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Journal of Gastroenterology

, Volume 52, Issue 6, pp 724–733 | Cite as

Strain elastography for assessment of liver fibrosis and prognosis in patients with chronic liver diseases

  • Kazuto Tajiri
  • Kengo Kawai
  • Toshiro Sugiyama
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

Estimation of liver stiffness is essential in the treatment of liver diseases. Various procedures alternative to liver biopsy have been developed, and transient elastography using shear wave is an established method for evaluating liver stiffness and has been shown to be a prognostic indicator. In contrast, strain elastography (SE) has been applied to evaluate liver stiffness, however the significance remains uncertain.

Methods

We retrospectively analyzed 598 patients who underwent SE to evaluate the ability of estimating liver stiffness and the prognosis. Elasticity index (EI) was evaluated as an indicator of liver stiffness in this study.

Results

EI was increased as histological fibrosis advanced. EI was significantly different between mild fibrosis (F0–2) and advanced fibrosis (F3, 4). In contrast, EI was similar among those with different activity scores. EI showed better diagnostic performance in estimating advanced fibrosis than other serological markers and good reproducibility. Furthermore, EI was shown to be an independent prognostic factor in patients with chronic liver diseases and also with hepatocellular carcinoma (HCC) with advanced stage.

Conclusions

SE could estimate advanced liver fibrosis without influence of liver inflammation unlike other serological liver fibrosis markers. SE might be a prognostic factor in chronic liver diseases and HCC.

Keywords

Strain elastography Liver stiffness Liver biopsy Hepatocellular carcinoma Prognosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

535_2016_1277_MOESM1_ESM.pptx (58 kb)
Supplementary material 1 (PPTX 58 kb)

