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Scientific Session On-demand channel 4 Liver - Diffuse Liver Disease

SS 1 - Optimising assessment of chronic liver diseases (ID 20)

Moderators
Date
Wed, 20.05.2020
Time
09:00 - 10:30
Topic
Liver - Diffuse Liver Disease

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On-demand

SS 1.2 - Prevalence of significant hepatic fibrosis using MR elastography in a health check-up clinic population

Presentation Number
SS 1.2
Speakers:
Session Name
SS 1 - Optimising assessment of chronic liver diseases
Channel
On-demand channel 4

Abstract

Purpose

Using MR elastography (MRE), we investigated the prevalence of significant fibrosis in a community-based cohort.

Material and methods

From January 2015 to May 2018, 2,170 participants receiving a health examination at our institution were enrolled in this study. All participants underwent MR chemical shift technique and MRE to assess liver fat and fibrosis, respectively. We also conducted subgroup analyses for participants with nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, and diabetes mellitus (DM). For generalization, sex- and age-standardized prevalence estimates of hepatic fibrosis and fatty liver were also calculated based on the Korean Statistical Information Service (KOSIS) during 2015-2018.

Results

The prevalence of F2 (≥3.0 kPa) and F3 fibrosis (≥3.6 kPa) in the overall cohort was 5.1% and 1.3%, respectively (sex- and age-adjusted prevalence of 3.8% and 1.3%). NAFLD prevalence (>5% fat fraction) was 20.8% in the average-risk population (after excluding alcohol use and viral hepatitis), and the prevalence of significant and advanced fibrosis in NAFLD participants was 7.5% and 1.1%, respectively. The prevalence of DM was 7.7% in the overall cohort, with significant fibrosis in 13.7% and advanced fibrosis in 4.8%. In participants with fatty liver (of any etiology) plus diabetes, 27.5% had ≥F2 and 7.2% ≥F3. Multivariate analyses indicated that older age, insulin, diabetes, and fatty liver were independently associated with significant fibrosis.

Conclusion

In a health check-up clinic setting, the prevalence of significant and advanced fibrosis was 5.1% and 1.3% in (sex- and age-adjusted prevalence of 3.8% and 1.3%, respectively) and increased three- to fourfold with diabetes.

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On-demand

SS 1.5 - True diffusion parameter of intravoxel incoherent motion MRI in hepatic fibrosis staging: we need a new approach

Presentation Number
SS 1.5
Speakers:
Session Name
SS 1 - Optimising assessment of chronic liver diseases
Channel
On-demand channel 4

Abstract

Purpose

Hepatic myofibroblasts mediate both angiogenesis and fibrogenesis in cirrhotic process, and perfusion change accompanies diffusion restriction. The true diffusion (D) parameter is calculated using b values higher than 200 s/mm2 to filter perfusion effect in intravoxel incoherent motion MRI. However, no relationship between increased hepatic fibrosis severity and parameter D was found in previous studies using perfusion filtering. The aim of this study was to evaluate the efficacy of D parameter calculated with no filtering for perfusion and to compare the results with the classical method.

Material and methods

Respiratory triggered single-shot spin echo-­EPI using 12­b values (0-1000) was performed before the biopsy procedure in 37 chronic HBV patients that liver biopsy indicated. Patients were grouped as mild (stages F0-F1), moderate (stages F2-F3), and marked (stages F4-F5) fibrosis according to Ishak staging. D parameter maps were generated using all (D0-1000) and only higher than 200 s/mm2 (D200-1000) b values. A 10-mm ROI was placed in the biopsy site in joint decision with interventional radiologist in three consecutive slices to calculate mean D value.

Results

D0-1000 showed better inverse correlation than D200-1000 with Ishak stages (Spearman’s Rs= -0.685 and -0.485, respectively). All groups in D0-1000 and only mild and marked fibrosis groups in D200-1000 were significantly different (p<0.05, Tukey HSD). In terms of <F2 (mild) and ≥F4 (severe) disease discrimination, AUC was calculated as 0.848 and 0.935 for D0-1000 and 0.744 and 0.786 for D200-1000, respectively.

