Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis

Hartl, Johannes; Denzer, Ulrike W.; Ehlken, Hanno; Zenouzi, Roman; Peiseler, Moritz; Sebode, Marcial; Hübener, Sina; Pannicke, Nadine; Weiler‐Normann, Christina; Quaas, Alexander; Lohse, Ansgar W.; Schramm, Christoph

doi:10.1016/j.jhep.2016.05.023

Cited by 130 publications

(139 citation statements)

References 35 publications

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“…A recent study on AIH patients suggested that TE performs better in AIH patients treated more than 6 months compared to patients treated less than 3 months or untreated to differentiate patients with cirrhosis (18). We could not demonstrate a similar result, however, the number of treated patients was small (n = 18).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in a Chinese study, comparing diagnostic performance of TE and liver biopsy in 30 patients with AIH, liver stiffness measured by TE correlated significantly with the stage of liver fiibrosis, and in another study TE performed better than non-invasive markers (16, 17). It has been demonstrated that TE can accurately predict fiibrosis grade in treated AIH patients (18), and a non-invasive inflammatory score was proposed to discriminate patients with and without significant hepatic inflammation (19). The above mentioned score is easy to calculate but would be only applicable to patients without co-morbidities and would not account for patients with low inflammatory activity (20).…”

Section: Introductionmentioning

confidence: 99%

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Performance and Utility of Transient Elastography and Non-Invasive Markers of Liver Fiibrosis in Patients with Autoimmune Hepatitis: A Single Centre Experience

et al. 2016

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ObjectivesAutoimmune hepatitis (AIH) is a relatively rare cause of hepatic dysfunction, which can lead to acute liver failure (ALV) and cirrhosis if not treated. The performance of transient elastography (TE) compared to liver biopsy has been evaluated in many liver diseases. The aim of the present study was to evaluate the performance of TE and other non-invasive markers for liver fiibrosis in patients with biopsy-proven AIH.MethodsFifty-three patients who were treated at the department of gastroenterology and hepatology of the University Clinic Essen from 2008 to 2013 included in this retrospective study. Laboratory parameters were used to calculate non-invasive markers for liver fiibrosis. Every patient underwent a liver biopsy within 6 months of the liver stiffness measurement.ResultsTransient elastography score, non-alcoholic fatty liver disease (NAFLD) fiibrosis score, Fiibrosis 4 score (FIB-4), and FibroQ were associated with the stage of fiibrosis, whereas other non-invasive markers of liver fiibrosis (aspartate transaminase (AST) to alanine transaminase (ALT) ratio, and AST to platelet ratio index (APRI)) did not demonstrate a significant correlation. NAFLD fiibrosis score and FibroQ performed slightly better in ROC curve analysis than TE in differentiating mild to moderate from severe fiibrosis (AUC 0.895 and 0.773 vs. 0.739; P < 0.001 and = 0.01, respectively), while TE performed slightly better, but still not adequate, in differentiating mild from all other stages of fiibrosis compared to NAFLD fiibrosis score and FibroQ (AUC 0.779 vs. 0.752 and 0.684; P = 0.051 and 0.009).ConclusionsTransient elastography, NAFLD fiibrosis score, and FibroQ are valuable non-invasive markers for the evaluation of liver fiibrosis in autoimmune hepatitis but they cannot replace liver biopsy, especially in differentiating mild from more advanced stages of fiibrosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Performance and Utility of Transient Elastography and Non-Invasive Markers of Liver Fiibrosis in Patients with Autoimmune Hepatitis: A Single Centre Experience

