Elastography in the diagnosis of fibrosis in chronic diffuse liver diseases

Abstract

The presents modern information about a non-invasive instrumental technique for assessing fibrotic changes in the liver – elastography. The data on the history of the origin of the term «elastography» are presented, several of its definitions are given, and attention is also paid to the main principle of the technique – percussion, which is traditionally used in an objective study of a patient. The facts about the dual terminology of the technique in the literature are presented, in which some authors use the term «elastography», and the other part – «elastometry». When analyzing the literature, it turned out that in foreign sources the term «elastography» is much more often used, and both names of the method are used in Russian. Given the greater prevalence of the «elastography» option, it is more logical to use it, but each of these names has its own right to exist. Definitions are given for the basic physical concepts associated with the elastography method – «elasticity», «rigidity» and Young’s modulus of elasticity. From the point of view of application in clinical practice, elastography techniques can be divided into four groups: compression elastography, which is more often used in oncodiagnostics, transient, point and two-dimensional shear wave elastography, used in the diagnosis of liver fibrosis. Physical classification involves dividing elastography into two types: static, which includes compression elastography, and dynamic, which includes transient, point and two-dimensional shear wave elastography. Transient elastography is implemented in devices of the FibroScan family, point elastography – in ultrasound scanners from «Hitachi Aloka», «Siemens» and «Philips», two-dimensional shear wave elastography – in devices from «Supersonic Imagine», «Toshiba», «Siemens», «Mindray», «General Electric». The widest range of possibilities for assessing liver fibrosis is provided by two-dimensional shear wave elastography. The combined use of several techniques is expected to increase the diagnostic accuracy in determining fibrosis. Magnetic resonance elastography has the greatest accuracy among elastographic techniques, but its application is limited due to the complexity and high cost of equipment, therefore, this technique has not yet found wide application in clinical practice.

Keywords

chronic diffuse liver diseases / liver fibrosis / diagnostics / elastography / physical basis of elastography / compression elastography / shear wave elastography / transient elastography / point shear wave elastography / two-dimensional shear wave elastography / magnetic resonance elastography

References

[1] Аллахвердиева, Я.С. Современные возможности магнитно-резонансных технологий в диагностике ожирения печени / Я.С. Аллахвердиева, С.В. Воробьев, Н.И. Минеев // Мед. вестн. Сев. Кавказа. – 2018. – Т. 13, № 4. – С. 695–701.

[2] Жирков, И.И. Возможности транзиентной и двухмерной сдвиговолновой эластографии в диагностике фиброза при хронических диффузных заболеваниях печени невирусной этиологии / И.И. Жирков [и др.] // Экспер. и клин. гастроэнтерология. – 2020. – Т. 179, № 7. – С. 40–45.

[3] Зыкин, Б.И. Эластография: анатомия метода / Б.И. Зыкин, Н.А. Постнова, М.Е. Медведев // Променева діагностика, променева терапія. – 2012. – № 2–3. – С. 107–113.

[4] Изранов, В.А. Методы эластографии печени и проблемы русскоязычной терминологии / В.А. Изранов [и др.] // Вестн. Балт. фед. ун-та им. И. Канта. – 2019. – № 1. – С. 63–78.

[5] Изранов, В.А. Физические основы эластографии печени / В.А. Изранов [и др.] // Вестн. Балт. фед. ун-та им. И. Канта. – 2019. – № 2. – С. 69–87.

[6] Осипов, Л.В. Технологии эластографии в ультразвуковой диагностике. Обзор / Л.В. Осипов // Мед. алфавит. Диагностическая радиология и онкотерапия. – 2013. – № 3–4. – С. 5–21.

[7] Постнова, Н.А. Компрессионная эластография печени: методика, особенности получения эластограмм, анализ ошибок и артефактов (лекция) / Н.А. Постнова [и др.] // Радиология – практика. – 2015. – Т. 50, № 2. – С. 45–54.

[8] Тухбатуллин, М.Г. Современные ультразвуковые технологии в клинической практике / М.Г. Тухбатуллин, И.М. Алиева // Практ. мед. – 2012. – № 5. – C. 30–35.

[9] Физическая энциклопедия: в 5 томах / под ред. А.М. Прохорова. – М.: Большая российская энциклопедия, 1998. – 3544 с.

[10] Bedossa, P. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group / P. Bedossa, T. Poynard // Hepatology. – 1996. – Vol. 24, № 2. – P. 289–293.

[11] Dietrich, C.F. EFSUMB Guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). European Federation for Ultrasound in Medicine and Biology (EFSUMB) / C.F. Dietrich [et al.] // Ultraschall in der Medizin. – 2017. – Vol. 38, № 4. – P. 16–47.

[12] Dulai, P.S. Magnetic resonance imaging and magnetic resonance elastography for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: clinical trials to clinical practice / P.S. Dulai, C.B. Sirlin, R. Loomba // Journal of Hepatology. – 2016. – Vol. 65. – P. 1006–1016.

[13] Нagström, Н. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD / H. Hagström [et al.] // Journal of Hepatology. – 2017. – Vol. 67, № 6. – P. 1265–1273.

[14] Ophir, J. Elastography: a quantitative method for imaging the elasticity of biological tissues / J. Ophir [et al.] // Ultrasonic Imaging. – 1991. – Vol. 13. – P. 111–134.

[15] Shiina Т. JSUM ultrasound elastography practice guidelines: basics and terminology / Т. Shiina // Journal of Medical Ultrasonics. – 2013. – Vol. 40, № 4. – P. 325–357.

[16] Venkatesh, S.K. Magnetic resonance elastography of liver: technique, analysis, and clinical applications / S.K. Venkatesh, M. Yin, R.L. Ehman // Journal of Magnetic Resonance. – 2013. – Vol. 37. – P. 544–555.

RIGHTS & PERMISSIONS

Zhirkov I.I., Gordienko A.V., Pavlovich I.M., Yakovlev V.V., Serdyukov D.Y.