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Keywords:
Abdomen, Liver, Ultrasound, Diagnostic procedure, Haematologic diseases
Authors:
L. Cevasco, F. Paparo, M. Revelli, C. Puppo, E. Aleo, L. Bacigalupo, G. Forni, G. A. Rollandi; Genova/IT
DOI:
10.1594/ecr2014/B-0413
Purpose
In patients with liver iron overload related to primary (genetic) or secondary hemochromatosis [1,2],
the risk for developing fibrosis and cirrhosis has been associated to the liver iron content (liver iron concentration [LIC]),
the duration of iron exposure by the liver,
and the presence of co-factors of hepatotoxicity,
such as viruses and alcohol [3,4].
Liver biopsy is still considered the gold-standard method for evaluating the stage of hepatic fibrosis and to measure LIC in patients with hemochromatosis [5].
However,
this invasive technique has many procedure-related complications,
as well as wide variations in the results [6].
Sampling error studies have shown that a single biopsy may miss cirrhosis in 10–30% of patients and incorrectly classify fibrosis by at least one stage in 20–30% [7].
Currently,
magnetic resonance imaging (MRI) with T2*-weighted sequences is considered a reliable method for detecting iron deposits in the liver,
showing high correlation to the values found in specimens from biopsy,
which are expressed as milligrams of iron per gram of dried tis-sue (mg Fe/g dry weight) [8].
Beside LIC quantification,
a correct estimation of liver fibrosis has important implications regarding patient’s management,
prognosis assessment and long term follow-up.
In recent years,
non-invasive methods were developed in order to replace liver biopsy.
Non-invasive methods (Fibrotest,aspartate transaminase-to-platelet ratio index) using biological parameters such as bilirubin,
haptoglobin,
platelet count cannot be applied to hematological diseases requiring blood transfusion [9].
Ultrasound-based elastographic methods include transient elastography (TE),
acoustic radiation force impulse (ARFI) elastography,
shear wave elastography (SWE),
and real-time elastography (RTE) [10].
While TE has already been validated in patients with liver iron overload (i.e.
primary hemochromatosis [11],
multi-transfused adult β-thalassemia major and thalassemia intermedia patients [12],
sickle cell disease and myelodysplastic syndrome [13]),
no study has investigated the diagnostic performance of RTE in staging liver fibrosis in such patients.
The main objective of the present work was to determine the diagnostic value of RTE in assessing hepatic fibrosis stage according to the METAVIR classification [13] in a heterogeneous cohort of patients with liver iron overload using TE as reference standard.