Noninvasive Assessment of Diffuse Liver Diseases Using Vibration-Controlled Transient Elastography (VCTE)

Because of the limitations and invasive nature of liver biopsy, other noninvasive means are being tested for the evaluation of diffuse liver diseases. One of these methods is vibration-controlled transient elastography (VCTE). This chapter reviews the principle of VCTE, the examination technique, the normal range for liver stiffness values, the pathological changes that may influence liver stiffness, as well as the diagnostic performance in several diffuse liver diseases, especially chronic hepatitis C, chronic hepatitis B, nonalcoholic steatohepatitis, and alcoholic liver disease. Apart from the assessment of fibrosis stages, we will also discuss the diagnosis of cirrhosis and its complications as well as other applications of VCTE, reviewing its advantages and limitations

Noninvasive Evaluation of Fibrosis and Steatosis in Nonalcoholic Fatty Liver Disease by Elastographic Methods

An increasingly common cause of chronic liver disease in adults and children is nonalcoholic fatty liver disease (NAFLD). The diagnosis of NAFLD was traditionally based on the histopathological changes of the liver, evaluated by needle liver biopsy, an invasive method, with potential adverse effects and great inter and intraobserver variability. The noninvasive methods for the assessment of both fibrosis and steatosis in patients with NAFLD have increasingly been studied lately. Of these noninvasive methods, in this chapter, we will focus on the methods assessing the stiffness of liver parenchyma, i.e. elastographic methods, of which, the most widely used are ultrasound elastography techniques. We will discuss the principal elastographic methods of some utility in NAFLD, i.e. shear wdave elastography (SWE) (quantitative elastography), and especially transient elastography, point SWE (acoustic radiation force impulse elastography, ARFI) and two-dimensional real-time SWE (Supersonic). For each method usable in NAFLD cases, we will review the method principle, examination technique and performance in NAFLD evaluation

Ultrasonographic assessment of the cutaneous changes induced by topical flavonoid therapy

Ultrasonography allows the quantification of dermal density and echogenicity changes during the physiological senescence process. Some active ingredients are able to slow down the tissular degeneration and disorganization process. The purpose of this study was to assess the cutaneous changes induced by the topical use of products containing Viniferol® as active ingredient, using high-frequency ultrasound. The study was performed over 12 weeks and included 80 healthy Caucasian female subjects, aged 22–75 years, divided into two groups: the study group and the control group. The product was applied according to a predetermined protocol. The measurements performed for each subject were: the thickness of the epidermis and dermis (mm), the number of low, medium, and high echogenic pixels, and the number of low echogenic pixels in the upper dermis/number of low echogenic pixels in the lower dermis. All the parameters showed a significant improvement. Ultrasound measurements showed an increase of the mean thickness of the epidermis (P < 0.0001) and dermis (P < 0.0001) following the application of the Viniferol product as compared to the control group. The changes in the dermal echogenicity confirm the efficacy and direct action of Viniferol upon the cutaneous fibroblasts. No side effects related to the treatment were recorded. The study proves the efficacy of this active ingredient in the cutaneous senescence process as well, as the fact that anti-aging prophylaxis should be initiated in the 20–40 year critical age group. This interval involves specific changes in dermal echogenicity that quantify intense molecular, biochemical and structural changes, being thus mostly and highly responsive to the anti-aging therapy

Abdominal Tumor Characterization and Recognition Using Superior-Order Cooccurrence Matrices, Based on Ultrasound Images

The noninvasive diagnosis of the malignant tumors is an important issue in research nowadays. Our purpose is to elaborate computerized, texture-based methods for performing computer-aided characterization and automatic diagnosis of these tumors, using only the information from ultrasound images. In this paper, we considered some of the most frequent abdominal malignant tumors: the hepatocellular carcinoma and the colonic tumors. We compared these structures with the benign tumors and with other visually similar diseases. Besides the textural features that proved in our previous research to be useful in the characterization and recognition of the malignant tumors, we improved our method by using the grey level cooccurrence matrix and the edge orientation cooccurrence matrix of superior order. As resulted from our experiments, the new textural features increased the malignant tumor classification performance, also revealing visual and physical properties of these structures that emphasized the complex, chaotic structure of the corresponding tissue

Diagnostic accuracy of non-invasive tests to screen for at-risk MASH-An individual participant data meta-analysis

Background & Aims: There is a need to reduce the screen failure rate (SFR) in metabolic dysfunction-associated steatohepatitis (MASH) clinical trials (MASH+F2-3; MASH+F4) and identify people with high-risk MASH (MASH+F2-4) in clinical practice. We aimed to evaluate non-invasive tests (NITs) screening approaches for these target conditions. Methods: This was an individual participant data meta-analysis for the performance of NITs against liver biopsy for MASH+F2-4, MASH+F2-3 and MASH+F4. Index tests were the FibroScan-AST (FAST) score, liver stiffness measured using vibration-controlled transient elastography (LSM-VCTE), the fibrosis-4 score (FIB-4) and the NAFLD fibrosis score (NFS). Area under the receiver operating characteristics curve (AUROC) and thresholds including those that achieved 34% SFR were reported. Results: We included 2281 unique cases. The prevalence of MASH+F2-4, MASH+F2-3 and MASH+F4 was 31%, 24% and 7%, respectively. Area under the receiver operating characteristics curves for MASH+F2-4 were .78, .75, .68 and .57 for FAST, LSM-VCTE, FIB-4 and NFS. Area under the receiver operating characteristics curves for MASH+F2-3 were .73, .67, .60, .58 for FAST, LSM-VCTE, FIB-4 and NFS. Area under the receiver operating characteristics curves for MASH+F4 were .79, .84, .81, .76 for FAST, LSM-VCTE, FIB-4 and NFS. The sequential combination of FIB-4 and LSM-VCTE for the detection of MASH+F2-3 with threshold of .7 and 3.48, and 5.9 and 20 kPa achieved SFR of 67% and sensitivity of 60%, detecting 15 true positive cases from a theoretical group of 100 participants at the prevalence of 24%. Conclusions: Sequential combinations of NITs do not compromise diagnostic performance and may reduce resource utilisation through the need of fewer LSM-VCTE examinations