Advanced Ultrasound in Diagnosis and Therapy (Sep 2024)

Ultrasound-based Dual Elastography for Evaluating the Severity of Drug-induced Liver Injury: One Step Closer to Pathology

  • Liyun Xue, PhD, Hui Feng, MD, Fankun Meng, MD, Ying Zheng, MD, Guangwen Cheng, PhD, Yao Zhang, MD, Zhiyong Yin, MD, Jing Wu, MD, Jiabao Zhu, MD, Xueqi Li, MD, Jie Yu, PhD, Ping Liang, PhD, Hong Ding, PhD

DOI
https://doi.org/10.37015/AUDT.2024.240017
Journal volume & issue
Vol. 8, no. 3
pp. 106 – 115

Abstract

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Objective: Drug-induced liver injury (DILI) is one of the most challenging forms of liver disorder. We aimed to use ultrasound dual elastography, by combining strain and shear wave imaging, to noninvasively assess liver inflammation and injury severity of DILI. Methods: 291 DILI patients were included in the prospective multicenter study and divided into training and validation cohorts. All patients received liver biopsy and dual elastography examination. Liver inflammation grading (G0-4) and fibrosis staging (F0-4) were considered as the gold standard of liver injury and G+F ≥ 5 was defined as severe liver injury. Indexes of dual elastography and serological indicators (DESI) were selected and analyzed with multivariable logistic regression to build DESI models for evaluating liver inflammation, and the C score model was built with the same method for diagnosing severe liver injury. Results: Areas under the receiver operating characteristic curve (AUCs) of the DESI model to assess liver inflammation ≥ G2 were 0.887 and 0.868 in training and validation cohorts, respectively. AUCs of the DESI model in diagnosing ≥ G3 were 0.893 and 0.896 in the two cohorts, respectively. The C score accurately assessed severe liver injury with AUCs of 0.909 and 0.885 in two cohorts. Of the 87 patients with mild clinical severity, 10 (11.49%) had severe pathological injury, which could be identified by C score. Conclusion: Dual elastography demonstrated high performance in diagnosing liver inflammation and identifying severe pathological liver injury of DILI, making up for the deficiency of serological indicators alone for evaluating DILI severity.

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