Hepatic Elastography Using Ultrasound Waves


by

Ioan Sporea, Roxana Șirli

DOI: 10.2174/97816080546331120101
eISBN: 978-1-60805-463-3, 2012
ISBN: 978-1-60805-557-9



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Some time ago, Schiano raised the question "To B or not to B", which means "To Biopsy or not to Biopsy" the liver for the evaluation ...[view complete introduction]
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Table of Contents

About the Authors

- Pp. i-v (5)

Ioan Sporea and Roxana Șirli

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Foreword

- Pp. vi-vii (2)

Fabio Piscaglia

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Preface

- Pp. viii-ix (2)

Ioan Sporea and Roxana Șirli

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List of Contributors

- Pp. x

Ioan Sporea and Roxana Șirli

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Physics and Technical Information

- Pp. 3-24 (22)

Ioan Lie

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Transient Elastography (TE)

- Pp. 25-51 (27)

Ioan Sporea and Roxana Șirli

View Abstract Download Free

Acoustic Radiation Force Impulse Elastography

- Pp. 52-84 (33)

Simona Bota and Ioan Sporea

View Abstract Download Free

Real-Time Elastography (RT-E)

- Pp. 85-95 (11)

Ioan Sporea and Alina Popescu

View Abstract Download Free

ShearWave Elastography (SWE)

- Pp. 96-102 (7)

Alina Popescu and Ioan Sporea

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Combined Methods for Liver Fibrosis Evaluation

- Pp. 103-106 (4)

Ioan Sporea and Simona Bota

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Elastography in Focal Liver Lesions

- Pp. 107-117 (11)

Ana Jurchiș

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Index

- Pp. 118

Ioan Sporea and Roxana Șirli

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Foreword

Since the introduction of the grey scale B-mode scanners, the liver has been the organ with the most extensive and fruitful applications of ultrasonography in the abdomen. Starting from the 80’s focal liver lesions became detectable even when small in size, targeted interventions were made possible with real-time guidance even at the bed-side and, slightly later, duplex Doppler ultrasound provided functional and not only morphological assessment of the liver vasculature and new exciting diagnosis were made possible. It should be acknowledged that the introduction of ultrasonography significantly contributed to the recognition of hepatology as an independent discipline. In the next 15 years refinements in ultrasound equipments were introduced by the industries, but no sustantial change in the diagnostic capabilities did really appear. This remained true until the early years 2000, which witnessed two revolutionary new ultrasound based techniques. One is real-time low acoustic pressure contrast enhanced ultrasound (CEUS), introduced into the market in 2002. This technique developed very rapidly and is now fully mature and applied in the daily practice worldwide with well established guidelines, such as those released by EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology). The second one is ultrasound elastography, which was first presented in the medical literature in 2003. Ultrasound elastography provides a functional assessment of the liver, informing on tissue elasticity and thus on the disease stage. This information is obtained with greatest ease, non invasively and very rapidly at the bedside. Accordingly, transient elastography has been recently incorporated into international guidelines for the management of chronic viral hepatitis. It has also applications in other conditions involving the liver, beside chronic hepatitis. While contrast enhanced ultrasound underwent technical improvements, but is substantially one single modality, elastography is somehow different and various modalities are available, requiring different examination techniques and providing slightly different clinical information. Most of these modalities have been introduced only in the very last few years and their properties are still poorly known to clinical ultrasonographers. Therefore, the eBook by Prof. Ioan Sporea on liver elastography is very timely presented and greatly desired. In fact the ongoing spread of the technical possibility to perform liver elastography must be paralleled by adequate knowledge of the clinicals information that can be obtained by each of the different modalities. Worth to remind that beyond the self standing transient elastography equipment, nowadays several ultrasound scanners can be implemented with various elastographic techniques, either based on shear wave or strain imaging modalities.

Reading the eBook will be an exciting time, with immediate applicability of the information into the daily clinical practice for anyone involved in the management of liver disease and the authors are to be commended for their efforts, based on long standing clinical and research expertise in this field.

