Clin Endosc.  2018 Mar;51(2):181-185. 10.5946/ce.2017.095.

A Prospective Blinded Study of Endoscopic Ultrasound Elastography in Liver Disease: Towards a Virtual Biopsy

• Schulman A
• Lin MV
• Rutherford A
• Chan WW
• Ryou M

• KMID: 2410986
• DOI: http://doi.org/10.5946/ce.2017.095

Abstract

BACKGROUND/AIMS
Liver biopsy has traditionally been used for determining the degree of fibrosis, however there are several limitations. Endoscopic ultrasound (EUS) real-time elastography (RTE) is a novel technology that uses image enhancement to display differences in tissue compressibility. We sought to assess whether liver fibrosis index (LFI) can distinguish normal, fatty, and cirrhotic liver tissue.
METHODS
A total of 50 patients undergoing EUS were prospectively enrolled. RTE of the liver was performed to synthesize the LFI in each patient. Univariate and multivariable analyses were performed. Chi-square and t-tests were performed for categorical and continuous variables, respectively. A p-value of <0.05 was considered significant.
RESULTS
Abdominal imaging prior to endoscopic evaluation suggested normal tissue, fatty liver, and cirrhosis in 26, 16, and 8 patients, respectively. Patients with cirrhosis had significantly increased mean LFI compared to the fatty liver (3.2 vs. 1.7, p<0.001) and normal (3.2 vs. 0.8, p<0.001) groups. The fatty liver group showed significantly increased LFI compared to the normal group (3.8 vs. 1.4, p<0.001). Multivariable regression analysis suggested that LFI was an independent predictor of group features (p<0.001).
CONCLUSIONS
LFI computed from RTE images significantly correlates with abdominal imaging and can distinguish normal, fatty, and cirrhotic-appearing livers; therefore, LFI may play an important role in patients with chronic liver disease.

Keyword

Endosonography; Endoscopic ultrasound; Elasticity imaging techniques; Chronic liver disease; Advanced imaging

MeSH Terms

Adipose Tissue
Biopsy*
Elasticity Imaging Techniques*
Endosonography
Fatty Liver
Fibrosis
Humans
Image Enhancement
Liver Cirrhosis
Liver Diseases*
Liver*
Prospective Studies*
Ultrasonography*

Figure

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  Fig. 1. Schematic demonstration of endoscopic ultrasound-based real time elastography, which can evaluate both the right and left liver through the gastrointestinal wall compared to trans-abdominal elastography, which requires signal transmission through the thick abdominal wall.

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  Fig. 2. Flowchart showing the basic study design. EGD, esophagogastroduodenoscopy; EUS, endoscopic ultrasound; LFI, liver fibrosis index; INR, international normalized ratio.

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  Fig. 3. Representative endoscopic ultrasound real-time elastography images in patients with normal (A), fatty (B), and cirrhotic (C) liver tissue on cross-sectional imaging.

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  Fig. 4. Comparison of liver fibrosis index (LFI) scores between the normal, fatty, and cirrhotic liver imaging (ANOVA).

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  Fig. 5. Area under the receiver operator characteristic (ROC) curve for the prediction of cirrhosis on imaging by liver fibrosis index (LFI).

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