Transient elastography: Applications and limitations

Yoshioka, Kentaro; Kawabe, Naoto; Hashimoto, Senju

doi:10.1111/j.1872-034x.2008.00386.x

Cited by 55 publications

(68 citation statements)

References 37 publications

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“…In addition, it has also been recommended that the scan be used in combination with another non-invasive method to improve the accuracy of the liver fibrosis staging (Castera et al, 2008;Yoshioka et al, 2008). Hence, although the Fibroscan® is proving to be a useful tool for monitoring stiffness of the liver, biopsy should remain the gold standard until such a time as fibrosis staging can be more accurately identified by the scanner.…”

Section: Resultsmentioning

confidence: 99%

Assessment of the accuracy of an ultrasound elastography liver scanning system using a PVA-cryogel phantom with optimal acoustic and mechanical properties

Cournane¹,

Cannon²,

Browne³

et al. 2010

Phys. Med. Biol.

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The accuracy of a transient elastography liver-scanning ultrasound system was assessed using a novel application of PVA-cryogel as a tissue-mimicking material with acoustic and shear elasticity properties optimized to best represent those of liver tissue. Although the liver-scanning system has been shown to offer a safer alternative for diagnosing liver cirrhosis through stiffness measurement, as compared to the liver needle biopsy exam, the scanner's accuracy has not been fully established. The Young's elastic modulus values of 5-6wt% PVA-cryogel phantoms, also containing glycerol and 0.3μm Al 2 O 3 and 3μm Al 2 O 3 , were measured using a 'gold standard' mechanical testing technique and transient elastography. The mechanically measured values and acoustic velocities of the phantoms ranged between 1.6-16.1kPa and 1540-1570m/s, respectively, mimicking those observed in liver tissue. The values reported by the transient elastography system overestimated the Young's elastic modulus values representative of the progressive stages of liver fibrosis by up to 32%. These results were attributed to the relative rather than absolute nature of the measurement arising from the singlepoint acoustic velocity calibration of the system, rendering the measurements critically dependent on the speed of sound of the sample under investigation. Given the wide range of acoustic velocities which exist in the liver, spanning healthy tissue to cirrhotic pathology, coupled with the system's assumption that the liver is approximately elastic when it is rather highly viscoelastic, care should be exercised when interpreting the results from this system in patient groups.2

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Section: Resultsmentioning

confidence: 99%

Assessment of the accuracy of an ultrasound elastography liver scanning system using a PVA-cryogel phantom with optimal acoustic and mechanical properties

Cournane¹,

Cannon²,

Browne³

et al. 2010

Phys. Med. Biol.

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“…Using heart beats instead of manual www.wjgnet.com Del Poggio P et al . Transient elastography for screening liver disease compression for displacement [26] may improve the accuracy and lead to better standardization. Clearly more studies are needed and at this time only TE has sufficient body of evidence to be proposed for screening studies.…”

Section: New Techniques: Real Time Elastographymentioning

confidence: 99%

“…In one study comparing liver biopsy and real time ultrasonography the areas under the receiver operating curve (AUROC) were inferior to TE: 0.75 for equal or higher than F2 fibrosis, 0.73 for equal or higher than F3, 0.69 for F4 and APRI itself performed better than the new technique [25] . Using heart beats instead of manual www.wjgnet.com [26] may improve the accuracy and lead to better standardization. Clearly more studies are needed and at this time only TE has sufficient body of evidence to be proposed for screening studies.…”

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confidence: 99%

Is transient elastography a useful tool for screening liver disease?

