The Clinical Features of Transient Elastography (Fibroscan) Examination Among Liver Diseases Patients at Gastroenterohepatology Division of Dr. Soetomo Hospital, Surabaya (original) (raw)
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Transient elastography: Kill two birds with one stone?
World Journal of Hepatology, 2013
® ) is a non-invasive tool with satisfactory accuracy to estimate liver fibrosis and steatosis. Liver stiffness measurement (LSM) with TE has been well validated to detect advanced fibrosis in most liver diseases. LSM is useful in predicting hepatocellular carcinoma (HCC), portal hypertension, post-operative complications in HCC patients, and survival. The new XL probe increases the success rate of TE in obese patients. A novel ultrasonic controlled attenuation parameter (CAP) of the machine is useful to detect steatosis noninvasively. Simultaneous LSM and CAP results make TE very convenient to assess any patients with suspected or confirmed liver diseases.
Transient Elastography as Non-Invasive Examination of Hepatic Fibrosis
Proceedings of Surabaya International Physiology Seminar, 2017
Over the past decade, significant advances have been made in the noninvasive assessment of liver fibrosis in patients with chronic liver disease. Transient elastography appears to be excellent in assessing liver fibrosis. For the interpretation of liver stiffness measurements, the doctor should know the disease clinically, biologically and morphologically and its parameters. In chronic liver disease, especially in chronic hepatitis C, the value of liver stiffness is strongly correlated with fibrosis stage according to the histology score. Patients with similar fibrosis but high alanine aminotransferase levels tend to have higher liver stiffness values, especially in chronic hepatitis B, and diagnostic performance for low-stage fibrosis can be affected when ALT is elevated. Transient elastography is an excellent tool for early detection of cirrhosis. Although TE cannot completely fulfill the need for liver biopsy, it can be used as an important noninvasive tool that allows the setting up of more efficient and custom management strategies for patients with chronic liver disease.
Liver stiffness values in apparently healthy subjects: Influence of gender and metabolic syndrome
Journal of Hepatology, 2008
Background/Aims: Liver stiffness measurement by transient elastography is a very promising non-invasive method for the diagnosis of fibrosis in chronic liver diseases. However, studies on normal values of liver stiffness in healthy subjects are still lacking. The aim of the present study was to prospectively assess liver stiffness values in the general population and to determine potential factors, which may influence these values.
WFUMB Guidelines and Recommendations for Clinical Use of Ultrasound Elastography: Part 2; Breast
Ultrasound in medicine & biology, 2015
The breast section of these Guidelines and Recommendations for Elastography produced under the auspices of the World Federation of Ultrasound in Medicine and Biology (WFUMB) assesses the clinically used applications of all forms of elastography used in breast imaging. The literature on various breast elastography techniques is reviewed, and recommendations are made on evidence-based results. Practical advice is given on how to perform and interpret breast elastography for optimal results, with emphasis placed on avoiding pitfalls. Artifacts are reviewed, and the clinical utility of some artifacts is discussed. Both strain and shear wave techniques have been shown to be highly accurate in characterizing breast lesions as benign or malignant. The relationship between the various techniques is discussed, and recommended interpretation based on a BI-RADS-like malignancy probability scale is provided. This document is intended to be used as a reference and to guide clinical users in a pr...
World journal of gastrointestinal pharmacology and therapeutics, 2016
Transient elastography (TE) is a reliable tool for the non-invasive assessment of liver fibrosis in routine clinical practice. TE is currently approved for use in Europe, Asia and the United States. The widespread adoption of this technology is certain to increase the use of TE worldwide. Although TE has been well validated in chronic viral hepatitis, its clinical role in other liver diseases remains less clear. The advent of new treatment for chronic hepatitis C and emerging prevalence of non-alcoholic steatohepatitis raises new questions on the role of TE in current clinical practice. This review aims to examine the clinical applications, limitations and future role of TE in current clinical practice in light of the changing epidemiology of liver diseases and new clinical management paradigms. In current clinical practice, TE is the most accurate non-invasive method for diagnosis of liver cirrhosis. TE is useful to rule out fibrosis and cirrhosis but does not have sufficient accur...
