59 research outputs found
DIAGNOSTIC ACCURACY OF LIVER AND SPLEEN STIFFNESS MEASUREMENT FOR PORTAL HYPERTENSION USING BIDIMENSIONAL SHEAR WEAVE ELASTOGRAPHY
No full textErratum: Reliability Criteria for Liver Stiffness Measurements with Real-Time 2D Shear Wave Elastography in Different Clinical Scenarios of Chronic Liver Disease.
No full textNon-invasive measurement of HVPG using graph analysis based on dynamic contrast-enhanced ultrasound with ESAOTE MyLab: The CLEVER Study.
No full textBackground and aims: Non-invasive methods accurately estimating hepatic venous pressure gradient (HVPG) are un unmet clinical need. Preliminary data suggested that graph analysis of dynamic contrast enhanced ultrasonography (DCE-US) of the liver using a “connectome” approach allows assessment of the liver microcirculatory derangement and mirrors the severity of portal hypertension (Amat-Roldan et al. Radiology 2015). The EC-funded prospective CLEVER study (FP7-IAPP-GA-2013-612273-CLEVER) is aimed at developing a novel automatized software based on DCE-US able to improve prognostication in cirrhosis. First extended results were developed with a Siemens Acuson Sequoia in Barcelona, showing optimal correlation with HVPG. Here we report the adaptation of this CLEVER software to DCE-US videos acquired with ESAOTE MyLab equipments in Bologna to predict HVPG in a population of patients with F≥3 hepatopathy.
Method: Ten seconds long videoclip(s) of the right liver lobe were recorded in each patient producing one cycle of microbubble disruption and reperfusion during SonoVue infusion. A total of 90 videos from randomly selected 47 patients were utilized to optimize the autoselection algorithm of the computer among 5models based on platelet count and spleen diameter. Results: Applicability: the CLEVER software was technically able to provide portal pressure estimations from DCE-US in 41/90 videos corresponding to 28/47 patients (59.6%). The Spearman coefficient of correlation between CLEVER values and HVPG was r = 0.585 ( p < 0.001). The CLEVER software was then tested in a separate validation set of 17 technically successful patients, showing a correlation r = 0.701 ( p < 0.002).
Conclusion: We developed and validated the DCE-US based CLEVER software which allows an automatic and quantitative non-invasive estimation of portal pressure in patients with CLD. Larger set of patients with precise subgrouping will help improving the non-invasive predictability of portal pressure by DCE-US
Modified spleen stiffness measurement: a step forward, but still not the solution to all problems in the noninvasive assessment of cirrhotic patients
No full textEFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version).
No full textWe present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography with a focus on the assessment of diffuse liver disease. The short version provides clinical information about the practical use of elastography equipment and interpretation of results in the assessment of diffuse liver disease and analyzes the main findings based on published studies, stressing the evidence from meta-analyses. The role of elastography in different etiologies of liver disease and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users
EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)
No full textWe present here the first update of the 2013 EFSUMB (European
Federation of Societies for Ultrasound in Medicine and
Biology) Guidelines and Recommendations on the clinical use
of elastography with a focus on the assessment of diffuse liver
disease. The short version provides clinical information about
the practical use of elastography equipment and interpretation
of results in the assessment of diffuse liver disease and
analyzes the main findings based on published studies, stressing
the evidence from meta-analyses. The role of elastography
in different etiologies of liver disease and in several clinical
scenarios is also discussed. All of the recommendations are
judged with regard to their evidence-based strength according
to the Oxford Centre for Evidence-Based Medicine Levels
of Evidence. This updated document is intended to act as a reference
and to provide a practical guide for both beginners
and advanced clinical users
Pseudoaneurysm of Splenic Artery Ruptured in Pancreatic Pseudocyst and Complicated by Wirsungorrhagia: The Role of the Ultrasound Techniques and Contrast Substances
No full textPreemptive-TIPS improves outcome in high-risk variceal bleeding : An observational study
No full textObjective
Patients admitted with acute variceal bleeding (AVB) and Child Pugh C score (CP‐C) or Child Pugh B plus active bleeding at endoscopy (CP‐B+AB) are at high risk for treatment failure, rebleeding and mortality. Preemptive TIPS (p‐TIPS) has been shown to improve survival in these patients but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high‐risk patients.
Design
Multicenter, international, observational study including 671 patients from 34 centers admitted for AVB and high‐risk of treatment failure. Patients were managed according to current guidelines and use of drugs and endoscopic therapy (D+E) or preemptive TIPS (p‐TIPS) was based on individual center policy.
Results
p‐TIPS in the setting of AVB is associated with a lower mortality in Child C patients compared to D+E (1 year mortality 22% vs 47% in D+E group; P=0.002). Mortality rate in CP‐B+AB patients was low and p‐TIPS did not improve it. In CP‐C and CP‐B +AB patients, p‐TIPS reduces treatment failure and rebleeding (1 year CIF‐probability of remaining free of the composite endpoint: 92% vs 74% in the D+E group; P=0.017), development of “de novo” or worsening of previous ascites without increasing rates of hepatic encephalopathy.
