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Evaluation of Transient Elastography, Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients.

Karlas T, Dietrich A, Peter V, Wittekind C, Lichtinghagen R, Garnov N, Linder N, Schaudinn A, Busse H, Prettin C, Keim V, Tröltzsch M, Schütz T, Wiegand J - PLoS ONE (2015)

Bottom Line: TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).However, variations (median/range at d-15/-1) of TE (4.6/2.6-75 and 6.7/2.9-21.3 kPa) and ARFI (2.1/0.7-3.7 and 2.0/0.7-3.8 m/s) were high and associated with overestimation of fibrosis.In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss.

View Article: PubMed Central - PubMed

Affiliation: IFB AdiposityDiseases, University of Leipzig, Leipzig, Germany; Department of Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany.

ABSTRACT

Background: Liver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients.

Patients and methods: 41 patients (median BMI 47 kg/m2) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).

Results: Valid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6-75 and 6.7/2.9-21.3 kPa) and ARFI (2.1/0.7-3.7 and 2.0/0.7-3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients.

Conclusion: In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.

No MeSH data available.


Related in: MedlinePlus

Liver elastography in patients scheduled for bariatric surgery.Red lines indicate recommend cut-offs for detections of advanced liver fibrosis (TE) [13] and liver cirrhosis (acoustic radiation force impulse imaging, ARFI) [8]. Application of these cut-offs in patients scheduled for bariatric surgery results in overestimation of fibrosis severity in a high percentage of cases.
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pone.0141649.g002: Liver elastography in patients scheduled for bariatric surgery.Red lines indicate recommend cut-offs for detections of advanced liver fibrosis (TE) [13] and liver cirrhosis (acoustic radiation force impulse imaging, ARFI) [8]. Application of these cut-offs in patients scheduled for bariatric surgery results in overestimation of fibrosis severity in a high percentage of cases.

Mentions: In contrast to the biopsy proven fibrosis results, variations of TE and ARFI measurements were high (median/range before and after diet): 4.6 (2.6–75) and 6.7 (2.9–21.3) kPa for TE and 2.1 (0.7–3.7) and 2.0 (0.7–3.8) m/s for ARFI, respectively (Table 2, Fig 2). Compared to TE, ARFI showed a higher rate of incorrectly classified cases before diet (p = 0.0038; Table 2). No significant changes were observed in patients with available serial measurements before and after diet (p>0.15 for ARFI and TE, respectively). In patients without advanced fibrosis (n = 40), higher median LSM values were observed in cases with SLD > 35 mm at both examinations before and after dietary intervention: TE 7.0 vs. 3.4 kPa (p = 0.003) and 7.8 vs. 5.0 kPa (p = 0.154), and ARFI 2.4 vs. 1.1 m/s (p<0.001) and 2.6 vs. 1.3 m/s, respectively.


Evaluation of Transient Elastography, Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients.

Karlas T, Dietrich A, Peter V, Wittekind C, Lichtinghagen R, Garnov N, Linder N, Schaudinn A, Busse H, Prettin C, Keim V, Tröltzsch M, Schütz T, Wiegand J - PLoS ONE (2015)

Liver elastography in patients scheduled for bariatric surgery.Red lines indicate recommend cut-offs for detections of advanced liver fibrosis (TE) [13] and liver cirrhosis (acoustic radiation force impulse imaging, ARFI) [8]. Application of these cut-offs in patients scheduled for bariatric surgery results in overestimation of fibrosis severity in a high percentage of cases.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4631322&req=5

pone.0141649.g002: Liver elastography in patients scheduled for bariatric surgery.Red lines indicate recommend cut-offs for detections of advanced liver fibrosis (TE) [13] and liver cirrhosis (acoustic radiation force impulse imaging, ARFI) [8]. Application of these cut-offs in patients scheduled for bariatric surgery results in overestimation of fibrosis severity in a high percentage of cases.
Mentions: In contrast to the biopsy proven fibrosis results, variations of TE and ARFI measurements were high (median/range before and after diet): 4.6 (2.6–75) and 6.7 (2.9–21.3) kPa for TE and 2.1 (0.7–3.7) and 2.0 (0.7–3.8) m/s for ARFI, respectively (Table 2, Fig 2). Compared to TE, ARFI showed a higher rate of incorrectly classified cases before diet (p = 0.0038; Table 2). No significant changes were observed in patients with available serial measurements before and after diet (p>0.15 for ARFI and TE, respectively). In patients without advanced fibrosis (n = 40), higher median LSM values were observed in cases with SLD > 35 mm at both examinations before and after dietary intervention: TE 7.0 vs. 3.4 kPa (p = 0.003) and 7.8 vs. 5.0 kPa (p = 0.154), and ARFI 2.4 vs. 1.1 m/s (p<0.001) and 2.6 vs. 1.3 m/s, respectively.

Bottom Line: TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).However, variations (median/range at d-15/-1) of TE (4.6/2.6-75 and 6.7/2.9-21.3 kPa) and ARFI (2.1/0.7-3.7 and 2.0/0.7-3.8 m/s) were high and associated with overestimation of fibrosis.In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss.

View Article: PubMed Central - PubMed

Affiliation: IFB AdiposityDiseases, University of Leipzig, Leipzig, Germany; Department of Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany.

ABSTRACT

Background: Liver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients.

Patients and methods: 41 patients (median BMI 47 kg/m2) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).

Results: Valid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6-75 and 6.7/2.9-21.3 kPa) and ARFI (2.1/0.7-3.7 and 2.0/0.7-3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients.

Conclusion: In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.

No MeSH data available.


Related in: MedlinePlus