict complications of chronic liver disease. Keywords elasticity; elastography; liver fibrosis; MR elastography (MRE); MRI; ultrasound; viscosity In abdominal imaging, liver stiffness estimated by elastography techniques may be used as a quantitative imaging biomarker for detection, staging, and monitoring of liver fibrosis [1][2][3]. Liver stiffness is used to evaluate the severity of the underlying chronic liver disease, guide treatment decision, assess disease outcome, and evaluate response to therapy [4].In this second article of a two-part series [5], we will discuss the clinical applications in the liver. We will focus on diagnostic performance of ultrasound elastography and MR Address correspondence to C. B. Sirlin (csirlin@ucsd.edu).. Technologies developed by the team of G. Cloutier were licensed to Rheolution, Inc., and Acist Medical Systems. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript elastography techniques for detection, staging, and monitoring of liver fibrosis, the main current clinical applications of elastography in the abdomen. We will discuss potential confounders of stiffness measurements for assessment of liver fibrosis, which include technical and instrument-related factors (location and depth of measurements, wave frequencies, and device dependencies) and biologic and patient-related factors (concomitant hepatic steatosis, inflammation, cholestasis; breathing; right heart failure and hepatic venous congestion; and fasting vs postprandial state). Finally, we will briefly discuss future directions and technical innovations in this field of research.As will be shown in this article, elastography techniques integrated to clinical ultrasound and MR systems now provide the capability to examine by imaging what once could be examined only by direct palpation, which is likely to open new opportunities to noninvasively diagnose disease, guide management, and improve outcomes. Key Learning PointsFirst, the main current clinical indications for abdominal elastography techniques are detection and staging of liver fibrosis. In general, elastography techniques provide good-toexcellent diagnostic accuracy for the detection of advanced fibrosis but have more modest performance for detection of early or mild fibrosis. Most studies to date have been in adults; performance characteristics in children are less well known. Research is needed to better understand the performance of elastography for monitoring longitudinal changes in fibrosis. Emerg...

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Hepatic Venous Congestion After Living Donor Liver Transplantation: Quantitative Assessment of Liver Stiffness Using Shear Wave Elastography—A Case Report

Cited by 18 publications

References 14 publications

Improvement of liver stiffness in patients with hepatitis C virus infection who received direct‐acting antiviral therapy and achieved sustained virological response

Improvement of liver stiffness in patients with hepatitis C virus infection who received direct‐acting antiviral therapy and achieved sustained virological response

Utility of real‐time shear wave elastography for assessing liver fibrosis in patients with chronic hepatitis C infection without cirrhosis: Comparison of liver fibrosis indices

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

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