Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis

BACKGROUND: Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD. METHODS: This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: 2·67; NFS: 0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226. FINDINGS: Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression. INTERPRETATION: Simple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases. FUNDING: Innovative Medicines Initiative 2

Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis.

BACKGROUND Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD. METHODS This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: 2·67; NFS: 0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226. FINDINGS Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression. INTERPRETATION Simple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases. FUNDING Innovative Medicines Initiative 2

Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis

Objective: Liver biopsy is still needed for fibrosis staging in many patients with non-alcoholic fatty liver disease. The aims of this study were to evaluate the individual diagnostic performance of liver stiffness measurement by vibration controlled transient elastography (LSM- VCTE), Fibrosis-4 index (FIB-4) and NAFLD Fibrosis Score (NFS) and to derive diagnostic strategies that could reduce the need for liver biopsies.Design: Individual patient data meta-analysis of studies evaluating LSM-VCTE against liver histology was conducted. FIB-4 and NFS were computed where possible. Sensitivity, specificity and area under the receiver operating curve (AUROC) were calculated. Biomarkers were assessed individu-ally and in sequential combinations.Results: Data were included from 37 primary studies (n=5735; 45% female; median age: 54 years; median BMI: 30 kg/m2; 33% had type 2 diabetes; 30% had advanced fibrosis). AUROCs of individual LSM-VCTE, FIB-4 and NFS for advanced fibrosis were 0.85, 0.76 and 0.73. Sequential combination of FIB-4 cut-offs

Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis

BackgroundHistologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.MethodsThis was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0–4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0–2 vs F3 vs F4; LSM: 2·67; NFS: 0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.FindingsOf 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44–63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33–91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62–0·81) for histology, 0·76 (0·70–0·83) for LSM-VCTE, 0·74 (0·64–0·82) for FIB-4, and 0·70 (0·63–0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.InterpretationSimple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases

Impact of « Supersonic Shear Imaging » elastography in the noninvasive diagnosis of chronic liver diseases

Les maladies chroniques du foie constituent un problème majeur de santé publique. L’évaluation précise du degré de fibrose hépatique apporte au clinicien une estimation du pronostic dès la prise en charge initiale de ces patients, mais permet également la réalisation d’une surveillance évolutive, et intervient dans la décision et le choix d’un traitement. L’évaluation noninvasive de la fibrose hépatique par élastographie a permis de révolutionner la prise en charge des malades atteints d’une maladie chronique du foie. L’objectif de notre travail est d’évaluer les performances diagnostiques d’une nouvelle technique d’élastographie hépatique, appelée « Supersonic ShearImaging » (SSI), et d’analyser sa plus-value dans l’évaluation non-invasive des maladies chroniques du foie.Dans une première étude, nous avons prospectivement analysé et comparé les performances diagnostiques de l’élastographie SSI par rapport au FibroScan et l’ARFI pour le staging de la fibrose hépatique sur une série de 349 patients avec une maladie chronique du foie diagnostiquée et gradée par ponction-biopsiehépatique.Dans une seconde étude, nous avons prospectivement étudié l’impact diagnostique de l’élastographie SSIsur le foie et la rate chez une population de 401 patients avec cirrhose pour l’évaluation de la gravité de la maladie cirrhotique.Dans une troisième étude, nous avons réalisé une analyse prospective bicentrique (Angers et Bordeaux)de la performance diagnostique de l’élastographie SSI par rapport au FibroScan et l’ARFI dans l’évaluation non invasive de la fibrose hépatique sur une série de 291 patients avec stéatopathie non-alcoolique et ponction-biopsiehépatique.Abstract :The management and the prognosis for chronic liver diseases are widely based on the presence and the development of a liver fibrosis. The progressive worsening of liver fibrosis leads in a certain number of patients to the development of cirrhosis and its complications. Thus, the development of non-invasive diagnostic tools for the diagnosis and the monitoring of the liver fibrosis is of crucial interest. Liver elastography is one of the most promising techniques that have recently emerged in the field of chronic liver diseases. In this study, we aim to assess the diagnostic accuracy of a new elastography technique, named “Supersonic Shear Imaging” (SSI), and toanalyse its added value in the non invasive diagnosis of chronic liver diseases.In a first study, we prospectively analysed and compared the diagnostic performances of SSI elastography versus FibroScan and ARFI for the staging of liver fibrosis in a cohort of 349 patients with chronic liver diseases that consecutively underwent a liver biopsy. In a second study, we prospectively analysed the impact of liver and spleen SSI elastography in a cohortof 401 cirrhotic patients for the non invasive diagnosis of cirrhosis severity and oesophageal varices.In a third study, we assessed the clinical use of liver stiffness measurement evaluated by SSI, FibroScan,and ARFI in a cohort of nonalcoholic fatty liver disease patients who underwent liver biopsy. A total of 291 NAFLD patients were prospectively enrolled at 2 French university hospitals (Angers and Bordeaux)

Diagnostic et évaluation de la gravité des maladies chroniques du foie : impact de l’elastographie par ondes de cisaillement « supersonic shear imaging »

