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

Abstract

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.

Changes in Liver Mechanical Properties and Water Diffusivity During Normal Pregnancy Are Driven by Cellular Hypertrophy

“…Thus, in our study, the liver of the pregnant rats appeared more solid-like with lower viscosity. Based on our histology results, there were no other pregnancy-related extracellular matrix alterations such as changes in collagen or elastin fiber content which potentially also influence the mechanical properties of the liver (Feng et al, 2016;Hudert et al, 2018;Heucke et al, 2019). In additional to the aforementioned structural elements that contribute to the mechanical properties of the liver, production of macromolecule such as glycogen which was reported to increase especially at the begin of the pregnancy might also influence the observed hepatic viscoelasticity.…”

Clinical implications of hepatic structure and function evaluation based on vibration-controlled transient elastography and liver maximum function capacity test in patients with nonalcoholic fatty liver disease

“…Thus, assessment of the functional capacity of the liver may provide useful additional information which is not impaired by the anthropometry of obese individuals. The LiMAx test reliably measures liver function and fulfils important prerequisites for risk stratification in patients with chronic liver diseases: it is noninvasive, widely evaluated in biopsy-controlled studies, and reflects the clinical prognosis in patients with cirrhosis [16,19,25,30,31]. There is a correlation between ultrasound-based noninvasive structure assessment and functional assessment of the liver, and increased tissue stiffness is correlated with a decreased hepatic metabolic capacity [19].…”

“…In patients with type 2 diabetes (T2D), the recovery of liver function after bariatric surgery was significantly impaired [18]. A pilot study assessing the relationship between LiMAx and elastography in a cohort with different chronic liver diseases observed a negative correlation between hepatic function and shear wave speed measured by two-dimensional time-harmonic elastography indicating that increased tissue stiffness is associated with a decreased metabolic capacity of the liver [19].…”

Hepatectomy-Induced Alterations in Hepatic Perfusion and Function - Toward Multi-Scale Computational Modeling for a Better Prediction of Post-hepatectomy Liver Function

“…It can be performed in combination with US or MRI. Correlations exist between liver elasticity and liver functional reserve, as demonstrated with ICG (Sugiura et al, 2019 ) or LiMAx (Heucke et al, 2019 ).…”