Quantification of Liver Steatosis

The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) is increasing in the modern world. Fatty infiltration of the liver can be assessed by standard ultrasound, by controlled attenuation parameter (CAP) using the FibroScan device or, more recently, by ultrasound systems that evaluate the attenuation in the liver. Standard ultrasound (US) for steatosis evaluation was used for a long time as a semi-quantitative method for steatosis assessment in the liver. A “bright liver” with “posterior attenuation” is the typical US sign of liver steatosis. Considering the attenuation severity, steatosis is subjectively graded as mild, moderate or severe. Using the kidney/liver ratio, a more accurate evaluation can be made. Controlled attenuation parameter (CAP) was developed by EchoSens, France, and implemented into the FibroScan device. CAP manages an objective assessment of steatosis severity with rather good accuracy. More recently, ultrasound companies such as Hitachi, General Electric and Canon, implemented in their system algorithms which allow an objective assessment of liver steatosis, using the attenuation of the ultrasound beams

2D Shear Wave Elastography for Liver Fibrosis Evaluation

2D shear wave elastography is a technique embedded in ultrasound machines which allows the interrogation of the tissue by acoustic radiation force impulses induced into the tissues by focused ultrasonic beams and captures the propagation of resulting shear waves in real time. Elasticity is displayed using a color-coded image superimposed on a B-mode image, and at the same time, a quantitative estimation of liver stiffness (LS) can be performed in a certain region of interest (ROI). The published data showed a real value of this method for liver stiffness estimation in patients with chronic hepatitis. It has the following advantages: it is integrated into standard ultrasound systems; it is a real-time elastographic method; and it is also feasible in patients with ascites and with large and adjustable size of the ROI that will be evaluated

Liver Fibrosis Assessment by Point Shear-Wave Elastography Techniques

Point shear-wave elastographic (pSWE) techniques use acoustic radiation force impulse (ARFI) to stimulate the liver tissue and to generate shear waves that propagate into the liver. The shear-wave velocity (SWV) increases with the severity of fibrosis. The first type of pSWE was Virtual Touch Quantification (VTQ) developed by Siemens, followed by ElastPQ by Philips, and nowadays pSWE is available on other systems (Hitachi, Esaote, Samsung). To evaluate liver fibrosis by pSWE, ten valid measurements are performed in the right liver lobe; a median value is calculated, with the results expressed in meters/second or in kilopascals (kPa) (if the operator chooses). VTQ is a reproducible method, the intraclass correlation coefficient (ICC) for inter- and intraobserver measurements ranging from 0.81 to 0.87. Confounding factors for VTQ are non-fasting conditions, elevated aminotransferases, congestive heart failure, and extrahepatic cholestasis. In patients with chronic hepatopathies, the AUROCs for predicting significant fibrosis range between 0.75 and 0.85 and for predicting cirrhosis between 0.85 and 0.95. There were promising results regarding the value of VTQ to predict liver cirrhosis complications, especially portal hypertension. ElastPQ is a newly developed point shear-wave elastographic method (from Philips). Only few data were published but with promising results

Elastography for the Evaluation of Portal Hypertension

Liver cirrhosis, regardless of its etiology, is an important health problem with a chronic evolution, characterized by the possibility of developing several important complications. The best management of these patients implies the correct and early diagnosis of the disease and of its complications. A major complication of cirrhosis is portal hypertension. The reference method for its diagnosis is the direct measurement of hepatic vein portal gradient, an invasive procedure. In the last years, several noninvasive techniques for the evaluation of liver fibrosis were developed, such as biological tests and elastographic methods. Ultrasound-based and MRI-based elastographic techniques have been assessed as predictive tools for the presence and severity of portal hypertension. This paper reviews published data regarding the value of ultrasound and MRI-based elastography (liver, spleen, or both) for the evaluation of portal hypertension

Ultrasound Based Elastography Techniques for the Evaluation of Nonalcoholic Liver Disease

The number of NAFLD patients is increasing in the developed world and non-invasive modalities for their evaluation are needed. Ultrasound-based methods are very useful for this approach, starting with standard ultrasound used for steatosis detection, and continuing with new modalities for steatosis, fibrosis, and inflammation quantification. Modern ultrasound systems can quantify all these parameters in NAFLD patients, thus making ultrasound a real Multiparameter Ultrasound (MPUS). The performance of ultrasound-based methods is very well documented with liver stiffness assessment as a marker of fibrosis, and more recently, for quantification of steatosis and viscoelastic properties as a marker of inflammation