Poggio¹,

Colombo²

2009

WJG

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Transient elastography (TE) is a new non invasive tool for measuring liver stiffness, which is correlated to the histologic stage of liver fibrosis. Several studies in chronic liver disease (CLD) have determined a good accuracy of TE in predicting significant fibrosis and an optimal accuracy in predicting cirrhosis. Normal liver stiffness ranges between 3.3-7.8 KPa and using a cut off of 7.1 KPa, significant fibrosis and cirrhosis can be excluded with a very high negative predictive value (NPV). Positive predictive value (PPV) for the diagnosis of cirrhosis is lower using just a single scan but increases to 90% if high stiffness values are confirmed by a second independent scan. However the presence of fatty liver and metabolic syndrome slightly increases the readings and may reduce the accuracy of the test. It is uncertain if this increase is related to the presence of steatofibrosis or if it is caused by steatosis itself. TE can be used in screening patients attending the liver clinics to identify those with significant fibrosis or cirrhosis and may be particularly useful in discriminating HBV inactive carriers from chronic hepatitis B patients. TE, however, is not reliable in predicting the presence of esophageal varices in cirrhotics. Another potential indication for TE is the systematic screening of populations at high risk for CLD, such as intravenous drug users and alcoholics, but further studies are needed to determine its diagnostic accuracy in these settings. INTRODUCTIONTransient elastography (TE) is a new non invasive tool for measuring liver stiffness, which is correlated to the histologic stage of liver fibrosis [1] . The device (Fibroscan) generates an elastic wave by means of a vibrator applied to the thoracic wall at the level of the right liver lobe. The vibrator produces a shot and a low amplitude shear wave propagating through the liver parenchyma. The velocity of propagation is directly proportional to liver stiffness and is automatically calculated by the instrument. The range of measurements, expressed in kilopascals, varies from 2.5 to 74 KPa.Many studies have been published on the use of TE in patients with already diagnosed chronic liver disease (CLD) but few have addressed the issue of its possible use as a first line examination in the liver clinic or in facilities where patients at risk of liver disease are attending. HOW TO TAKE AND INTERPRET THE MEASUREMENTSIn order to obtain valid and reproducible measurements the probe should be placed at the center of the right liver lobe, two intercostal spaces below the upper liver margin and at the level of the anterior or middle axillary line. If measurements are taken below this point and too close to the lower liver edge both the percentage of valid shots and the median stiffness tend to decrease [2] . Ultrasound assistance to locate the upper liver margin is usually unnecessary if the patient is reasonably thin because the liver can be recognized by percussion alone. The device incorporates an M-mode window enabling the ope...

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“…So, non-invasive methods like transient elastography appear to be better option for monitoring of therapeutic response in these patients during and after therapy. 9,10 Given its simplicity, high acceptability by patients and intrinsic performance, transient elastography is already become an appropriate tool for the longitudinal follow-up of fibrosis changes in treated HCV-infected patients, 11 as shown in the present study.…”

Section: Discussionmentioning

confidence: 71%

Status of liver stiffness following directly acting antiviral treatment in patients with chronic hepatitis C: A Nepalese study

Sharma

Shrestha³

et al. 2017

J Coll Med Sci-Nepal

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Background & Objectives:Chronic hepatitis C is one of the leading causes of chronic liver disease in our country. With the introduction of directly acting antivirals, many patients are benefitted these days. Transient elastography is one of the newer technologies for measuring liver stiffness and quantifying liver fibrosis and has excellent accuracy for the diagnosis of fibrosis in patients with chronic hepatitis C. Our study analyzes changes of liver stiffness and its associated factors in patients with chronic hepatitis C treated with directly acting antivirals (DAAs).Materials & Methods: One hundred and seven patients with chronic hepatitis C, who were treated with DAAs (Sofosbuvir 400 mg and velpatasvir 100mg) and have significant fibrosis (>7.0 kPa) at baseline were included. Liver stiffness was measured at the time of enrollment, and after completion of DAAs with fibroscan and changes of stiffness and its associated factors were analyzed. Results:The study showed significant decrease in liver stiffness at the end of treatment, which continued after treatment only in patients who achieved a sustained virological response.Conclusion: Liver stiffness decreased following 12 weeks of successful DAAs therapy in patients with chronic hepatitis C at the end of treatment who achieved sustained virological response.

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Transient elastography: Applications and limitations

Cited by 55 publications

References 37 publications

Assessment of the accuracy of an ultrasound elastography liver scanning system using a PVA-cryogel phantom with optimal acoustic and mechanical properties

Assessment of the accuracy of an ultrasound elastography liver scanning system using a PVA-cryogel phantom with optimal acoustic and mechanical properties

Is transient elastography a useful tool for screening liver disease?

Status of liver stiffness following directly acting antiviral treatment in patients with chronic hepatitis C: A Nepalese study

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