title: High risk of misinterpreting liver and spleen stiffness using 2D shear-wave and transient elastography after a moderate or high calorie meal.
abstract: Food intake increases liver stiffness, but it is believed that liver stiffness returns to baseline two hours after a meal. The aim of this study was to investigate the impact of different sized meals on liver stiffness. Liver and spleen stiffness was measured with transient elastography (TE) and real-time 2-dimensional shear wave elastography (2D-SWE). Patients ingested a 625 kcal and a 1250 kcal liquid meal on two consecutive days. We measured liver and spleen elasticity, Controlled attenuation parameter (CAP) and portal flow at baseline and after 20, 40, 60, 120 and 180 minutes. Sixty patients participated, 83% with alcoholic liver disease. Twenty-eight patients had METAVIR fibrosis score F0-3 and 32 patients had cirrhosis. Liver stiffness, spleen stiffness and CAP increased after both meals for all stages of fibrosis. False positive 2D-SWE liver stiffness measurements caused 36% and 52% of patients with F0-3 fibrosis to be misclassified with higher stages of fibrosis after the moderate and high caloric meal. Likewise, 10% and 13% of compensated cirrhosis patients were misclassified with clinically significant portal hypertension after the two meals. We observed similar misclassification rates with TE. After three hours, liver stiffness remained elevated more than 20% from baseline in up to 50% of patients.
  
  
  CONCLUSIONS
  Liver stiffness, spleen stiffness and CAP increase after a meal across all stages of fibrosis and across elastography techniques. Up to half of patients may be misclassified with higher stages of fibrosis, if they are assessed after less than three hours fasting period.
authors.affiliation: Department and Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.|Odense Patient data Explorative Network (OPEN), Odense, Denmark.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0001-8452-1820
authors.initials: M
authors.lastname: Kjærgaard
authors.affiliation: Department and Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.|Odense Patient data Explorative Network (OPEN), Odense, Denmark.|Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Maja
authors.initials: M
authors.lastname: Thiele
authors.affiliation: Department of Internal Medicine I, Universitätsklinikum Bonn, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jansen
authors.affiliation: Department and Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.|Odense Patient data Explorative Network (OPEN), Odense, Denmark.|Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Stæhr Madsen
authors.affiliation: Department of Internal Medicine I, Universitätsklinikum Bonn, Bonn, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Görtzen
authors.affiliation: Department of Internal Medicine I, Universitätsklinikum Bonn, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Strassburg
authors.affiliation: Department and Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.|Department of Clinical Research, University of Southern Denmark, Odense, Denmark.|Department of Internal Medicine I, Universitätsklinikum Bonn, Bonn, Germany.|European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain.
authors.forename: Jonel
authors.initials: J
authors.lastname: Trebicka
authors.affiliation: Department and Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.|Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Krag
mesh_terms: D000328:Adult; D000368:Aged; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D002149:Energy Intake; D005189:False Positive Reactions; D005260:Female; D019698:Hepatitis C, Chronic / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000503:physiopathology; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008102:Liver Circulation / Q000502:physiology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D008108:Liver Diseases, Alcoholic / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D062407:Meals; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D013154:Spleen / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013997:Time Factors