Study: Sono-elastography useful for depicting liver hardness

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Transabdominal real-time elastography is a useful method in depicting liver hardness, based on study results published in the April edition of the World Journal of Gastroenterology, analyzing whether computer-enhanced dynamic analysis of elastography movies is able to better characterize and differentiate between different degrees of liver fibrosis.

Led by Dan Ionu Gheonea, MD, PhD, from the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy in Craiova, Romania, the researchers found that elasticity measurements have reportedly been useful for the diagnosis and differentiation of many tumors, which are usually harder than normal surrounding tissues.

“Recently, transabdominal real-time elastography was proposed as a new method for noninvasive staging of liver fibrosis,” explained Gheonea and colleagues. “For many years, liver biopsy was the only method to evaluate liver fibrosis and it has traditionally been considered as the gold standard. However, it is a painful invasive method associated with poor patient compliance, discomfort and, in very rare cases, with serious complications.”

For their prospective study, the researchers recruited 132 consecutive patients, 73 men and 59 women, between the ages of 26-74 years. As a result of the limitations of the method, the patients considered for further elastography analysis consisted of 27 healthy volunteers, 26 individuals with chronic viral B and C hepatitis, 29 with liver cirrhosis and 21 with fatty alcoholic liver disease.

Each participant was examined by way of transabdominal ultrasound elastography performed by two physicians who were made aware of the patient’s underlying disease, and had different degrees of experience in ultrasound, with one being a proficient physician and the other a physician beginner in ultrasound technique, wrote the authors.

The volunteers that made up the control group consisted of healthy adults with negative tests for blood viral markers who did not have a history of relevant concomitant illness or cancer and did not have an excessive daily alcohol intake. In all patients with chronic viral hepatitis proven by the presence of hepatitis C virus antibodies, liver biopsy was performed one to three days before real-time elastography. Fatty alcoholic liver disease was diagnosed by ultrasound aspects of the liver and excessive alcohol intake, and portal hypertension signs diagnosed liver cirrhosis, they wrote.

Citing the limitations of the single-site prospective study design and the low penetrability of elastography into the tissues, the researchers obtained high-quality elastography information in 73.48 percent of the patients. They determined that computer-aided diagnosis of elastography calculations can be a useful method in depicting the hardness of the liver.

Despite this finding, the authors noted that they were unable to distinguish between intermediate degrees of liver fibrosis though the use of real-time elastography.

“Although it has been tested incompletely in large multicenter studies and should be compared with other noninvasive methods (blood markers, transient elastography), we suggest an improvement of the examination methodology, which should take into account previous observations made by different authors (better transducers, improved elastography software) to establish real-time elastography as a new revolutionary method that can replace liver biopsy for assessment of different stages of fibrosis in patients with chronic hepatitis,” concluded Gheonea and colleagues.