Noninvasive Assessment of Schistosoma‐Related Periportal Fibrosis

Abstract

Schistosomiasis affects nearly 250 million individuals in the world. Hepatosplenic schistosomiasis (HSS) results in periportal fibrosis (PPF) and portal hypertension (pHTN). Ultrasound has been extensively used for the diagnosis of Schistosoma‐related PPF and a number of staging methods have been validated for this purpose such as Strickland classification and Niamey protocol. Nevertheless, the application of noninvasive techniques, particularly elastography modalities, has not been well explored. In this review, we describe the various noninvasive diagnostic tools for assessment of Schistosoma‐related PPF including US parameters, serum biomarkers, and US‐based elastography techniques. While elastography techniques have demonstrated value in the evaluation of HSS, the evidence remains limited with most studies recruiting a small number of patients. Longitudinal studies with larger sample size are required in order to devise robust criteria to accurately assess the performance of noninvasive techniques in the prediction of both regression and progression of the degree of PPF and identify their cost‐effectiveness in community screening.

Assessment of periportal fibrosis in Schistosomiasis mansoni patients by proton nuclear magnetic resonance-based metabonomics models

“…Generally, US scan and serum biomarkers have been used for PPF assessment in schistosomiasis patients[ 2 , 20 ]. Among serum biomarkers for PPF assessment, liver enzymes and platelet count alone or combined with ALP, as in the Coutinho-index, have been given importance in the literature[ 2 , 6 , 7 ]. In agreement with these authors, laboratory data found in this study indicate a higher serum level of GGT in particular, and lower platelet count in patients with significant PPF.…”

“…Ultrasonography (US) scan is used for diagnosis and assessment of PPF by the Niamey-Belo Horizonte Protocol, the WHO Standard Protocol. This protocol classifies 6 PPF patterns from A (no-fibrosis) up F (very advanced fibrosis), plus mixed patterns, such as the D/C or E/C patterns[ 4 - 6 ].…”

“…Some serum biomarkers, alone or in association (indexes), have been used for this purpose. Some authors reported an inversely proportional relationship between platelet count and PPF pattern, as well as a directly proportional relationship between liver enzymes serum levels and PPF patterns[ 5 , 6 ].…”

The role of point-of-care ultrasound in the assessment of schistosomiasis-induced liver fibrosis: A systematic scoping review

“…Accurate disease staging is needed to guide the monitoring of disease progression and stage-appropriate treatment interventions. Currently, abdominal ultrasound imaging is the most used non-invasive method for diagnosis and staging of PPF caused by schistosomiasis [ 3 ]. Point-of-care ultrasound imaging is inexpensive, portable, and carries no additional health risks, unlike methods such as computed tomography (CT) which expose the patient to harmful radiation.…”

Noninvasive diagnosis of liver fibrosis in schistosomiasis japonica: Opportunities and challenges

“…Acoustic radiation force impulse elastography (point shear wave elastography, pSWE; two-dimensional shear wave elastography, 2DSWE) can also be used to diagnose HSS, enabling the detection of fibrosis in an ROI and yielding better diagnostic accuracy than conventional TE. 11 A recent study that explored the application of pSWE in the context of schistosomiasis showed that pSWE was able to differentiate between mild and significant PPF at higher velocities (1.40 m/s). 12 With the application of artificial intelligence technology in the medical field, an emerging technology called radiomics that is widely used in disease diagnosis can provide the automated quantification of image features from a large number of medical images.…”