Conclusion

D, calculated without filtering perfusion effect, is an effective and accurate parameter for demonstrating the severity of hepatitis B-induced liver fibrosis.

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SS 1.6 - Performance of liver surface nodularity for the differentiation between porto-sinusoidal vascular disease and cirrhosis

Presentation Number
SS 1.6
Speakers:
Session Name
SS 1 - Optimising assessment of chronic liver diseases
Channel
On-demand channel 4

Abstract

Purpose

To assess the performance of liver surface nodularity (LSN) quantification for the differentiation between porto-sinusoidal vascular disease (PSVD) and cirrhosis.

Material and methods

The study included patients from 2011 to 2018 with histologically proven cirrhosis (n=104) or PSVD (n=52) matched for severity who underwent hepatic CT or MRI during the initial diagnostic workup. Performance of LSN for diagnosing PSVD was assessed using a receiver operating characteristic curve (ROC) analysis. Student's t test and ANOVA were used.

Results

Patients were mostly men (110, 71%), with a mean age of 56±10 yrs (range 29-79). Overall, PSVD patients had a lower LSN value than patients with cirrhosis (2.70±0.63 vs. 3.23 ± 0.74, p<0.001). AUROC of LSN was 0.71±0.04. A cutoff value of 2.73 had a specificity of 74% for the diagnosis of PSVD. Stratifying cirrhosis patients by Child-Pugh score, LSN of patients with PSVD was lower in Child A (p=0.002) or Child B (p=0.005) patients, but not in Child C (p=0.40). Spleen diameter was significantly higher in patients with PSVD (mean 160 ± 47 vs. 138 ± 30mm, p<0.001). Combining LSN<2.73 and splenomegaly increased the diagnostic performance (AUROC=0.79±0.04).

Conclusion

LSN quantification is a promising new tool for the differentiation between PSVD and cirrhosis, especially in patients with compensated disease. Association of LSN and splenomegaly appears to improve the diagnostic performance.

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SS 1.7 - The performance of transient elastography for the detection of advanced fibrosis in non-alcoholic fatty liver disease

Presentation Number
SS 1.7
Speakers:
Session Name
SS 1 - Optimising assessment of chronic liver diseases
Channel
On-demand channel 4

Abstract

Purpose

With obesity on the rise, non-alcoholic fatty liver disease (NAFLD) has become one of the most common liver diseases worldwide. The detection of advanced liver fibrosis is key in prognosis and long-time management. Large patient volume and the inarguable drawbacks of liver biopsy have led to the development of newer diagnostic techniques for the assessment of hepatic fibrosis. The aim of this study was to evaluate the accuracy of transient elastography for the diagnosis of advanced liver fibrosis and cirrhosis in NAFLD.

Material and methods

Forty-two patients with NAFLD were enrolled in this study. All subjects had satisfactory liver biopsy specimens and reliable liver stiffness measurements (LSM). The diagnostic performance of TE was determined using ROC curve analysis. Optimal cut-off points with the highest Youden index for the diagnosis of F >= 3 and F = 4 fibrosis were selected.

Results

For transient elastography, the calculated AUROCs for the detection of both advanced fibrosis and cirrhosis were 0.971 (95% CI = 0.928-1) and 0.984 (95% CI = 0.952-1), respectively. The optimal cut-off points were 8.9 kPa for F >= 3 (sensitivity 100%, specificity 90.3%) and 13.4 kPa for F = 4 (sensitivity 100%, specificity 94.3%).

Conclusion

Transient elastography has an excellent diagnostic accuracy for the detection of both advanced fibrosis and cirrhosis in NAFLD. It can be successfully used to rapidly identify patients with a higher risk of liver-related complications.

