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Valerio Nobili - One of the best experts on this subject based on the ideXlab platform.
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combined paediatric nafld Fibrosis index and transient elastography to predict clinically significant Fibrosis in children with fatty liver disease
Liver International, 2013Co-Authors: Naim Alkhouri, Rocio Lopez, Emad Sedki, Anna Alisi, Massimo Pinzani, Ariel E Feldstein, Valerio NobiliAbstract:Background Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to steatohepatitis, to Fibrosis and cirrhosis. The paediatric NAFLD Fibrosis index (PNFI) and transient elastography (TE) are potential noninvasive markers for Fibrosis. To prospectively evaluate the performance of PNFI and TE in assessing clinically significant Fibrosis in children with biopsy-proven NAFLD. Methods Our cohort consisted of 67 consecutive children with biopsy-proven NAFLD. The stage of Fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. Fibrosis ≥ 2 was considered clinically significant. PNFI was calculated using age, waist circumference and triglycerides. TE was performed using the Fibroscan apparatus. Results Ten patients had Fibrosis stage 2–3 and 57 patients had stage 0–1. Both PNFI and TE values were significantly higher in patients with significant Fibrosis (P < 0.05). The area under the receiver operating characteristic (ROC) curve for predicting significant Fibrosis of PNFI and TE were 0.747 and 1.00 respectively (P = 0.005). The combined use of PNFI and TE could predict the presence or absence of clinically significant Fibrosis in 98% of children with NAFLD. Conclusions In children with NAFLD, the combination of PNFI and TE can be used to accurately assess the presence of clinically significant liver Fibrosis. This will help to identify patients who should undergo liver biopsy because the confirmation of advanced Fibrosis would lead to closer follow-up and screening for cirrhosis-related complications.
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Transient elastography for assessment of Fibrosis in paediatric liver disease
Pediatric Radiology, 2011Co-Authors: Valerio Nobili, Anna Alisi, Andrea Pietrobattista, Lidia Monti, Cristina Lo Zupone, Paolo TomàAbstract:The prognosis and management of chronic liver diseases in children largely depend on the extent and progression of liver Fibrosis, which is often the most important predictor of disease outcome, and thus influences the indication for potential therapy. Unfortunately, liver biopsy continues to be the gold standard for the staging and grading of Fibrosis. Liver biopsy is an invasive and painful technique with several limitations. These limitations have led to the development of alternative noninvasive methods for the accurate assessment of Fibrosis and for the maintenance of an acceptable risk/benefit ratio. In the last decades, transient elastography (TE) has received increasing consideration as a means of evaluating disease progression in paediatric chronic liver disease. TE is an accurate and reproducible methodology for identifying subjects without Fibrosis or significant Fibrosis, or with advanced Fibrosis. In this review, we provide an outline of liver Fibrosis in paediatric liver diseases, including fibrogenesis, and noninvasive techniques for the diagnosis and follow-up of Fibrosis, and then focus on the characteristics of TE and on its strength in the assessment of liver Fibrosis, paying particular attention to studies conducted in children.
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A combination of the pediatric NAFLD Fibrosis index and enhanced liver Fibrosis test identifies children with Fibrosis.
Clinical Gastroenterology and Hepatology, 2010Co-Authors: Naim Alkhouri, Rocio Lopez, Massimo Pinzani, Ariel E Feldstein, Christine Carter–kent, William Rosenberg, Giorgio Bedogni, Valerio NobiliAbstract:Background & Aims Nonalcoholic fatty liver disease (NAFLD) encompasses diseases from simple steatosis, to steatohepatitis, to Fibrosis, and cirrhosis. The pediatric NAFLD Fibrosis index (PNFI) and the enhanced liver Fibrosis (ELF) test are potential noninvasive markers for Fibrosis. We prospectively evaluated the performance of PNFI and ELF in assessing Fibrosis in children with biopsy-proven NAFLD. Methods We analyzed 111 consecutive children with NAFLD. The stage of Fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. PNFI was calculated based on age, waist circumference, and levels of triglycerides. The ELF test was used to determine levels of hyaluronic acid, the amino-terminal propeptide of type III collagen, and tissue inhibitor of metalloproteinase-1. Results Some degree of Fibrosis was detected in 68.5% of patients (62 had stage 1, 5 had stage 2, and 9 had stage 3). PNFI and ELF test values was higher among patients with Fibrosis ( P Conclusions In children with NAFLD, the combined results from the PNFI and ELF test can accurately assess the presence of liver Fibrosis and identify patients that should be evaluated by liver biopsy.
