Comparison of point shear wave elastography and transient elastography in the evaluation of patients with NAFLD.

PURPOSE: To compare point shear wave elastography (pSWE, ElastPQ®) and transient elastography (TE) with Liver Biopsy in order to evaluate fibrosis stage in non-alcoholic fatty liver disease (NAFLD). METHODS: Our prospective study from September 2017 to October 2020 included 50 consecutively enrolled patients with NAFLD (52.2 ± 13.0 years, 32 male). All patients underwent clinical evaluation, B-mode ultrasound, pSWE, TE and liver biopsy in a single evaluation. The clinical, laboratory and liver biopsy data were compared with liver stiffness (LS) measurement obtained with pSWE and TE. TE and pSWE diagnostic accuracy for the diagnosis of the different fibrosis stages were evaluated using the area under receiver operating characteristic curve (AUROC). RESULTS: Only fibrosis stage was independently associated with TE and pSWE. The median liver stiffness measurement for fibrosis stages F0, F1, F2, F3, and F4 using TE was 4.8 (4.7-6.1) kPa, 5.5 (4.4-7.3) kPa, 7.7 (6.1-9.1) kPa, 9.9 (8.8-13.8) kPa, and 20.2 kPa, respectively. The corresponding median liver stiffness measurement using pSWE was 4.2 (4.0-4.8) kPa, 4.7 (4.2-5.8) kPa, 5.1 (4.1-6.9) kPa, 8.5 (5.2-13.3), and 15.1 kPa, respectively. The AUROC of TE for diagnosis of fibrosis stage F1, ≥ F2, ≥ F3, and F4 were 0.795, 0.867, 0.927, and 0.990, respectively. The corresponding AUROC of pSWE was 0.717, 0.733, 0.908, and 1.000, respectively. No association was observed with other histological parameters. CONCLUSION: TE was significantly better than pSWE for the diagnosis of fibrosis stage ≥ F2. No statistically significant differences were found between TE and pSWE AUROC of fibrosis stage ≥ F1, ≥ F3, and F4.

Shear wave elastography and transient elastography in HCV patients after direct-acting antivirals.

PURPOSE: To compare the ultrasound (US) and pulse shear wave elastography (pSWE, Elast PQ®) methods with transient elastography (TE), clinical scores and laboratory tests, during the follow-up of HCV patients receiving direct-acting antiviral drugs (DAA). METHODS: Our prospective study from June 2016 to December 2017 included 22 consecutively enrolled HCV-positive patients (59.7 ± 12.3 years, 11 male) which were subjected to antiviral therapy. All patients underwent B-mode ultrasound, color-Doppler, pSWE and TE five times: before therapy (T0), at the end of therapy (post-Tx), and at 12, 24, 48 weeks post-therapy. The liver stiffness (LS) values obtained with pSWE and TE and the data coming from US assessment and clinical evaluation were compared. RESULTS: We obtained a statistically significant reduction of LS values (kPa) measured by pSWE, between T0 (14.3 ± 9.3), post-Tx (11.8 ± 10.5), 12 weeks (7.5 ± 3.3), 24 weeks (8 ± 3.8) and 48 weeks (8.5 ± 4.6) (p = 0.02). The reduction of kPa measured by TE was not significant between T0 (14.7 ± 9.3), post-Tx (12 ± 9.5), 12 weeks (11.6 ± 7.7), 24 weeks (10.3 ± 6) and 48 weeks (10.8 ± 7.5) (p > 0.05). Multivariate baseline analysis showed significant independent association among measurement of TE stiffness with cirrhosis, type of vein hepatic flow and showed significant independent association between delta-pSWE measurement (difference between stiffness measurements at the baseline and 12 months after treatment) with staging of fibrosis (p = 0.006) and sustained virologic response after 12 weeks of treatment (SVR12, p = 0.017). CONCLUSION: The pSWE method has shown better ability than TE to identify a reduction in LS. Therefore, pSWE allow to evaluate stiffness reduction in HCV patient during DAA treatment follow-up, which is related to SVR12.

Videofluorography swallow study in patients with systemic sclerosis: correlation with clinical and radiological features.

OBJECTIVES: The aim of our study was to assess the role of videofluorography (VFG) in the evaluation of swallowing and oesophageal peristalsis in patients with systemic sclerosis (SSc). METHODS: From June 2014 to September 2017, 55 consecutive SSc patients, defined according to the 2013 ACR/EULAR classification criteria, underwent VFG study using a remote-controlled digital device. In order to evaluate possible abnormalities, 18 dynamic parameters were chosen, dividing the act of swallowing into three phases: oral, pharyngeal and oesophageal phases. The following dynamic radiological findings were considered: veil motility in phonation, leakage, drooling, salivation and presence of residues in the oral cavity, pharyngeal residues, penetration, aspiration, altered motility of the upper oesophageal sphincter, efficacy of primary peristaltic contractions, oesophageal clearance capacity, reflux, oesophagitis and motility of the lower oesophageal sphincter. RESULTS: The VFG study was well tolerated in all patients. Dysfunctions of oesophageal motility were common and included abnormal motility of UES (12.7%) and LES (76.4%), inadequate primary peristalsis (52.7%), abnormal secondary peristalsis (29.1%) and non-peristaltic contractions (40%). A defective oesophageal clearance was observed in 69.4% of patients. Moreover, most patients presented signs of oesophageal reflux (63.6%), oesophagitis (81.8%) and hiatal hernia (80%). Pharyngeal abnormalities were less common and involved up to 50% of patients. Oesophageal dysfunction and defective clearance were associated with dcSSc and pulmonary involvement. CONCLUSIONS: The VFG study is a useful technique for the morphological and functional evaluation of swallowing in SSc patients.