Efficacy and Safety of a Novel Therapeutic of Natural Origin (NTN) in Adult Patients with Lactose Intolerance: A Multicenter, Randomized, Crossover, Double-Blind, Placebo-Controlled Study

Food intolerance; Intestinal barrier; Natural therapeuticIntolerància alimentària; Barrera intestinal; Terapèutica naturalIntolerancia alimentaria; Barrera intestinal; Terapéutica naturalBackground: Film-forming substances, such as natural polysaccharides (NP) and pea proteins (PP), act as a protective barrier for treating various gastrointestinal conditions. We assessed the efficacy and safety of a novel therapeutic of natural origin (NTN) containing NP and PP for symptomatic treatment of lactose intolerance. Methods: In this multicenter, randomized, double-blind, parallel-group study, patients with lactose intolerance received NTN (n = 30) or placebo (n = 30) for 7 days, then the alternate treatment for 7 days. Patients rated their gastrointestinal symptoms using a 7-point Likert scale. The lactose hydrogen breath test was used to assess exhaled hydrogen. Results: NTN as primary or crossover treatment significantly improved patient-reported symptoms of bloating, distension, and abdominal pain. Abdominal pain also improved under primary treatment with placebo. Primary treatment with NTN, but not placebo, normalized mean exhaled hydrogen levels. In the group allocated initially to placebo, crossover to NTN attenuated the increase in hydrogen production. No treatment-related adverse effects were reported in either group. Conclusions: Subjective improvements in bloating, distension, and abdominal pain with NTN were supported by objective evidence of hydrogen production normalization. NTN appears to be a useful alternative to lactose avoidance or enzyme replacement in patients with lactose intolerance.The study was sponsored by Novinthetical Pharma SA, Lugano, Switzerland

Feasability, accuracy and reproducibility of transient elastography

Abstract Background: Transient elastography (TE) is a non-invasive method for the evaluation of liver diseases which is increasingly being accepted by patients and hepatologists. Aim: To evaluate the capacity of the TE (FibroScan) in estimating liver fi brosis in clinical practice. Material and methods: During 2 years 3459 examinations were performed. The time required for examination, the rate of valid determinations and the rate of uninterpetable results, taking into account the interquartilic range (IQR) and the success rate (SR), were evaluated. The TE reproducibility (intra-and inter-observer reproducibility analyzed by 3 independent examiners) in 287 cases was evaluated using the intra-class correlation coeffi cient (ICC). A group of 167 healthy volunteers were examined to establish the average value of the liver stiffness. Results: The average time required for one examination was 4 min 15 s. In 94.7% of cases the determinations were valid. In 446 cases IQR was > 30% and SR < 60% resulting in 13.6% of cases without TE valid results, and 86.4% TE useful results for the evaluation of the chronic liver disease. Intra-observer reproducibility for the three operators were: 0.985, 0.949, and respectively 0.874 and the inter-observer reproducibility was analyzed with overall ICC 0982. The average value of the liver stiffness in the control group was 4.8 -1.9 kPa. Conclusions: TE is an easy and quick way to evaluate liver stiffness, user-and patient-friendly. Intra-and inter-observer reproducibility is excellent, TE being an operator-independent method

Acoustic Radiation Force Impulse and Supersonic Shear Imaging Versus Transient Elastography for Liver Fibrosis Assessment

AbstractOur study compared three elastographic methods—transient elastography (TE), acoustic radiation force impulse (ARFI) imaging and supersonic shear imaging (SSI)—with respect to the feasibility of their use in liver fibrosis evaluation. We also compared the performance of ARFI imaging and SSI, with TE as the reference method. The study included 332 patients, with or without hepatopathies, in which liver stiffness was evaluated using TE, ARFI and SSI. Reliable measurements were defined as a median value of 10 (TE, ARFI imaging) or 5 (SSI) liver stiffness measurements with a success rate ≥60% and an interquartile range interval <30%. A significantly higher percentage of reliable measurements were obtained using ARFI than by using TE and SSI: 92.1% versus 72.2% (p < 0.0001) and 92.1% versus 71.3% (p < 0.0001). Higher body mass index and older age were significantly associated with inability to obtain reliable measurements of liver stiffness using TE and SSI. In 55.4% of patients, reliable liver stiffness measurements were obtained using all three elastographic methods, and ARFI imaging and TE were similarly accurate in diagnosing significant fibrosis and cirrhosis, with TE as the reference method