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accuracy and reproducibility of transient elastography for the diagnosis of Fibrosis in pediatric nonalcoholic steatohepatitis
Hepatology, 2008Co-Authors: Valerio Nobili, Francesco Vizzutti, Umberto Arena, Juan G Abraldes, Fabio Marra, Andrea Pietrobattista, Rodolfo Fruhwirth, Matilde Marcellini, Massimo PinzaniAbstract:Transient elastography (TE) has received increasing attention as a means to evaluate disease progression in chronic liver disease patients. In this study, we assessed the value of TE for the prediction of Fibrosis stage in a cohort of pediatric patients with nonalcoholic steatohepatitis. Furthermore, TE interobserver agreement was evaluated. TE was performed in 52 consecutive biopsy-proven nonalcoholic steatohepatitis patients (32 males, 20 females, age 13.6 ± 2.44 years). The area under the receiver operating characteristic curves for the prediction of “any” (≥1), significant (≥2), or advanced Fibrosis (≥3) were 0.977, 0.992, and 1, respectively. Calculation of multilevel likelihood ratios showed that TE values <5, <7, and <9 kPa, suggest the presence of “any” Fibrosis, significant Fibrosis, and advanced Fibrosis, respectively. TE values between 5 and 7 kPa predict a Fibrosis stage of 1, but with some degree of uncertainty. TE values between 7 and 9 kPa predict Fibrosis stages 1 or 2, but cannot discriminate between these two stages. TE values of at least 9 kPa are associated with the presence of advanced Fibrosis. The intraclass correlation coefficient for absolute agreement was 0.961. Conclusion: TE is an accurate and reproducible methodology to identify pediatric subjects without Fibrosis or significant Fibrosis, or with advanced Fibrosis. In patients in which likelihood ratios are not optimal to provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. (HEPATOLOGY 2008.)
Ryoichi Takayanagi - One of the best experts on this subject based on the ideXlab platform.
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retroperitoneal Fibrosis associated with immunoglobulin g4 related disease
World Journal of Gastroenterology, 2013Co-Authors: Nao Fujimori, Tetsuhide Ito, Hisato Igarashi, Takamasa Oono, Taichi Nakamura, Yusuke Niina, Masayuki Hijioka, Lingaku Lee, Masahiko Uchida, Ryoichi TakayanagiAbstract:Retroperitoneal Fibrosis is a rare disease characterized by the development of inflammation and Fibrosis in the soft tissues of the retroperitoneum and other abdominal organs. Retroperitoneal Fibrosis can be of 2 types: idiopathic and secondary. The recently advocated concept and diagnostic criteria of immunoglobulin G4 (IgG4)-related disease, derived from research on autoimmune pancreatitis (AIP), has led to widespread recognition of retroperitoneal Fibrosis as a condition caused by IgG4-related disease. We now know that previously diagnosed idiopathic retroperitoneal Fibrosis includes IgG4-related disease; however, the actual prevalence is unclear. Conversely, some reports on AIP suggest that retroperitoneal Fibrosis is concurrently found in about 10% of IgG4-related disease. Because retroperitoneal Fibrosis has no specific symptoms, diagnosis is primarily based on diagnostic imaging (computed tomography and magnetic resonance imaging), which is also useful in evaluating the effect of therapy. Idiopathic retroperitoneal Fibrosis can occur at different times with other lesions of IgG4-related disease including AIP. Thus, the IgG4 assay is recommended to diagnose idiopathic retroperitoneal Fibrosis. High serum IgG4 levels should be treated and monitored as a symptom of IgG4-related disease. The first line of treatment for retroperitoneal Fibrosis is steroid therapy regardless of its cause. For patients with concurrent AIP, i.e., IgG4-related retroperitoneal Fibrosis, the starting dose of steroid is usually 30-40 mg/d. The response to steroid therapy is generally favorable. In most cases, the pancreatic lesion and retroperitoneal Fibrosis improve after the initial treatment. However, the epidemiology, treatment for recurring retroperitoneal Fibrosis, and long-term prognosis are still largely unknown. Further analysis of such cases and research are necessary.
Massimo Pinzani - One of the best experts on this subject based on the ideXlab platform.
