7最近有关无创性纤维化检测，分期的报道

StephenW

7 recent reports on noninvasive fibrosis detection, staging
July 5, 2018

Recent studies of early liver fibrosis and advanced fibrosis or cirrhosis have analyzed several noninvasive methods to accurately detect fibrosis, stage fibrosis, and improve survival through early detection. Other studies have taken the next step after detection to determine the safety of certain gastrointestinal procedures in patients with fibrosis and hospitalization outcomes.

The following studies include data on elastography point quantification, virtual touch quantification, and deep learning radiomics of elastography for fibrosis staging, as well as survival outcomes based on level of fibrosis or cirrhosis.

Elastography point quantification accurately stages fibrosis

Elastography point quantification displayed good to excellent performance as a noninvasive measurement of liver fibrosis staging among patients with chronic liver disease, according to a recently published study.

“This technique provides similar diagnostic performance compared with (transient elastography [TE]) in identification of all stages of fibrosis but, with respect to TE, is implemented on conventional ultrasound systems and has the advantage of B-mode imaging TE,” Fabio Conti, MD, PhD, from the University of Bologna in Italy, and colleagues wrote. Read more

Bariatric surgery safe in compensated cirrhosis

Patients with nonalcoholic fatty liver disease and compensated cirrhosis who underwent bariatric surgery did not have higher rates of in-hospital mortality compared with patients without cirrhosis who underwent the procedure, according to a study presented at Digestive Disease Week 2018.

“Obesity is associated with NAFLD, which in 20% to 40% of cases leads to cirrhosis,” Abdulfatah Issak, MD, from the Ohio State University, said in his presentation. “There are many behavioral, medical and surgical approaches to the treatment of weight loss for morbid obesity. However, bariatric surgery is the most effective weight loss strategy, and in the U.S. its use has increased from 160,000 cases per year in 2011 to 200,000 cases per year in 2016.” Read more

Cirrhosis biomarker predicts 1-year mortality after hospitalization

Neutrophil-to-lymphocyte ratio as a biomarker correlated with 1-year mortality after nonelective hospitalization in patients with cirrhosis, according to published results of a retrospective study.

“The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, objective, reliable, and widely available biomarker that we and others have shown to be predictive of mortality in patients with cirrhosis,” Jonathan Rice, MD, from the University of Colorado, and colleagues wrote. “NLR is easily calculated from a routinely available complete blood cell count by dividing absolute neutrophil count by absolute lymphocyte count.”

New virtual touch quantification criteria offer reliable fibrosis detection

Researchers developed new and comprehensive reliability criteria for virtual touch quantification to assess liver fibrosis based on the interquartile range/median ratio and the shear wave speed measurement result, according to recently published data.


“The correct interpretation of elastography results plays a crucial role in ensuring appropriate patient management, but remains a challenge for physicians, as several conditions other than liver fibrosis can increase liver stiffness,” Jérôme Boursier, MD, PhD, from the Hospices Civils de Lyon in France, and colleagues wrote. “We defined new and comprehensive reliability criteria for [virtual touch quantification (VTQ)] examination resulting in ‘very reliable,’ ‘reliable,’ and ‘unreliable’ categories, all with significantly different diagnostic accuracies.” Read more

Fibrosis severity determines cause-specific mortality in NAFLD

New data showed that in nonalcoholic fatty liver disease, patients with cirrhosis were more likely to experience liver-related events while those with bridging fibrosis were more likely to experience non-hepatic cancers and vascular events.

“Taken as a whole, previous and current findings highlight the importance of underlying fibrosis stage in determining clinical outcomes and cause-specific mortality,” Eduardo Vilar-Gomez, MD, PhD, from the Indiana University School of Medicine, and colleagues wrote. Read more

New imaging model provides superior fibrosis stage diagnosis

Deep learning radiomics of elastography demonstrated superior predictive value in assessing cirrhosis and advanced fibrosis compared with 2D shear wave elastography and biomarkers among patients with chronic hepatitis B, according to recently published data.

“Utilizing the data acquired from limited number of hospitals to train and establish the [deep learning radiomics of elastography (DLRE)] model is likely to be sufficient in applying it for assessing liver fibrosis stages in other hospitals with a consistent accuracy,” Kun Wang, MD, from the Third Affiliated Hospital of Sun Yat-sen University in China, and colleagues wrote. Read more

Bi-annual liver cancer screening for cirrhosis improves diagnosis, survival

Compliance with hepatocellular carcinoma surveillance correlated with early diagnosis, better allocation of curative treatment and longer overall survival among patients with hepatitis C- or hepatitis B-associated compensated cirrhosis, according to a recently published study.

“Monitoring for HCC in patients with cirrhosis, based on bi-annual ultrasound examination is recommended by international guidelines,” Charlotte Costentin, MD, from the Hôpital Henri Mondor in France, and colleagues wrote. “Improving compliance with surveillance guidelines should translate into a significant improvement in the prognosis of this deadly cancer.”

