title: Real-time elastography as a noninvasive technique for quantification of fibrosis in patients with chronic viral liver disease: Preliminary findings.
abstract: BACKGROUND
  Real-time elastography (RTE) is a novel technique for measuring tissue elasticity. The aims of this study were to prospectively measure liver stiffness with RTE in patients with chronic viral hepatitis and to evaluate the possible correlation between RTE data and the extent of fibrosis based on liver biopsy findings (Ishak score).
  
  
  METHODS
  Between February and October 2011, 26 patients (18M, 8F, mean age 41 ± 13 [standard deviation], range 22-62) with chronic viral hepatitis were prospectively evaluated with ultrasonography (US) that included RTE. All patients then underwent US-guided percutaneous liver biopsy (right lobe) for evaluation of fibrosis. Examinations were performed with a iU22 scanner (Philips, Bothell, WA, USA); a convex transducer (C5-1) was used for the US examination, and a linear transducer (L12-5) for RTE. In the RTE images, relative tissue stiffness is expressed according to a color scale with soft areas represented in green/red and hard areas in blue. Patients were examined in the supine position in suspended normal respiration; three loops of 20 RTE frames were recorded for each case. For each patient, we calculated the mean strain ratio (MSR) for the 3 loops. The Spearman correlation coefficient was used to assess correlation between the ASR and fibrosis stage (F) reflected by the Ishak score.
  
  
  RESULTS
  The Spearman coefficient showed significant correlation between the MSR and F (Rho = 0.470, p = 0.015).
  
  
  CONCLUSIONS
  RTE appears to be a useful tool for noninvasive evaluation of fibrosis in patients with chronic viral hepatitis although these findings need to be confirmed in larger case series.
authors.affiliation: Department of Digestive Diseases and Internal Medicine, St. Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Fiorini
authors.forename: V
authors.initials: V
authors.lastname: Cipriano
authors.forename: C
authors.initials: C
authors.lastname: De Molo
authors.forename: S
authors.initials: S
authors.lastname: Righi
authors.forename: M E
authors.initials: ME
authors.lastname: Ainora
authors.forename: A
authors.initials: A
authors.lastname: Arcelli
authors.forename: C
authors.initials: C
authors.lastname: Bertusi
authors.forename: M
authors.initials: M
authors.lastname: Montanari
authors.forename: G
authors.initials: G
authors.lastname: Bianchi
authors.forename: C
authors.initials: C
authors.lastname: Serra
keywords: Liver disease; Liver fibrosis; Real-time elastography