References

  1. 1.
    National Institutes of H. National Institutes of Health consensus development conference statement: management of hepatitis C: 2002-June 10–12, 2002. Hepatology. 2002;36:S3–20.Google Scholar
  2. 2.
    Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495–500.CrossRefPubMedGoogle Scholar
  3. 3.
    Maharaj B, Maharaj RJ, Leary WP, et al. Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. Lancet. 1986;1:523–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Regev A, Berho M, Jeffers LJ, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002;97:2614–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Martinez SM, Crespo G, Navasa M, et al. Noninvasive assessment of liver fibrosis. Hepatology. 2011;53:325–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 3: liver. Ultrasound Med Biol. 2015;41:1161–79.CrossRefPubMedGoogle Scholar
  7. 7.
    Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960–74.CrossRefPubMedGoogle Scholar
  9. 9.
    Ganne-Carrie N, Ziol M, de Ledinghen V, et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatology. 2006;44:1511–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Foucher J, Castera L, Bernard PH, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol. 2006;18:411–2.CrossRefPubMedGoogle Scholar
  11. 11.
    Fraquelli M, Rigamonti C, Casazza G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut. 2007;56:968–73.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hirooka M, Koizumi Y, Hiasa Y, et al. Hepatic elasticity in patients with ascites: evaluation with real-time tissue elastography. AJR Am J Roentgenol. 2011;196:W766–71.CrossRefPubMedGoogle Scholar
  13. 13.
    Yada N, Kudo M, Morikawa H, et al. Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis. Oncology. 2013;84(Suppl 1):13–20.CrossRefPubMedGoogle Scholar
  14. 14.
    Koizumi Y, Hirooka M, Kisaka Y, et al. Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography—establishment of the method for measurement. Radiology. 2011;258:610–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Ochi H, Hirooka M, Koizumi Y, et al. Real-time tissue elastography for evaluation of hepatic fibrosis and portal hypertension in nonalcoholic fatty liver diseases. Hepatology. 2012;56:1271–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Shiraishi A, Hiraoka A, Aibiki T, et al. Real-time tissue elastography: non-invasive evaluation of liver fibrosis in chronic liver disease due to HCV. Hepatogastroenterology. 2014;61:2084–90.PubMedGoogle Scholar
  17. 17.
    Ferraioli G, Tinelli C, Malfitano A, et al. Performance of real-time strain elastography, transient elastography, and aspartate-to-platelet ratio index in the assessment of fibrosis in chronic hepatitis C. AJR Am J Roentgenol. 2012;199:19–25.CrossRefPubMedGoogle Scholar
  18. 18.
    Friedrich-Rust M, Schwarz A, Ong M, et al. Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease. Ultraschall Med. 2009;30:478–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Kan QC, Cui XW, Chang JM, et al. Strain ultrasound elastography for liver diseases. J Hepatol. 2015;63:534.CrossRefPubMedGoogle Scholar
  20. 20.
    Tsutsumi M. The history of the diagnostic criteria for alcoholic liver disease and current status of alcoholic liver disease in Japan. Nihon Shokakibyo Gakkai Zasshi. 2012;109:1509–17.PubMedGoogle Scholar
  21. 21.
    Hashimoto E, Tokushige K, Ludwig J. Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: current concepts and remaining challenges. Hepatol Res. 2015;45:20–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Alvarez F, Berg PA, Bianchi FB, et al. International autoimmune hepatitis group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–38.CrossRefPubMedGoogle Scholar
  23. 23.
    Ishibashi H, Komori A. Development of the clinical practice guideline of primary biliary cirrhosis (PBC). Nihon Shokakibyo Gakkai Zasshi. 2013;110:1–7.PubMedGoogle Scholar
  24. 24.
    Takikawa H, Onji M. A proposal of the diagnostic scale of drug-induced liver injury. Hepatol Res. 2005;32:250–1.CrossRefPubMedGoogle Scholar
  25. 25.
    Bedossa P, Dargere D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003;38:1449–57.CrossRefPubMedGoogle Scholar
  26. 26.
    Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest. Hepatology. 2007;46:32–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.CrossRefPubMedGoogle Scholar
  28. 28.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMedGoogle Scholar
  29. 29.
    Bruix J, Sherman M. American Association for the Study of Liver Disease. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Fujimoto K, Kato M, Kudo M, et al. Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C. Oncology. 2013;84(Suppl 1):3–12.CrossRefPubMedGoogle Scholar
  31. 31.
    Morikawa H, Fukuda K, Kobayashi S, et al. Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C. J Gastroenterol. 2011;46:350–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Tatsumi C, Kudo M, Ueshima K, et al. Non-invasive evaluation of hepatic fibrosis for type C chronic hepatitis. Intervirology. 2010;53:76–81.CrossRefPubMedGoogle Scholar
  33. 33.
    Wang J, Guo L, Shi X, et al. Real-time elastography with a novel quantitative technology for assessment of liver fibrosis in chronic hepatitis B. Eur J Radiol. 2012;81:e31–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Colombo S, Buonocore M, Del Poggio A, et al. Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis. J Gastroenterol. 2012;47:461–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Pons M, Simon-Talero M, Millan L, et al. Basal values and changes of liver stiffness predict the risk of disease progression in compensated advanced chronic liver disease. Dig Liver Dis. 2016;48:1214–9.Google Scholar
  36. 36.
    Singh S, Fujii LL, Murad MH, et al. Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11:1573–84 e1-2; quiz e88-9.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Robic MA, Procopet B, Metivier S, et al. Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. J Hepatol. 2011;55:1017–24.CrossRefPubMedGoogle Scholar
  38. 38.
    Klibansky DA, Mehta SH, Curry M, et al. Transient elastography for predicting clinical outcomes in patients with chronic liver disease. J Viral Hepat. 2012;19:e184–93.CrossRefPubMedGoogle Scholar
  39. 39.
    Pang JX, Zimmer S, Niu S, et al. Liver stiffness by transient elastography predicts liver-related complications and mortality in patients with chronic liver disease. PLoS One. 2014;9:e95776.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Fraquelli M, Pozzi R. The accuracy of noninvasive methods in the prediction of clinically relevant outcomes in patients with chronic liver disease. Expert Rev Gastroenterol Hepatol. 2012;6:679–82.CrossRefPubMedGoogle Scholar
  41. 41.
    Adachi E, Maeda T, Matsumata T, et al. Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma. Gastroenterology. 1995;108:768–75.CrossRefPubMedGoogle Scholar
  42. 42.
    Tarao K, Takemiya S, Tamai S, et al. Relationship between the recurrence of hepatocellular carcinoma (HCC) and serum alanine aminotransferase levels in hepatectomized patients with hepatitis C virus-associated cirrhosis and HCC. Cancer. 1997;79:688–94.CrossRefPubMedGoogle Scholar
  43. 43.
    Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: clinical applications. Ultraschall Med. 2013;34:238–53.CrossRefPubMedGoogle Scholar
  44. 44.
    Sporea I, Bota S, Saftoiu A, et al. Romanian national guidelines and practical recommendations on liver elastography. Med Ultrason. 2014;16:123–38.CrossRefPubMedGoogle Scholar
  45. 45.
    Habu D, Nishiguchi S, Kawamua E, et al. Meshwork pattern is an important risk factor for development of hepatocellular carcinoma in patients with HBV-related chronic hepatitis and cirrhosis. Hepatol Res. 2003;25:166–73.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2016

Authors and Affiliations

  1. 1.The Third Department of Internal MedicineToyama University HospitalToyamaJapan

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