et al. 2016

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“…While shear wave imaging has been reported to be useful in the detection of fibrosis in the diagnosis of AIH, it has also been reported that liver stiffness varies greatly depending on the level of hepatic inflammation activity [16,17] . In several liver diseases both of these elastography methods are useful to diagnose the degree of liver fibrosis, but it is said that only shear wave imaging is influenced by liver inflammation, jaundice, liver congestion, etc.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Objective: In order to evaluate the influence of liver inflammation on liver stiffness measurement (LSM) by the simultaneous use of shear wave and strain imaging (combinational elastography), shear wave and strain imaging were compared before and after initial therapy for autoimmune hepatitis (AIH). Methods: Nine AIH patients initially treated with steroid were enrolled. Transient elastography and real-time tissue elastography were performed just before and 1 month after the start of initial steroid treatment. Blood samples, LSM, and the liver fibrosis index (LFI) were compared. Results: Aspartate aminotransferase (p = 0.002) and alanine aminotransferase (ALT) (p = 0.015) were significantly decreased after initial treatment. The LSM was 15.5 ± 9.6 kPa at baseline, decreasing to 7.2 ± 2.3 kPa after initial treatment p = 0.034). The LFI was 1.67 ± 0.67 at baseline and 1.61 ± 0.66 after initial treatment; no significant change in LFI was recognized (p = 0.842). Between ΔALT and ΔLSM, a significant regression equation could be calculated as follows: ΔALT = -0.55 + 0.654 × ΔLSM. Conclusions: Combinational elastography was useful in evaluating not only the degree of liver fibrosis, but also the degree of liver inflammation in AIH.

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“…One possible explanation is that the presence of hepatic inflammation, which causes swelling of hepatocytes, interstitial edema, and infiltration of inflammatory cells, results in increased apparent liver stiffness . Inflammatory reaction differs according to various chronic liver diseases, including the hepatitis C virus, the hepatitis B virus, autoimmune hepatitis, and steatohepatitis, which result in different apparent stiffness values . Liver stiffness generally consists of elasticity and viscosity, and intrahepatic hemodynamic changes, such as inflammation, congestion, and portal hypertension .…”

Section: Discussionmentioning

confidence: 99%

Dual‐frequency MR elastography to differentiate between inflammation and fibrosis of the liver: Comparison with histopathology

Sofue

Onoda

Tsurusaki

et al. 2019

Magnetic Resonance Imaging

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Background Differentiation between inflammation and fibrosis is an important clinical distinction in patients with chronic liver disease, which has been difficult so far with MR elastography. Purpose To investigate whether dual‐frequency MR elastography can estimate necroinflammation of the liver and improve diagnostic performance for the staging of liver fibrosis. Study Type Retrospective. Subjects In all, 30 patients (14 males, 16 females) with chronic liver disease. Field Strength/Sequence 1.5T/dual‐frequency MR elastography at 60‐Hz and 80‐Hz vibration frequencies. [Correction added on November 12, 2019, after first online publication: The field strength in the preceding sentence was corrected.] Assessment Necroinflammation activity and fibrosis were assessed using the METAVIR scoring system. Stiffness values at 60‐Hz (G60‐Hz) and 80‐Hz (G80‐Hz) were obtained with an MR elastogram. The difference value between G80‐Hz and G60‐Hz (ΔG) was calculated. Four values (G60‐Hz, G80‐Hz, G60‐Hz – ΔG, and G80‐Hz + ΔG) were generated to estimate necroinflammation and fibrosis. Statistical Tests The ΔG were correlated with necroinflammation activity grade and fibrosis stage using Spearman's rank correlation. Diagnostic performance of the four values for necroinflammation activity grade and fibrous stage was assessed by using area under the receiver operating characteristic curve (AUC). Results The mean value of G80‐Hz (6.23 ± 3.67 kPa) was significantly higher than that of G60‐Hz (5.27 ± 3.14 kPa) (P < 0.0001). The ΔG demonstrated a strong correlation with necroinflammation grade (ρ = 0.625, P < 0.001) and no correlation with fibrosis stage (ρ = 0.306, P = 0.113). The AUC of the G80‐Hz and G80‐Hz + ΔG showed higher accuracy for necroinflammation, and optimal cutoff values yielded better discrimination of ≥A1, ≥A2, and = A3. The AUC demonstrated that all the generated values had high diagnostic performance (≥0.87 for all) for fibrosis. Data Conclusion Dual‐frequency MR elastography shows potential in estimating necroinflammation of the liver and may improve diagnostic performance for staging liver fibrosis. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1053–1064.

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Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis

Cited by 130 publications

References 35 publications

Performance and Utility of Transient Elastography and Non-Invasive Markers of Liver Fiibrosis in Patients with Autoimmune Hepatitis: A Single Centre Experience

Performance and Utility of Transient Elastography and Non-Invasive Markers of Liver Fiibrosis in Patients with Autoimmune Hepatitis: A Single Centre Experience

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

Dual‐frequency MR elastography to differentiate between inflammation and fibrosis of the liver: Comparison with histopathology

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