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- 주제어 : Compensated advanced chronic liver disease (검색결과 3 건)
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( Seong Hee Kang ),( Seung Kook Cho ),( Seungheon Kang ),( Shin Myung Kang ),( Hohyun Park ),( Soon Koo Baik ),( Moon Young Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Baveno VI and extended Baveno VI criteria have been proposed to avoid screening endoscopies. However, this ap proach has not been validated in the diagnostic performance of shear wave elastography (SWE). In this study, we aimed to validate these criteria in patients with SWE, also considering potential differences in predictable value with transient elas tograpy (TE) and SWE. Methods: We evaluated in 526 patients with compensated advanced chronic liver disease (cACLD) was defined by liver stiffness (LS) measurement ≥10kPa, Child-Pugh class A and no prior liver decompensation. LS was obtained by TE (FibroScan, Echosense) or 2D-SWE (APLIO 500, Toshiba). Baveno VI (LS< 20 and PLT >150,000) and extended Baveno VI (LSM< 25 and PLT >110,000) criteria were tested. Results: Any grade EV were found in 22.2% of the patients with cACLD, while VNT in 18.6%. Two hundred sixty-two pa tients had LSM by TE, 305 patients by 2D-SWE. In the subgroup of 262 patients with TE, Baveno VI and Baveno VI extended criteria spared 21.6% and 37.1% of endoscopy, missing 7.1% and 12.5% of VNT, respectively. We identified as the best thresholds for rule-out presence of EV, LSM<23.3 kPa and high risk EV, LSM<25.2 kPa for TE. In the subgroup of 305 pa tients with 2D-SWE, Baveno VI and Baveno VI extended criteria spared 38.7% and 60.0% of endoscopy, missing 5.9% and 9.8% of VNT, reflecting better diagnostic performance than TE. In this subgroup for SWE, we identified as the best thresholds for rule-out presence of EV, LSM<16.5 kPa and high risk EV, LSM<17.2 kPa. For predicting EV, AUROC of SWE was higher than that of TE (0.791 vs. 0.744). Conclusions: The Baveno VI and Baveno VI extended criteria with 2D-SWE spare more endoscopies than with TE with a min imal risk of missing VNT in patients with cACLD.
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David J. M. Bauer,Annalisa De SilvestriI,Ruxandra Mare,Laura Maiocchi,Ambra Raimondi,Georg Semmler,Mattias Mandorfer,Ioan Sporea,Giovanna Ferraioli,Thomas Reiberger 대한초음파의학회 2023 ULTRASONOGRAPHY Vol.42 No.4
Purpose: This study evaluated ElastQ, a two-dimensional shear wave elastography (2D-SWE) technique, for the non-invasive assessment of liver fibrosis risk using liver stiffness measurement (LSM). The aim was to determine its diagnostic accuracy and establish LSM cutoffs for clinical risk stratification. Methods: A prospective multicenter study was conducted, employing vibration-controlled transient elastography (VCTE) as a reference standard. The statistical analysis utilized Pearson correlations and Lin concordance correlation coefficients, diagnostic areas under the curve (AUCs), and 90%-specific rule-in and 90%-sensitive rule-out ElastQ cutoffs. Results: The study included 875 patients at risk for liver disease, of whom 816 (376 women, 46.1%; median age, 57.0 years [interquartile range, 19.0]) had successful and reliable VCTE- and ElastQ-LSMs. The median LSM was 13.0 kPa (range, 2.0 to 75.0 kPa) for VCTE and 6.6 kPa (range, 2.9 to 26.5 kPa) for ElastQ. The correlation between VCTE-LSM and ElastQ-LSM was adequate for VCTE-LSM <15 kPa (Pearson r=0.63) but lower for VCTE-LSM ≥15.0 kPa (Pearson r=0.27). VCTE-LSM indicated no fibrosis risk (<5.0 kPa) in 178 cases (21.8%), gray zone (5.0-9.9 kPa) in 347 cases (42.5%), and advanced chronic liver disease (ACLD; ≥10.0 kPa) in 291 cases (35.7%). The diagnostic AUC for ElastQ-LSM was 0.82 for fibrosis risk and 0.90 for ACLD. The clinically relevant ElastQ cutoffs for ruling out fibrosis risk and ruling in compensated ACLD (cACLD) were <5.0 kPa and ≥9.0 kPa, respectively. Conclusion: ElastQ 2D-SWE enables accurate, non-invasive assessments of liver fibrosis and cACLD risk. In clinical practice, ElastQ-LSM <5.0 kPa rules out fibrosis, while ElastQ-LSM ≥9.0 kPa rules in cACLD.
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( Han Ah Lee ),( Jihwan Lim ),( Seung Up Kim ),( Young-sun Lee ),( Seong Hee Kang ),( Young Kul Jung ),( Moon Young Kim ),( Ji Hoon Kim ),( Sang Gyune Kim ),( Ki Tae Suk ),( Soung Won Jung ),( Jae You 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: We investigated the performance of spleen size in predicting presence of varices in patients with compensated advanced chronic liver disease (cACLD), considering the impact of age and height in spleen size. Methods: Patients with cACLD, defined as liver stiffness (LS)≥10 kPa with transient elastography, who underwent upper gastrointestinal endoscopy and abdominal ultrasound were included. Results: A total of 1218 patients were included. Mean age was 56.0 years. Mean LS and spleen diameter were 24.2 kPa and 11.3cm, respectively. Varices were combined in 533 patients (43.8%). On multivariate analysis, older age, lower platelet count, lower albumin level, higher LS, and longer spleen diameter were significantly associated with the presence of varices (all P<0.05). On multivariate analysis for the factors associated with spleen size, younger age, taller height, alcoholic etiology, lower albumin level, higher MELD score, and higher LS were significantly associated with the longer spleen size. Using these results, formula for predictive spleen size was conducted as follows: Estimated spleen size (cm)=0.029 × height (cm) - 0.019 × age (year) + 6.670. Interestingly, estimated and measured spleen size was comparable in patients without varices (10.5cm vs. 10.4cm, P=0.134), while measured spleen size was significantly greater than estimated spleen size in patients with varices (12.4cm vs. 10.3cm, P<0.001). The ratio of measured and estimated spleen sizes (MESS ratio) were calculated as follows: MESS ratio=measured spleen size (cm)/estimated spleen size (cm). AUROC of MESS ratio for the prediction of varices was significantly higher than that of measured spleen size (0.729 vs 0.721, P=0.005). Optimal cutoff value of MESS ratio was 1.042 with sensitivity, specificity, PPV, and NPV of 73.0%, 61.0%, 59.3%, and 74.4%, respectively. Conclusions: Younger age and taller height is associated with greater spleen diameter. It should be considered in evaluating performance of spleen size in predicting varices in patients with cACLD.
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