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Letter to the Editor| Volume 63, ISSUE 2, P535, August 2015

Reply to: “Strain ultrasound elastography for liver diseases”

Open AccessPublished:May 07, 2015DOI:https://doi.org/10.1016/j.jhep.2015.04.024
Reply to: “Strain ultrasound elastography for liver diseases”
Previous ArticleStrain ultrasound elastography for liver diseases
Next ArticleErratum to “Hepatic hepcidin expression is decreased in cirrhosis and HCC” [J Hepatol 2015;62:977–979]

      Linked Article

      • New imaging techniques for liver diseases
        Journal of HepatologyVol. 62Issue 3
        • Preview
          Newly developed or advanced methods of ultrasonography and MR imaging provide combined anatomical and quantitative functional information about diffuse and focal liver diseases. Ultrasound elastography has a central role for staging liver fibrosis and an increasing role in grading portal hypertension; dynamic contrast-enhanced ultrasonography may improve tumor characterization. In clinical practice, MR imaging examinations currently include diffusion-weighted and dynamic MR imaging, enhanced with extracellular or hepatobiliary contrast agents.
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      • Strain ultrasound elastography for liver diseases
        Journal of HepatologyVol. 63Issue 2
        • Preview
          In a review published in a recent issue [1], Van Beers et al. described the new ultrasonography and magnetic resonance imaging (MRI) techniques for the evaluation of diffuse and focal liver diseases. Regarding the section of ultrasound elastography, however, the authors failed to include strain elastography (SE), which is also one of the important elastography techniques for liver disease [2–4].
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        Open Access
      To the Editor:
      We thank Dr. Cui for his comment about the use of ultrasound strain elastography to assess liver disease. The aim of our review was not to perform a detailed analysis of all variants of ultrasound and MR imaging methods in assessing liver disease, but to discuss the value of new quantitative imaging methods, including ultrasound and MR elastography [
      • Van Beers B.E.
      • Daire J.L.
      • Garteiser P.
      New imaging techniques for liver diseases.
      J Hepatol. 2015; 62: 690-700
      ].
      Besides the quantitative dynamic elastography methods that we discussed in our review, the quasi-static strain elastography method has been developed [
      • Ophir J.
      • Céspedes I.
      • Ponnekanti H.
      • Yazdi Y.
      • Li X.
      Elastography: a quantitative method for imaging the elasticity of biological tissues.
      Ultrason Imaging. 1991; 13: 111-134
      ]. Strain imaging is essentially qualitative because quantification of strain would require knowledge about stress distribution within the body [
      • Shiina T.
      • Nightingale K.R.
      • Palmeri M.L.
      • Hall T.J.
      • Bamber J.C.
      • Barr R.G.
      • et al.
      WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology.
      Ultrasound Med Biol. 2015; ([Epub ahead of print])
      ]. Strain elastography may be rendered semi-quantitative by assessing the strain pattern within the region of interest or comparing the strain of the examined region relative to that of a reference region. Various strain elastography imaging and analysis methods have been developed [
      • Koizumi Y.
      • Hirooka M.
      • Kisaka Y.
      • Konishi I.
      • Abe M.
      • Murakami H.
      • et al.
      Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography–establishment of the method for measurement.
      Radiology. 2011; 258: 610-617
      ,
      • Fujimoto K.
      • Kato M.
      • Kudo M.
      • Yada N.
      • Shiina T.
      • Ueshima K.
      • et al.
      Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C.
      Oncology. 2013; 84: 3-12
      ]. These methods need standardization [
      • Ferraioli G.
      • Filice C.
      • Castera L.
      • Choi B.I.
      • Sporea I.
      • Wilson S.R.
      • et al.
      WFUMB guidelines and recommendations for clinical use of ultrasound elastography Part 3: Liver.
      Ultrasound Med Biol. 2015; ([Epub ahead of print])
      ].
      The value of strain elastography should also be compared to the other elastography methods. In three studies comparing the accuracy of strain elastography relative to dynamic elastography for assessing liver fibrosis, dynamic elastography performed better than strain elastography [
      • Friedrich-Rust M.
      • Schwarz A.
      • Ong M.
      • Dries V.
      • Schirmacher P.
      • Herrmann E.
      • et al.
      Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease.
      Ultraschall Med. 2009; 30: 478-484
      ,
      • Colombo S.
      • Buonocore M.
      • Del Poggio A.
      • Jamoletti C.
      • Elia S.
      • Mattiello M.
      • et al.
      Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis.
      J Gastroenterol. 2012; 47: 461-469
      ,
      • Ferraioli G.
      • Tinelli C.
      • Malfitano A.
      • Dal Bello B.
      • Filice G.
      • Filice C.
      • et al.
      Performance of real-time strain elastography, transient elastography, and aspartate-to-platelet ratio index in the assessment of fibrosis in chronic hepatitis C.
      AJR Am J Roentgenol. 2012; 199: 19-25
      ].
      Currently, the level of evidence about strain elastography usefulness in the evaluation of diffuse liver diseases is still low, according to the 2013 EFSUMB and 2015 WFUMB recommendations [
      • Ferraioli G.
      • Filice C.
      • Castera L.
      • Choi B.I.
      • Sporea I.
      • Wilson S.R.
      • et al.
      WFUMB guidelines and recommendations for clinical use of ultrasound elastography Part 3: Liver.
      Ultrasound Med Biol. 2015; ([Epub ahead of print])
      ,
      • Cosgrove D.
      • Piscaglia F.
      • Bamber J.
      • Bojunga J.
      • Correas J.M.
      • Gilja O.H.
      • et al.
      Dietrich CF; EFSUMB. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications.
      Ultraschall Med. 2013; 34: 238-253
      ]. The results of further multicenter strain elastography trials and of elastography comparative studies are awaited.

