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العنوان
Real time ultrasound tissue Elastography
in post-hepatitis chronic liver disease;
role, limitations and pitfalls /
المؤلف
Ahmed,Shimaa Mohamed Radwan.
هيئة الاعداد
باحث / شيماء محمد رضوان احمد
مشرف / نهي محمد ضياء
مشرف / ميرهان احمد نصر
مشرف / محمد ممدوح محمد
تاريخ النشر
2019
عدد الصفحات
231p.:
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
الأشعة والطب النووي والتصوير
تاريخ الإجازة
1/1/2021
مكان الإجازة
جامعة عين شمس - كلية الطب - الأشعة التشخيصية
الفهرس
Only 14 pages are availabe for public view

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from 211

Abstract

The progressive hepatic fibrosis with the development of
cirrhosis is a feature of almost all chronic liver diseases.
Approximately 10–20% of patients with chronic hepatitis C
virus infection have cirrhosis at first clinical presentation,
and as many 20–30% of those who do not have cirrhosis
will eventually develop this condition and its complications
with in one or more decades These complications are liver
failure, ascites, variceal bleeding, portal-systemic
encephalopathy, and hepatocellular carcinoma. (Foucher et
al., 2005).
Until recently, liver biopsy (LB) examination was the only
way of evaluating liver fibrosis. However, LB examination
is invasive and painful, and can have life-threatening
complications. The poor acceptability of LB examination
can lead to treatment delays, and LB examination is
difficult to repeat in poorly symptomatic subjects. The
accuracy of LB examination for assessing fibrosis also has
been questioned because of sampling errors and intra- and
inter-observer variability that may lead to over- or under
staging of fibrosis. There is thus a need for accurate noninvasive methods of measuring the degree of liver fibrosis.
Proposed approaches include physical examination, routine biochemical and hematologic tests, surrogate serum fibrosis
markers have been used (Castera, 2005).
The Fibroscan is a simple and low-cost device that could
be used to assess instantaneously and directly the elasticity
of the liver. The measurements are fully non-invasive, and
may be performed by physicians or even non physicians
after a short training period, there is no intra-or
interobserver variability and the technique is reproducible
(Sandrin et al., 2005).
Correlation with fibrosis grade is good with good
sensitivity and specificity values and high positive
predictive values(in comparison to liver biopsy) especially
in moderate and sever stages of fibrosis ≥ f2 (reaches more
than 90%) (Foucher et al., 2006).
Because the Transient Elastography completely noninvasive and because stiffness is a continuous variable,
repeated measurements could show changes in the amount
of fibrosis and help follow-up in these patients (Ziol et al.,
2005).
Also elasticity measurements have good correlation with
complication of fibrosis as cirrhosis, oesophageal varices
and hepatocellular carcinoma (Foucher J et al., 2006).Transient elastography could be useful not only to evaluate
liver fibrosis as to monitor liver disease progression, but
also to monitor anti-viral or antifibrotic therapy effects and
to help taking decisions in daily clinical practice (Gomez et
al., 2006).
Several studies evaluated the accuracy of Fibroscan, blood
tests, or combinations compared with liver biopsy (Shiha et
al., 2009). Most of these studies include patients with HCV
infection, one includes patients with chronic liver disease
of any origin, one includes patients with biliary cirrhosis
due to primary biliary cirrhosis or primary sclerosing
cholangitis, and one includes only those patients who are co
infected with HIV and HCV. These studies show that
Fibroscan results are reproducible across operators and
time. All the studies report that FibroScan‟s diagnostic
performance is good, indicating that it agrees perfectly with
liver biopsy. (Shiha et al., 2009)
Elasticity measurements are difficult or impossible in obese
patients and patients with narrow intercostal spaces, also fat
tissue may absorb or diminish low-frequent vibration,
resulting in a poor signal to noise ratio that affects the
elasticity measurement algorithm in this patient. The lowfrequency elastic waves do not propagate Through liquids,
indicating that elastometry is impossible in patients with ascites. The chest wall contributes to prevent the liver from
being directly compressed by the probe itself, and to give a
static and plane surface for the probe positioning. Blood
flow might be another consistent factor for the
measurement It self (Saito et al., 2003). But this last
limitation is to be overcome by technical improvements
such as the development of new probes.
Our study showed that the relation between fibroscan
and US finding had positive correlation as most of
patients with hepatomegaly, coarse hepatic texture,
dilated PV or splenomegaly reported as high fibrosis
(F3 and F4 scores) while sporadic cases were reported
in (F0, F1 and F2 scores).
Also in our study there was highly statistically
significant agreement between degrees of fibrosis by
biopsy and degrees of fibrosis by fibro-scan , that
means that Fibroscan is a good tool in detection of
hepatic fibrosis and follow up of it.