The role of transient elastography in patients with hepatitis B viral disease
Digestive and Liver Disease, 2011
This review focuses on the role of ultrasound and transient elastography (TE) in patients with hepatitis B virus (HBV) infection. Among the ultrasonographic signs analyzed, liver surface nodularity has the highest diagnostic accuracy and is particularly useful in confirming the presence of severe fibrosis or cirrhosis, due to its high specificity. The role of TE in patients with hepatitis B virus disease was assessed in inactive carriers and patients with chronic liver disease (CHB). In inactive HBV carriers, mean TE values are similar to normal controls and significantly lower than in patients with CHB. In this latter group, the available studies showed a significant positive correlation between TE values and fibrosis stages at liver histology. However, as for HCV patients, there is a certain degree of overlap among the lower stages of hepatic fibrosis and the accuracy of this technique is not optimal for the diagnosis of significant fibrosis, whereas its diagnostic performances are higher for the diagnosis of liver cirrhosis. The development of diagnostic algorithms, with a confirmatory and an exclusion liver stiffness threshold, seems to be a promising tool for a correct classification of patients.
Pitfalls of liver stiffness measurement: A 5-year prospective study of 13,369 examinations
Hepatology, 2010
Liver stiffness measurement (LSM) based on transient elastography (TE, FibroScan) is gaining in popularity for noninvasive assessment of liver fibrosis. However, LSM has limitations, which have not yet been thoroughly evaluated. We prospectively investigated the frequency and determinants of LSM failure and unreliable results over a 5-year period, based on 13,369 examinations (134,239 shots). LSM failure was defined as zero valid shots, and unreliable examinations were defined as fewer than 10 valid shots, an interquartile range (IQR)/LSM greater than 30%, or a success rate less than 60%. LSM failure occurred in 3.1% of all examinations (4% at first examination [n ؍ 7261]) and was independently associated at first examination with body mass index (BMI) greater than 30 kg/m 2 (odds ratio [OR], 7.5; 95% confidence interval [CI], 5.6-10.2; P ؍ 0.0001), operator experience fewer than 500 examinations (OR 2.5 [1.6-4.0]; P ؍ 0.0001); age greater than 52 years (OR 2.3 [1.6-3.2]; P ؍ 0.0001), and type 2 diabetes (OR 1.6 [1.1-2.2]; P ؍ 0.009). Unreliable results were obtained in a further 15.8% of cases (17% at first examination) and were independently associated at first examination with BMI greater than 30 kg/m 2 (OR 3.3 [2.8-4.0]; P ؍ 0.0001), operator experience fewer than 500 examinations (OR 3.1 [2.4-3.9]; P ؍ 0.0001), age greater than 52 years (OR 1.8 [1.6-2.1]; P ؍ 0.0001), female sex (OR 1.4 [1.2-1.6], P ؍ 0.0001), hypertension (OR 1.3 [1.1-1.5]; P ؍ 0.003), and type 2 diabetes (OR 1.2 [1.0-1.5]; P ؍ 0.05). When metabolic syndrome and waist circumference were taken into account in a subgroup of 2835 patients, waist circumference was the most important determinant of LSM failure and unreliable results. Conclusion: In our experience, liver stiffness measurements are uninterpretable in nearly one in five cases. The principal reasons are obesity, particularly increased waist circumference, and limited operator experience. These results emphasize the need for adequate operator training and for technological improvements in specific patient subpopulations. (HEPATOLOGY 2010;51:828-835.) T ransient elastography (TE) (FibroScan; Echosens, Paris, France) is a novel noninvasive method for measuring liver stiffness. 1 Values range from 2.5 to 75 kPa, 2 and values of approximately 5.5 kPa were recently reported to define normality. 3 Liver stiffness measured by means of TE correlates with hepatic fibrosis stages, both in chronic hepatitis C 4,5 and in other chronic liver diseases. 6-14 The diagnostic accuracy of liver stiffness measurement (LSM) is excellent for cirrhosis, 15-17 and, among noninvasive methods, TE appears to be the most accurate for early detection of cirrhosis. 18 Because TE is a user-friendly technique that can be performed rapidly (less than 5 minutes) at the bedside, with immediate results and high patient acceptance, it is likely to become an important tool in clinical practice in the near future. 19-22 However, TE has limitations: LSM results may be influenced by acute liver injury (as reflected by ALT flares), with a risk of overestimating liver stiffness, 6,23,24 and also by extrahepatic cholestasis. 25 In addition, LSM is difficult in patients who are obese or who have narrow intercostal spaces, and impossible in patients with ascites (in whom the diagnosis of cirrhosis is obvious). The TE interpreta
Ultrasound in medicine & biology, 2018
The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver diseases. For each available technique, the reproducibility, results and limitations are analyzed, and recommendations are given. This set of guidelines updates the first version, published in 2015. Since the prior guidelines, there have been several advances in technology. The recommendations are based on the international published literature, and the strength of each recommendation is judged according to the Oxford Centre for Evidence-Based Medicine. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.