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Non-Invasive Assesment of Chronic Liver Disease by Two Dimensional Shear Wave Elastography: An Overview

Grgurevic, I; Bokun, T; Pinzani, M; (2018) Non-Invasive Assesment of Chronic Liver Disease by Two Dimensional Shear Wave Elastography: An Overview. Current Medical Imaging Reviews , 14 (2) pp. 163-171. 10.2174/1573405613666161227155433. Green open access

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Abstract

Background: Liver Stiffness (LS) assessed by Sonoelastography (SE), has been demonstrated as reliable non-invasive indicator of liver fibrosis stage in patients with Chronic Liver Diseases (CLD). Sonoelastography performs best in ruling-out cirrhosis (F=4) and ruling-in signifficant fibrosis (F≥2). However, it is insufficiently accurate to replace endoscopy for detection of Esophageal Varices (EV), being able to only ruling-out large EV. LS ≥ 25 kPa by Transient Elastography (TE) is considered highly suggestive for the presence of Clinically Significant Portal Hypertension (CSPH). Higher liver and spleen stiffness have been asociated with adverse clinical outcomes in CLD. Two-dimensional shear wave elastography (2D-SWE), the latest developed SE method, allows both visualisation and quantification of liver elasticity in real time superimposed over B-mode ultrasound image. Discussion: Meta-analysis of studies with Supersonic Shear Imaging (SSI) revealed comparable performance of this 2D-SWE to TE in fibrosis staging, with AUROCs 0.85 for F≥2 (LS cut-off 8.04 kPa) and 0.93 for F=4 (LS cut-off 11.12 kPa). Few studies reported very good performance of 2DSWE (SSI) to rule-in CSPH (AUROCs 0.79-0.95; LS cut-offs 15-25 kPa). While conflicting data exist with respect to its performance in predicting the presence of EV, prognostic utility of 2D-SWE (SSI) was demonstrated in a single study that reported 3.4-fold (P=0.026) higher risk of adverse outcome in patients with baseline LS≥21.5 kPa followed over 28 months. Conclusion: 2D-SWE (SSI) might be used to stage liver fibrosis in CLD, identify patients with compensated cirrhosis under risk of adverse outcomes and potentially stratify risk of having CSPH and EV.

Type: Article
Title: Non-Invasive Assesment of Chronic Liver Disease by Two Dimensional Shear Wave Elastography: An Overview
Open access status: An open access version is available from UCL Discovery
DOI: 10.2174/1573405613666161227155433
Publisher version: https://doi.org/10.2174/1573405613666161227155433
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Elasticity imaging techniques, esophageal varices, fibrosis, liver cirrhosis, prognosis, ultrasonography.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: http://discovery.ucl.ac.uk/id/eprint/10056543
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