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SS 1.8 - Quantitative MRI characterisation of non-alcoholic steatohepatitis in a dietary rodent model

Presentation Number
SS 1.8
Speakers:
Session Name
SS 1 - Optimising assessment of chronic liver diseases
Channel
On-demand channel 4

Abstract

Purpose

To assess the diagnostic performance of quantitative MRI parameters for the diagnosis of early non-alcoholic steatohepatitis (NASH) in a dietary rodent model.

Material and methods

We included 74 mice (C57bl6) with 2 control groups fed with normal diet (for 5 and 17 weeks, N=7), 3 dietary groups (5, 11 and 16 weeks, N=10) fed with high-fat diet deficient in choline and supplemented with methionine and 3 dietary groups (5, 11 and 16 weeks, N=10) fed with high-fat diet. The liver was scanned with a 7T system. Proton density fat fraction (PDFF), R2*, mechanical properties at 400, 600 and 800Hz including storage modulus (G’), loss modulus (G’’), damping ratio, shear modulus (G*) and G* frequency dispersion coefficient were obtained with dedicated imaging sequences. At histopathology, the grade of steatosis, ballooning, inflammation, and the fibrosis stage were assessed. NASH was diagnosed according to the FLIP algorithm. Receiver operating characteristic (ROC) analysis, Spearman correlations and multivariate regression were used to test the variables.

Results

Nineteen mice had NASH including 15 with stage 1 fibrosis. Thirty-two had simple steatosis. G’’ at 400Hz had the largest AUROC for NASH (0.84; p<0.01) and for diagnosing NASH versus simple steatosis (0.80; p<0.01). Cutoff of G’’>0.38 kPa had 89% sensitivity and 79% specificity for NASH diagnosis. PDFF correlated with steatosis % (rho 0.81; p<0.01). In multivariate analysis, inflammation was the only determinant of the frequency dispersion coefficient.

Conclusion

At quantitative MRI, the loss modulus had the best diagnostic performance for diagnosing early NASH. Frequency dispersion coefficient might be a marker of liver inflammation.

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SS 1.9 - 2D shear wave elastography for significant liver fibrosis in patients with chronic hepatitis B: a systematic review and meta-analysis

Presentation Number
SS 1.9
Speakers:
Session Name
SS 1 - Optimising assessment of chronic liver diseases
Channel
On-demand channel 4

Abstract

Purpose

To determine the diagnostic performance and cutoff of 2D shear wave elastography (2D SWE) for detecting significant liver fibrosis in patients with chronic hepatitis B (CHB).

Material and methods

A systematic literature search of the PubMed, EMBASE, Cochrane Library databases and Web of Science was conducted. Bivariate modelling and summary receiver-operating characteristic (ROC) modelling were constructed to summarize the diagnostic performance of 2D SWE. Meta-regression analyses were performed to explore the source of heterogeneity.

Results

Eleven eligible studies with 2623 patients were included. 2D SWE showed a summary sensitivity of 88% (95% CI: 83–91), specificity of 83% (95% CI: 78–88) and area under the ROC curve (AUC) of 0.92 (95% CI: 0.89-0.94) for detecting significant fibrosis in CHB patients. The mean cutoff of 2D SWE was 7.91 kPa (range: 6.73-10.00 kPa). Notably, the cutoffs of studies excluding patients with a history of prior antiviral therapy were generally lower than that of studies without excluding those who had received antiviral treatment, with an average of 7.15 kPa and 8.87 kPa, respectively (p < 0.01). Meta-regression analysis revealed that enrollment of consecutive patients was the only significant factor influencing heterogeneity (p < 0.01). Specifically, studies recruiting consecutive patients with CHB had significantly lower sensitivity than those with the absence of consecutive enrolment (0.83 vs 0.92, p < 0.01).

Conclusion

2D SWE is an excellent modality for the prediction of significant liver fibrosis in CHB populations. Further work is required to establish the cutoffs that account for antiviral treatment as a potential confounding factor.

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  • PPT Sun, 10.05.2020 19:07
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