Influence of Liver Inflammation on Liver Stiffness Measurement in Patients with Autoimmune Hepatitis Evaluation by Combinational Elastography

Yada, Norihisa; Sakurai, Toshiharu; Minami, Tomohiro; Arizumi, Tadaaki; Takita, Masahiro; Hagiwara, Satoru; Ida, Hiroshi; Ueshima, Kazuomi; Nishida, Naoshi; Kudo, Masatoshi

doi:10.1159/000451011

Cited by 25 publications

(23 citation statements)

References 22 publications

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“…In these participants, treatment decision may rely on clinical data rather than on liver stiffness values. In fact, inflammation was proven to be an important confounding factor of liver stiffness measurements in our study, which negatively impacted the diagnostic performance of 2D SWE, as was shown in previous studies (28,29). In this study, AUCs of 2D SWE were higher in A0-A2 than were those in A3 in participants with advanced fibrosis, and, especially in cirrhosis (P = .001).…”

Section: Discussionsupporting

confidence: 66%

“…Second, the centers that participated in our study were all high-level teaching hospitals in different regions of China and a prevalence bias was observed, in which participants were more likely to be in the severe stages of disease. Third, inflammation could impact the diagnostic performances of liver stiffness measurement (28,29). Approximately two-thirds of participants in our study were in the chronic hepatitis group, which indicated that they were more likely to be in severe stages of inflammation.…”

Section: Discussionmentioning

confidence: 76%

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Liver Fibrosis with Two-dimensional US Shear-Wave Elastography in Participants with Chronic Hepatitis B: A Prospective Multicenter Study

Gao¹,

Zheng²,

Liang³

et al. 2018

Radiology

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Purpose To investigate the diagnostic performance of two-dimensional (2D) shear-wave elastography (SWE) in chronic hepatitis B. Materials and Methods This prospective multicenter study from January 2015 to January 2016 was conducted at 12 hospitals and included 654 participants with chronic hepatitis B who had undergone liver biopsy and 2D SWE examination. Participants were divided into chronic infection and chronic hepatitis groups. The diagnostic performance of 2D SWE was compared with the aspartate amino transferase-to-platelet ratio index (APRI), the Fibrosis-4 index (FIB-4), and transient elastography (TE) by using a DeLong test and was also compared between two subgroups. Dual cutoff values for cirrhosis were determined with multilevel likelihood ratio analysis. Results Overall, 402 participants with chronic hepatitis B were enrolled (154 with chronic infection and 248 with chronic hepatitis). The areas under the receiver operating characteristic curve of 2D SWE (0.87; 95% confidence interval [CI]: 0.83, 0.90) were higher than those of TE (0.80; 95% CI: 0.68, 0.88), APRI (0.70; 95% CI: 0.65, 0.74), and FIB-4 (0.73; 95% CI: 0.69, 0.78) in cirrhosis. The high area under the receiver operating characteristic curve (0.92; 95% CI: 0.87, 0.96) was achieved in the chronic infection group and was significantly higher than that of the chronic hepatitis group (0.84; 95% CI: 0.78, 0.88; P = .017). Dual cutoff values with the likelihood ratios below 0.1 and above 10 (8.4 kPa and 11.0 kPa to rule out and rule in a diagnosis of cirrhosis, respectively) were effectively determined in chronic infection; a total of 81.2% (125 of 154) participants with cirrhosis were definitively diagnosed. Conclusion The performance of two-dimensional (2D) shear-wave elastography (SWE) was higher than that of other noninvasive methods. 2D SWE was most effective in ruling in and ruling out cirrhosis in participants with chronic infection, which may prompt antiviral treatment. © RSNA, 2018 Online supplemental material is available for this article.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 76%

Liver Fibrosis with Two-dimensional US Shear-Wave Elastography in Participants with Chronic Hepatitis B: A Prospective Multicenter Study

Gao¹,

Zheng²,

Liang³

et al. 2018

Radiology

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“…Strain imaging such as RTE is not affected by inflammation, jaundice, or congestion [1,2,32,33] . In this study, we analyzed only cases without jaundice and congestion to evaluate fibrosis and inflammation.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Fibrosis and Activity by a Combined Use of Strain and Shear Wave Imaging in Patients with Liver Disease