      Conflict of interest

      The author declared that he does not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

      References

        • Van Beers B.E.
        • Daire J.L.
        • Garteiser P.
        New imaging techniques for liver diseases.
        J Hepatol. 2015; 62: 690-700
        View in Article
        • Ophir J.
        • Céspedes I.
        • Ponnekanti H.
        • Yazdi Y.
        • Li X.
        Elastography: a quantitative method for imaging the elasticity of biological tissues.
        Ultrason Imaging. 1991; 13: 111-134
        View in Article
        • Shiina T.
        • Nightingale K.R.
        • Palmeri M.L.
        • Hall T.J.
        • Bamber J.C.
        • Barr R.G.
        • et al.
        WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology.
        Ultrasound Med Biol. 2015; ([Epub ahead of print])
        View in Article
        • Koizumi Y.
        • Hirooka M.
        • Kisaka Y.
        • Konishi I.
        • Abe M.
        • Murakami H.
        • et al.
        Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography–establishment of the method for measurement.
        Radiology. 2011; 258: 610-617
        View in Article
        • Fujimoto K.
        • Kato M.
        • Kudo M.
        • Yada N.
        • Shiina T.
        • Ueshima K.
        • et al.
        Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C.
        Oncology. 2013; 84: 3-12
        View in Article
        • Ferraioli G.
        • Filice C.
        • Castera L.
        • Choi B.I.
        • Sporea I.
        • Wilson S.R.
        • et al.
        WFUMB guidelines and recommendations for clinical use of ultrasound elastography Part 3: Liver.
        Ultrasound Med Biol. 2015; ([Epub ahead of print])
        View in Article
        • Friedrich-Rust M.
        • Schwarz A.
        • Ong M.
        • Dries V.
        • Schirmacher P.
        • Herrmann E.
        • et al.
        Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease.
        Ultraschall Med. 2009; 30: 478-484
        View in Article
        • Colombo S.
        • Buonocore M.
        • Del Poggio A.
        • Jamoletti C.
        • Elia S.
        • Mattiello M.
        • et al.
        Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis.
        J Gastroenterol. 2012; 47: 461-469
        View in Article
        • Ferraioli G.
        • Tinelli C.
        • Malfitano A.
        • Dal Bello B.
        • Filice G.
        • Filice C.
        • et al.
        Performance of real-time strain elastography, transient elastography, and aspartate-to-platelet ratio index in the assessment of fibrosis in chronic hepatitis C.
        AJR Am J Roentgenol. 2012; 199: 19-25
        View in Article
        • Cosgrove D.
        • Piscaglia F.
        • Bamber J.
        • Bojunga J.
        • Correas J.M.
        • Gilja O.H.
        • et al.
        Dietrich CF; EFSUMB. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications.
        Ultraschall Med. 2013; 34: 238-253
        View in Article

      Article info

      Publication history

      Published online: May 07, 2015

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      DOI: https://doi.org/10.1016/j.jhep.2015.04.024

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      © 2015 European Association for the Study of the Liver. Published by Elsevier B.V.

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