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      Principles and clinical application of ultrasound elastography for diffuse liver disease

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          Abstract

          Accurate assessment of the degree of liver fibrosis is important for estimating prognosis and deciding on an appropriate course of treatment for cases of chronic liver disease (CLD) with various etiologies. Because of the inherent limitations of liver biopsy, there is a great need for non-invasive and reliable tests that accurately estimate the degree of liver fibrosis. Ultrasound (US) elastography is considered a non-invasive, convenient, and precise technique to grade the degree of liver fibrosis by measuring liver stiffness. There are several commercial types of US elastography currently in use, namely, transient elastography, acoustic radiation force impulse imaging, supersonic shear-wave imaging, and real-time tissue elastography. Although the low reproducibility of measurements derived from operator-dependent performance remains a significant limitation of US elastography, this technique is nevertheless useful for diagnosing hepatic fibrosis in patients with CLD. Likewise, US elastography may also be used as a convenient surveillance method that can be performed by physicians at the patients’ bedside to enable the estimation of the prognosis of patients with fatal complications related to CLD in a non-invasive manner.

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          Most cited references44

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          Elastography: a quantitative method for imaging the elasticity of biological tissues.

          J Ophir (1991)
          We describe a new method for quantitative imaging of strain and elastic modulus distributions in soft tissues. The method is based on external tissue compression, with subsequent computation of the strain profile along the transducer axis, which is derived from cross-correlation analysis of pre- and post-compression A-line pairs. The strain profile can then be converted to an elastic modulus profile by measuring the stresses applied by the compressing device and applying certain corrections for the nonuniform stress field. We report initial results of several phantom and excised animal tissue experiments which demonstrate the ability of this technique to quantitatively image strain and elastic modulus distributions with good resolution, sensitivity and with diminished speckle. We discuss several potential clinical uses of this technique.
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            EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology.

            The technical part of these Guidelines and Recommendations, produced under the auspices of EFSUMB, provides an introduction to the physical principles and technology on which all forms of current commercially available ultrasound elastography are based. A difference in shear modulus is the common underlying physical mechanism that provides tissue contrast in all elastograms. The relationship between the alternative technologies is considered in terms of the method used to take advantage of this. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided on optimisation of scanning technique, image display, image interpretation and some of the known image artefacts. © Georg Thieme Verlag KG Stuttgart · New York.
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              EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications.

              The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation. Diffuse liver disease forms the largest section, reflecting the wide experience with transient and shear wave elastography . Then follow the breast, thyroid, gastro-intestinal tract, endoscopic elastography, the prostate and the musculo-skeletal system using strain and shear wave elastography as appropriate. The document is intended to form a reference and to guide clinical users in a practical way. © Georg Thieme Verlag KG Stuttgart · New York.
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                Author and article information

                Journal
                Ultrasonography
                Ultrasonography
                USG
                Ultrasonography
                Korean Society of Ultrasound in Medicine
                2288-5919
                2288-5943
                July 2014
                24 March 2014
                : 33
                : 3
                : 149-160
                Affiliations
                [1 ]Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
                [2 ]Health Medical Equipment Business, Samsung Electronics, Seoul, Korea
                [3 ]Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
                Author notes
                Correspondence to: Hyo K. Lim, MD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea Tel. +82-2-3410-2505 Fax. +82-2-3410-2559 E-mail: rfalim@ 123456skku.edu
                Author information
                http://orcid.org/0000-0002-0676-2116
                http://orcid.org/0000-0003-3269-7503
                http://orcid.org/0000-0001-7206-2081
                http://orcid.org/0000-0003-3096-0558
                http://orcid.org/0000-0002-1069-0135
                Article
                usg-14003
                10.14366/usg.14003
                4104950
                25038804
                84b83722-c85d-4708-91d1-a150b1b1934f
                Copyright © 2014 Korean Society of Ultrasound in Medicine (KSUM)

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 9 January 2014
                : 24 March 2014
                Categories
                Review Article

                elasticity imaging techniques,liver cirrhosis,hypertension, portal,ultrasonography

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