Yada

Tamaki

Koizumi

et al. 2017

Dig Dis

Self Cite

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Objective: Performing shear wave imaging is simple, but can be difficult when inflammation, jaundice, and congestion are present. Therefore, the correct diagnosis of liver fibrosis using shear wave imaging alone might be difficult in mild-to-moderate fibrosis cases. Strain imaging can diagnose liver fibrosis without the influence of inflammation. Therefore, the combined use of strain and shear wave imaging (combinational elastography) for cases without jaundice and congestion might be useful for evaluating fibrosis and inflammation. Methods: We enrolled consecutive patients with liver disease, without jaundice or liver congestion. Strain and shear wave imaging, blood tests, and liver biopsy were performed on the same day. The liver fibrosis index (LF index) was calculated by strain imaging; real-time tissue elastography, and the shear wave velocity (V_s) was calculated by shear wave imaging. Fibrosis index (F index) and activity index (A index) were calculated as a multiple regression equation for determining hepatic fibrosis and inflammation using histopathological diagnosis as the gold standard. The diagnostic ability of F index for fibrosis and A index for inflammation were compared using LF index and V_s. Results: The total number of enrolled cases was 388. The area under the receiver operating characteristic (AUROC) was 0.87, 0.80, 0.83, and 0.80, at diagnosis of fibrosis stage with an F index of F1 or higher, F2 or higher, F3 or higher, and F4, respectively. The AUROC was 0.94, 0.74, and 0.76 at diagnosis of activity grade with an A index of A1 or higher, A2 or higher, and A3, respectively. The diagnostic ability of F index for liver fibrosis and A index for inflammation was higher than for other conventional diagnostic values. Conclusions: The combined use of strain and shear wave imaging (combinational elastography) might increase the positive diagnosis of liver fibrosis and inflammation.

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“…TE has also been applied in the study of autoimmune liver disease, with excellent diagnostic performance (166), though several studies have reported that acute inflammation as a result of autoimmune hepatitis may affect liver stiffness (167,168). TE has also been shown to be an accurate method for staging fibrosis in primary biliary cirrhosis (169-171), primary sclerosing patients (Fig 4).…”

Section: Other Etiologies Of Liver Diseasementioning

confidence: 99%

Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions

Kennedy¹,

Wagner²,

Castéra³

et al. 2018

Radiology

235

205

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Chronic liver diseases often result in the development of liver fibrosis and ultimately, cirrhosis. Treatment strategies and prognosis differ greatly depending on the severity of liver fibrosis, thus liver fibrosis staging is clinically relevant. Traditionally, liver biopsy has been the method of choice for fibrosis evaluation. Because of liver biopsy limitations, noninvasive methods have become a key research interest in the field. Elastography enables the noninvasive measurement of tissue mechanical properties through observation of shear-wave propagation in the tissue of interest. Increasing fibrosis stage is associated with increased liver stiffness, providing a discriminatory feature that can be exploited by elastographic methods. Ultrasonographic (US) and magnetic resonance (MR) imaging elastographic methods are commercially available, each with their respective strengths and limitations. Here, the authors review the technical basis, acquisition techniques, and results and limitations of US- and MR-based elastography techniques. Diagnostic performance in the most common etiologies of chronic liver disease will be presented. Reliability, reproducibility, failure rate, and emerging advances will be discussed. RSNA, 2018 Online supplemental material is available for this article.

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Influence of Liver Inflammation on Liver Stiffness Measurement in Patients with Autoimmune Hepatitis Evaluation by Combinational Elastography

Cited by 25 publications

References 22 publications

Liver Fibrosis with Two-dimensional US Shear-Wave Elastography in Participants with Chronic Hepatitis B: A Prospective Multicenter Study

Liver Fibrosis with Two-dimensional US Shear-Wave Elastography in Participants with Chronic Hepatitis B: A Prospective Multicenter Study

Diagnosis of Fibrosis and Activity by a Combined Use of Strain and Shear Wave Imaging in Patients with Liver Disease

Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions

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