StephenW

7最近有关无创性纤维化检测，分期的报道
2018年7月5日

最近对早期肝纤维化和晚期纤维化或肝硬化的研究已经分析了几种非侵入性方法，以准确地检测纤维化，分期纤维化，并通过早期检测提高生存率。其他研究在检测后采取了下一步措施，以确定某些胃肠道手术对纤维化和住院治疗结果的安全性。

以下研究包括弹性成像点量化，虚拟触摸量化和纤维化分期弹性成像的深度学习放射学，以及基于纤维化或肝硬化水平的生存结果。

弹性成像点定量准确地分期纤维化

根据最近发表的一项研究，弹性成像点定量显示出良好至优异的性能，作为慢性肝病患者肝纤维化分期的无创测量。

“这种技术与（瞬态弹性成像[TE]）在识别纤维化的所有阶段方面提供了类似的诊断性能，但就TE而言，是在传统的超声系统上实施的，并具有B模式成像TE的优势，”Fabio Conti来自意大利博洛尼亚大学的医学博士和同事们写道。阅读更多

减肥肝硬化减肥手术安全

根据2018年消化疾病周提供的一项研究，接受减肥手术的非酒精性脂肪肝和代偿性肝硬化患者的院内死亡率与接受该手术的无肝硬化患者相比没有更高的院内死亡率。

“肥胖与NAFLD有关，其中20％至40％的病例导致肝硬化，”俄亥俄州立大学的医学博士Abdulfatah Issak在他的发言中说。 “有许多行为，医学和手术方法来治疗病态肥胖的体重减轻。然而，减肥手术是最有效的减肥策略，在美国，其使用量已从2011年的每年160,000例增加到2016年的每年200,000例。“阅读更多

肝硬化生物标志物预测住院后1年死亡率

根据一项回顾性研究的结果，中性粒细胞与淋巴细胞比率作为生物标志物与肝硬化患者非住院治疗后的1年死亡率相关。

“中性粒细胞与淋巴细胞比率（NLR）是一种廉价，客观，可靠且广泛可用的生物标志物，我们和其他人已经证明可以预测肝硬化患者的死亡率，”科罗拉多大学医学博士Jonathan Rice说道。和同事们写道。 “通过将绝对中性粒细胞计数除以绝对淋巴细胞计数，可以从常规可用的全血细胞计数中轻松计算NLR。”
新的虚拟触摸量化标准提供可靠的纤维化检测

根据最近公布的数据，研究人员根据四分位数范围/中位数比和剪切波速测量结果，为虚拟触摸量化开发了新的全面可靠性标准，以评估肝纤维化。


“对弹性成像结果的正确解释在确保适当的患者管理方面起着至关重要的作用，但对医生来说仍然是一个挑战，因为肝纤维化以外的一些疾病可以增加肝硬度，”来自Hospices Civils de Lyon的医学博士JérômeBoursier博士说。在法国和同事们写道。 “我们为[虚拟触摸量化（VTQ）]检查定义了新的和全面的可靠性标准，导致”非常可靠“，”可靠“和”不可靠“的类别，所有这些都具有明显不同的诊断准确性。”

纤维化严重程度决定了NAFLD中的原因特异性死亡率

新数据显示，在非酒精性脂肪性肝病中，肝硬化患者更容易出现肝脏相关事件，而桥接纤维化患者更可能出现非肝癌和血管事件。

印第安纳大学医学院的医学博士Eduardo Vilar-Gomez及其同事写道：“总的来说，先前和当前的研究结果强调了潜在纤维化阶段在确定临床结果和特定原因死亡率方面的重要性。”阅读更多

新的成像模型提供了卓越的纤维化阶段诊断

根据最近公布的数据，与二维剪切波弹性成像和慢性乙型肝炎患者的生物标志物相比，弹性成像的深度学习放射组学在评估肝硬化和晚期纤维化方面表现出更高的预测价值。

“利用从有限数量的医院获得的数据来训练和建立[弹性成像深度学习（DLRE）]模型，可能足以用于评估其他医院的肝纤维化阶段，具有一致的准确性，”王坤，医学博士，来自中国中山大学附属第三医院，同事们写道。

肝硬化双年度肝癌筛查可提高诊断，生存率

根据最近发表的一项研究，符合肝细胞癌监测与丙型肝炎或乙型肝炎相关代偿性肝硬化患者的早期诊断，更好的治疗方案分配和更长的总生存期相关。

法国HôpitalHenriMondor的医学博士Charlotte Costentin及其同事写道：“根据国际指南推荐，对肝硬化患者进行HCC监测是基于两年一次的超声检查。” “改善对监测指南的依从性应该可以显着改善这种致命癌症的预后。”