Fabio Piscaglia, MD PhD,
University of Bologna
Italy
President EFSUMB


Preface

Liver chronic diseases become more and more frequent in daily medical practice, despite of medical progress in the treatment of chronic viral hepatitis. The incidence of diseases such as non-alcoholic steato-hepatitis (NASH) or alcoholic steato-hepatitis (ASH) increases in many regions of the world (especially in Europe and the USA), but the evaluation of chronic hepatitis HCV or HBV still represents a major challenge for the hepatologist, internal medicine or general practitioner. The evaluation of cholestatic diseases, of autoimmune hepatitis or of post-transplant patients is another field in which hepatologists try to find solutions.

Traditionally, liver biopsy is used for chronic liver diseases staging and grading, but this method is not very well accepted by patients and usually it is rarely repeated during the follow-up. In the last years, non-invasive modalities for the evaluation of chronic hepatopathies became more and more popular, especially in Europe. Blood tests and elastographic methods for liver stiffness assessment become part of routine evaluation of patients with chronic liver diseases. Ultrasound based elastographic methods for the evaluation of liver stiffness started with Transient Elastography, but in the last 2-3 years, other methods that use ultrasound waves opened the door of hepatology. Acoustic Radiation Force Impulse Elastography, Real Time Elastography or Shear Wave Elastography are now available, trying to prove their value for liver stiffness assessment as a marker for fibrosis or for the evaluation of liver masses in the liver.

Thus, so much new information concerning the non-invasive evaluation of liver fibrosis or of liver masses, in such a short time, can make the practician to have some problems concerning these methods, such as the types of waves used, or the results of the examinatiotn, that can be expressed in kiloPascals or in meters/second, with a large values spectrum.

In this eBook we try to clarify some notions regarding elastography, which we think that will be useful for practitioners (fellows in training or specialists): what is transient elastography or shear waves elastography, from physics point of view; how do different types of elastography work and which are the differences between them; and, finally, which is their practical value (scientific proves) methods. Surely, this field is a very dynamic one, and each month papers are published showing new results of these methods.

Thus, the aim of this eBook is to show how ultrasound wave based elastographic methods work and which their results in the field of hepatology are. We hope that the level of presentation (especially information regarding the physics of elastography) is adapted to the medical personnel, making this eBook useful for daily practice of everyone interested in this field.

Ioan Sporea
Roxana Șirli

Department of Gastroenterology and Hepatology
“Victor Babeș” University of Medicine and Pharmacy Timișoara
Romania

List of Contributors

Editor(s):
Ioan Sporea
Department of Gastroenterology and Hepatology "Victor Babeș"
University of Medicine and Pharmacy
Romania


Roxana Șirli
Department of Gastroenterology and Hepatology "Victor Babeș"
University of Medicine and Pharmacy
Timișoara
Romania




Contributor(s):
Simona Bota MD
Fellow in Gastroenterology, Department of Gastroenterology and Hepatology
“Victor Babeș” University of Medicine and Pharmacy Timișoara
Romania 10, Iosif Bulbuca Bv
Timișoara, 300736
Romania


Ana Jurchiș MD
Fellow in Gastroenterology, Department of Gastroenterology and Hepatology
“Victor Babeș” University of Medicine and Pharmacy Timișoara
Romania 10, Iosif Bulbuca Bv
Timișoara, 300736
Romania


Ioan Lie PhD
Assoc. Prof., Applied Electronics Department, Electronics and Telecomunications Faculty,
“Politehnica” University Timișoara 2
Vasile Pârvan Bv
Timișoara, 300223
Romania


Alina Popescu MD, PhD
Fellow in Gastroenterology, Department of Gastroenterology and Hepatology
“Victor Babeș” University of Medicine and Pharmacy Timișoara
Romania 10, Iosif Bulbuca Bv
Timișoara, 300736
Romania


Ioan Sporea MD, PhD
Prof., Head of the Department of Gastroenterology and Hepatology
“Victor Babeș” University of Medicine and Pharmacy, Timișoara
Romania 10, Iosif Bulbuca Bv
Timișoara, 300736
Romania


Roxana Șirli MD, PhD
Assist. Prof. of Gastroenterology, Department of Gastroenterology and Hepatology
“Victor Babeș” University of Medicine and Pharmacy Timișoara
Romania 10, Iosif Bulbuca Bv
Timișoara, 300736
Romania




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