Abstract :The management and the prognosis for chronic liver diseases are widely based on the presence and the development of a liver fibrosis. The progressive worsening of liver fibrosis leads in a certain number of patients to the development of cirrhosis and its complications. Thus, the development of non-invasive diagnostic tools for the diagnosis and the monitoring of the liver fibrosis is of crucial interest. Liver elastography is one of the most promising techniques that have recently emerged in the field of chronic liver diseases. In this study, we aim to assess the diagnostic accuracy of a new elastography technique, named “Supersonic Shear Imaging” (SSI), and toanalyse its added value in the non invasive diagnosis of chronic liver diseases.In a first study, we prospectively analysed and compared the diagnostic performances of SSI elastography versus FibroScan and ARFI for the staging of liver fibrosis in a cohort of 349 patients with chronic liver diseases that consecutively underwent a liver biopsy. In a second study, we prospectively analysed the impact of liver and spleen SSI elastography in a cohortof 401 cirrhotic patients for the non invasive diagnosis of cirrhosis severity and oesophageal varices.In a third study, we assessed the clinical use of liver stiffness measurement evaluated by SSI, FibroScan,and ARFI in a cohort of nonalcoholic fatty liver disease patients who underwent liver biopsy. A total of 291 NAFLD patients were prospectively enrolled at 2 French university hospitals (Angers and Bordeaux).Les maladies chroniques du foie constituent un problème majeur de santé publique. L’évaluation précise du degré de fibrose hépatique apporte au clinicien une estimation du pronostic dès la prise en charge initiale de ces patients, mais permet également la réalisation d’une surveillance évolutive, et intervient dans la décision et le choix d’un traitement. L’évaluation noninvasive de la fibrose hépatique par élastographie a permis de révolutionner la prise en charge des malades atteints d’une maladie chronique du foie. L’objectif de notre travail est d’évaluer les performances diagnostiques d’une nouvelle technique d’élastographie hépatique, appelée « Supersonic ShearImaging » (SSI), et d’analyser sa plus-value dans l’évaluation non-invasive des maladies chroniques du foie.Dans une première étude, nous avons prospectivement analysé et comparé les performances diagnostiques de l’élastographie SSI par rapport au FibroScan et l’ARFI pour le staging de la fibrose hépatique sur une série de 349 patients avec une maladie chronique du foie diagnostiquée et gradée par ponction-biopsiehépatique.Dans une seconde étude, nous avons prospectivement étudié l’impact diagnostique de l’élastographie SSIsur le foie et la rate chez une population de 401 patients avec cirrhose pour l’évaluation de la gravité de la maladie cirrhotique.Dans une troisième étude, nous avons réalisé une analyse prospective bicentrique (Angers et Bordeaux)de la performance diagnostique de l’élastographie SSI par rapport au FibroScan et l’ARFI dans l’évaluation non invasive de la fibrose hépatique sur une série de 291 patients avec stéatopathie non-alcoolique et ponction-biopsiehépatique

Aspects neuroradiologiques de la neuromyélite optique

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge des tumeurs malignes du foie en radiologie interventionnelle

International audienceInterventional radiology (IR) has considerably grown since the 90s and has currently a central position in the management of patients suffering from cancer. The aim of this paper is to describe the principle, indications, technique and results of three common hepatic oncologic IR procedures: preoperative portal vein embolization, transarterial chemoembolization and radioembolization. Portal vein embolization is performed before a right hepatectomy in order to increase the left liver volume and functional capacity to ensure adequate liver function of the future remnant liver and to prevent the post-hepatectomy liver failure. It is a proven, well-tolerated and effective technique, allowing most of patients to undergo surgery. Transarterial chemoembolization consists of an injection of a chemotherapeutic agent and an embolic agent into the hepatic artery to locally act on liver tumors. It is the standard of care for BCLC stage B hepatocellular carcinoma and is also recommended for the liver metastases treatment, mainly from neuroendocrine tumors. Radioembolization is an IR procedure on the rise that consists of the injection into the hepatic artery of Yttrium 90 loaded microparticles, which will preferentially deliver high dose on the tumors, sparing the adjacent hepatic parenchyma. Radioembolization is recommended for the palliative treatment of HCC and for colorectal cancer liver metastases resistant to treatment. It is a very well tolerated intervention which place has yet to be defined in the management of neuroendocrine tumors liver metastases and unresectable cholangiocarcinoma. IR is a constantly evolving discipline with proven techniques playing a major role in the oncological management of liver tumor patients. In oncology, IR is now the 4th patient management linchpin alongside oncology, surgery and radiotherapy

Liver chemoembolization of hepatocellular carcinoma using TANDEM ® microspheres

IF 2.369 (2017)International audienceTransarterial chemoembolization (TACE) combines intra-arterial delivery of a chemotherapeutic agent with selective embolization to obtain a synergistic effect. TACE is recognized as the standard treatment of hepatocellular carcinoma patients at an intermediate stage. If conventional TACE, defined as the injection of an emulsion of a drug with ethiodized oil, still has a role to play, the development of drug-eluting beads has allowed many improvements and optimization of the technique. TANDEM® microspheres are second-generation drug-loadable microspheres. This device raised a special interest due to its tightly calibrated spherical microspheres, with small sizes down to 40 μm available. In this review, we describe the technical characteristics of these microspheres, analyze the scientific literature and hypothesize on the future perspectives