Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C

Department of Hepatology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka 545-8585, Japan.
Journal of Gastroenterology (Impact Factor: 4.52). 03/2011; 46(3):350-8. DOI: 10.1007/s00535-010-0301-x
Source: PubMed


Although histopathological examination by "invasive" liver biopsy remains the gold standard for evaluating disease progression in chronic liver disease, noninvasive tools have appeared and have led to great progress in diagnosing the stage of hepatic fibrosis. The aim of this study was to assess the value of real-time tissue elastography, using an instrument made in Japan, for the visible measurement of liver elasticity; in particular, comparing the results with those of transient elastography (Fibroscan).
Real-time tissue elastography (RTE), transient elastography (Fibroscan), liver biopsy, and routine laboratory analyses were performed in 101 patients with chronic hepatitis C. The values for tissue elasticity obtained using novel software (Elasto_ver 1.5.1) connected to RTE were transferred to four image features, Mean, Standard Deviation (SD), Area, and Complexity. Their association with the stage of fibrosis at biopsy and with liver stiffness (kPa) obtained by Fibroscan was analyzed.
Colored images obtained by RTE were classified into diffuse soft, intermediate, and patchy hard patterns and the calculated elasticity differed significantly between patients according to and correlated with the stages of fibrosis (p < 0.0001). Mean, SD, Area, and Complexity showed significant differences between the stages of fibrosis (Tukey-Kramer test, p < 0.05). In discriminating patients with cirrhosis, the areas under the receiver operating characteristic curves (AUC) were 0.91 for Mean, 0.84 for SD, 0.91 for Area, 0.93 for Complexity, and 0.95 for Fibroscan.
RTE is a noninvasive instrument for the colored visualization of liver elasticity in patients with chronic liver disease.

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    • "e normal diag - nostic depth of superficial organs such as the breast and thyroid gland ; however , stress is not easily transmitted to deep organs such as the liver , making it difficult to elicit strain . Therefore , strain induced by either cardio - vascular pulsation or respiration is used for evaluation of liver fibrosis with strain imaging ( Morikawa et al . 2011 ) ."
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    ABSTRACT: Conventional diagnostic ultrasound images of the anatomy (as opposed to blood flow) reveal differences in the acoustic properties of soft tissues (mainly echogenicity but also, to some extent, attenuation), whereas ultrasound-based elasticity images are able to reveal the differences in the elastic properties of soft tissues (e.g., elasticity and viscosity). The benefit of elasticity imaging lies in the fact that many soft tissues can share similar ultrasonic echogenicities but may have different mechanical properties that can be used to clearly visualize normal anatomy and delineate pathologic lesions. Typically, all elasticity measurement and imaging methods introduce a mechanical excitation and monitor the resulting tissue response. Some of the most widely available commercial elasticity imaging methods are 'quasi-static' and use external tissue compression to generate images of the resulting tissue strain (or deformation). In addition, many manufacturers now provide shear wave imaging and measurement methods, which deliver stiffness images based upon the shear wave propagation speed. The goal of this review is to describe the fundamental physics and the associated terminology underlying these technologies. We have included a questions and answers section, an extensive appendix, and a glossary of terms in this manuscript. We have also endeavored to ensure that the terminology and descriptions, although not identical, are broadly compatible across the WFUMB and EFSUMB sets of guidelines on elastography (Bamber et al. 2013; Cosgrove et al. 2013). Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
    Ultrasound in medicine & biology 03/2015; 41(5). DOI:10.1016/j.ultrasmedbio.2015.03.009 · 2.21 Impact Factor
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    • "It is technically different from fibroscan, which measures the propagation speed of shear waves [10–12]. RTE captures 2D strain images induced by internal heartbeats, and the strain images show progressively increasing patchiness with increasing severity of fibrosis [9, 13]. Therefore, it can be possible to perform in obese patients or with ascites differently from transient elastography. "
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    ABSTRACT: The aim of this study was to investigate the diagnostic usefulness of real-time elastography (RTE) for liver fibrosis in chronic viral hepatitis B (CHB) and C (CHC). Fifty-one and thirty-two of the patients were diagnosed with CHB and CHC, respectively. Enrolled patients underwent liver biopsy and RTE. The FIB-4 index and aspartate transaminase-to-platelet ratio index (APRI) were also measured. The liver fibrosis index (LFI) by RTE increased significantly with the Knodell fibrosis stage: 3.14 ± 0.62 for F0, 3.28 ± 0.42 for F1, 3.43 ± 0.53 for F3, and 4.09 ± 1.03 for F4 (P = 0.000). LFI as well as APRI, FIB-4, platelet, albumin, and prothrombin time showed the difference in patients with advanced fibrosis (≥F3) and those with mild fibrosis (≤F1). In addition, RTE had better discrimination power between ≥F3 and F4 than between FIB-4 and APRI. In CHC patients, the area under receiver operating characteristic curves of RTE for advanced fibrosis was higher than that in CHB patients (0.795 versus 0.641). RTE is useful for the assessment of advanced fibrosis in patients with CHB and CHC and has better discrimination power than other serologic markers.
    Gastroenterology Research and Practice 08/2014; 2014:210407. DOI:10.1155/2014/210407 · 1.75 Impact Factor
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    • "Studies employing the RTE fibrosis index achieved good results. Morikawa et al. (2011) reported the clinical utility of four parameters retrieved from secondary analysis of RTE elastograms (mean, standard deviation, area and complexity), suggesting that mean and area may directly represent liver elasticity, whereas standard deviation and complexity may reflect the loss of the uniform architecture of the liver parenchyma concomitant with developing parenchymal fibrosis. The mean and area parameters were highly accurate for the diagnosis of significant fibrosis (F . "
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    ABSTRACT: Despite its invasiveness, liver biopsy is still considered the gold standard for the assessment of hepatic fibrosis. Non-invasive ultrasound-based techniques are increasingly employed to assess parenchymal stiffness and the progression of chronic diffuse liver diseases. Real-time elastography is a rapidly evolving technique that can reveal the elastic properties of tissues. This review examines qualitative and semi-quantitative methods developed for analysis of real-time liver elastograms, to estimate parenchymal stiffness and, indirectly, the stage of fibrosis. Qualitative analysis is the most immediate approach for elastogram analysis, but this method increases intra- and inter-observer variability, which is seen as a major limitation of real-time elastography. Semi-quantitative methods include analysis of the histogram derived from color-coded maps, as well as calculation of the elastic ratio and fibrosis index.
    Ultrasound in Medicine & Biology 06/2014; DOI:10.1016/j.ultrasmedbio.2014.03.021 · 2.21 Impact Factor
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