Conclusion
p‐TIPS must be the treatment of choice in CP‐C patients with AVB. Due to the strong benefit in preventing further bleeding and ascites, p‐TIPS could be a good treatment strategy for CP‐B+AB patients
Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
No full textCirrhosis; Portal hypertension; Acute variceal bleedingCirrosi; Hipertensió portal; Hemorràgia varicosa agudaCirrosis; Hipertensión portal; Hemorragia varicosa agudaBackground & Aims
Severe alcohol-related hepatitis (AH) and acute variceal bleeding (AVB) may occur simultaneously. The impact of a pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) in high-risk patients (patients with Child–Pugh (CP) B and active bleeding or CP C10–13 cirrhosis) with AVB and concomitant severe AH is unknown. The objective of the study was to compare the outcomes of severe AH in patients with high-risk AVB treated with pTIPS or endoscopic and drug treatment (Endo+drugs).
Methods
Patients were screened in four existing cohorts of patients with cirrhosis and AVB treated either with pTIPS or Endo+drugs. The inclusion criteria were AVB, high-risk patients, suspected severe AH (recent onset of jaundice, alcohol-related liver disease, absence of abstinence, model for end-stage liver disease score >20 and aspartate aminotransferase <500 UI/L). The primary endpoint was 42-day mortality, considering liver transplantation as a competing event. Secondary endpoints were rebleeding and further development of ascites or hepatic encephalopathy at 6 months.
Results
A total of 142 patients with AVB were included (pTIPS: n = 47, Endo+drugs: n = 95). Baseline characteristics (age 53, male sex 84%, model for end-stage liver disease score 23.4) were similar between the two groups. Overall, 56% had histologically proven AH. The 42-day mortality was 16% in the pTIPS group vs. 30% in the Endo+drugs group (p = 0.2). The cumulative incidence of rebleeding and ascites was significantly lower in the pTIPS group (2.8% vs. 24%, p = 0.026, and 6% vs. 52%, p <0.001, respectively), whereas hepatic encephalopathy occurrence was similar in the two groups (p = 0.2). Corticosteroid therapy was given in 55% and 46% of patients in the pTIPS and Endo+drugs groups, respectively (p = 0.3).
Conclusions
In severe AH, pTIPS is associated with better outcomes than Endo+drugs, and should not be contraindicated.
Impact and implications
Severe alcohol-related hepatitis and acute variceal bleeding may occur concomitantly, yet the role of pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) placement in this setting remains unclear. In this study, compared to standard of care, pTIPS treatment was associated with lower mortality, although this difference did not reach statistical significance, as well as a significantly reduced risk of rebleeding and recurrent ascites. These findings suggest that severe alcohol-related hepatitis should not be viewed as a contraindication to pTIPS placement when otherwise indicated, such as in patients with Child–Pugh B cirrhosis with a score greater than 7 and active bleeding, or Child–Pugh C10–13 disease
Reliabilitätskriterien für die Messung der Lebersteifigkeit mittels Echtzeit-2D-Shearwave-Elastografie bei verschiedenen klinischen Szenarien der chronischen Lebererkrankung
No full textPurpose: Liver stiffness measurement by real-time 2-dimensional shear wave elastography (2D-SWE) lacks universal reliability criteria. We sought to assess whether previously published 2D-SWE reliability criteria for portal hypertension were applicable for the evaluation of liver fibrosis and cirrhosis, and to look for criteria that minimize the risk of misclassification in this setting. Materials and Methods: In a biopsy-controlled diagnostic study, we obtained five 2D-SWE measurements of optimal image quality. Correctly classified cases of fibrosis and cirrhosis were compared to misclassified cases. We compared reliability predictors (standard deviation (SD), SD/mean, size of region of interest (ROI) and difference between a single measurement and the patient's median) with those obtained in a prior study on clinically significant portal hypertension. Results: We obtained 678 2D-SWE measurements from 142 patients. Overall, the variability in liver stiffness within single 2D-SWE measurements was low (SD = 1.1 ± 1.5kPa; SD/mean = 12 ± 9 %). Intra-observer analysis showed almost perfect concordance (intraclass correlation coefficient = 0.95; 95 % CI 0.94 - 0.96; average difference from median = 0.4 ± 0.9kPa). For the diagnosis of cirrhosis, a smaller SD (optimally ≤ 1.75 kPa) and larger ROI size (optimally ≥ 18 mm) were associated with higher accuracy. Similarly, within the published cohort of patients assessed for portal hypertension, a low variability of measurements was associated with high reliability. Conclusion: A high quality 2D-SWE elastogram ensures low variability and high reliability, regardless of indication. We recommend aiming for a combination of low standard deviation and large ROI
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