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combined paediatric nafld Fibrosis index and transient elastography to predict clinically significant Fibrosis in children with fatty liver disease
Liver International, 2013Co-Authors: Naim Alkhouri, Rocio Lopez, Emad Sedki, Anna Alisi, Massimo Pinzani, Ariel E Feldstein, Valerio NobiliAbstract:Background Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to steatohepatitis, to Fibrosis and cirrhosis. The paediatric NAFLD Fibrosis index (PNFI) and transient elastography (TE) are potential noninvasive markers for Fibrosis. To prospectively evaluate the performance of PNFI and TE in assessing clinically significant Fibrosis in children with biopsy-proven NAFLD. Methods Our cohort consisted of 67 consecutive children with biopsy-proven NAFLD. The stage of Fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. Fibrosis ≥ 2 was considered clinically significant. PNFI was calculated using age, waist circumference and triglycerides. TE was performed using the Fibroscan apparatus. Results Ten patients had Fibrosis stage 2–3 and 57 patients had stage 0–1. Both PNFI and TE values were significantly higher in patients with significant Fibrosis (P < 0.05). The area under the receiver operating characteristic (ROC) curve for predicting significant Fibrosis of PNFI and TE were 0.747 and 1.00 respectively (P = 0.005). The combined use of PNFI and TE could predict the presence or absence of clinically significant Fibrosis in 98% of children with NAFLD. Conclusions In children with NAFLD, the combination of PNFI and TE can be used to accurately assess the presence of clinically significant liver Fibrosis. This will help to identify patients who should undergo liver biopsy because the confirmation of advanced Fibrosis would lead to closer follow-up and screening for cirrhosis-related complications.
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A combination of the pediatric NAFLD Fibrosis index and enhanced liver Fibrosis test identifies children with Fibrosis.
Clinical Gastroenterology and Hepatology, 2010Co-Authors: Naim Alkhouri, Rocio Lopez, Massimo Pinzani, Ariel E Feldstein, Christine Carter–kent, William Rosenberg, Giorgio Bedogni, Valerio NobiliAbstract:Background & Aims Nonalcoholic fatty liver disease (NAFLD) encompasses diseases from simple steatosis, to steatohepatitis, to Fibrosis, and cirrhosis. The pediatric NAFLD Fibrosis index (PNFI) and the enhanced liver Fibrosis (ELF) test are potential noninvasive markers for Fibrosis. We prospectively evaluated the performance of PNFI and ELF in assessing Fibrosis in children with biopsy-proven NAFLD. Methods We analyzed 111 consecutive children with NAFLD. The stage of Fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. PNFI was calculated based on age, waist circumference, and levels of triglycerides. The ELF test was used to determine levels of hyaluronic acid, the amino-terminal propeptide of type III collagen, and tissue inhibitor of metalloproteinase-1. Results Some degree of Fibrosis was detected in 68.5% of patients (62 had stage 1, 5 had stage 2, and 9 had stage 3). PNFI and ELF test values was higher among patients with Fibrosis ( P Conclusions In children with NAFLD, the combined results from the PNFI and ELF test can accurately assess the presence of liver Fibrosis and identify patients that should be evaluated by liver biopsy.
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accuracy and reproducibility of transient elastography for the diagnosis of Fibrosis in pediatric nonalcoholic steatohepatitis
Hepatology, 2008Co-Authors: Valerio Nobili, Francesco Vizzutti, Umberto Arena, Juan G Abraldes, Fabio Marra, Andrea Pietrobattista, Rodolfo Fruhwirth, Matilde Marcellini, Massimo PinzaniAbstract:Transient elastography (TE) has received increasing attention as a means to evaluate disease progression in chronic liver disease patients. In this study, we assessed the value of TE for the prediction of Fibrosis stage in a cohort of pediatric patients with nonalcoholic steatohepatitis. Furthermore, TE interobserver agreement was evaluated. TE was performed in 52 consecutive biopsy-proven nonalcoholic steatohepatitis patients (32 males, 20 females, age 13.6 ± 2.44 years). The area under the receiver operating characteristic curves for the prediction of “any” (≥1), significant (≥2), or advanced Fibrosis (≥3) were 0.977, 0.992, and 1, respectively. Calculation of multilevel likelihood ratios showed that TE values <5, <7, and <9 kPa, suggest the presence of “any” Fibrosis, significant Fibrosis, and advanced Fibrosis, respectively. TE values between 5 and 7 kPa predict a Fibrosis stage of 1, but with some degree of uncertainty. TE values between 7 and 9 kPa predict Fibrosis stages 1 or 2, but cannot discriminate between these two stages. TE values of at least 9 kPa are associated with the presence of advanced Fibrosis. The intraclass correlation coefficient for absolute agreement was 0.961. Conclusion: TE is an accurate and reproducible methodology to identify pediatric subjects without Fibrosis or significant Fibrosis, or with advanced Fibrosis. In patients in which likelihood ratios are not optimal to provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. (HEPATOLOGY 2008.)
Heike Bantel - One of the best experts on this subject based on the ideXlab platform.
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biopsy controlled liver Fibrosis staging using the enhanced liver Fibrosis elf score compared to transient elastography
PLOS ONE, 2012Co-Authors: K Wahl, Bernhard Vaske, Matthias J Bahr, W Rosenberg, Klaus Schulzeosthoff, Michael P Manns, Heike BantelAbstract:Background and Aims: Chronic liver diseases are characterized by inflammatory and fibrotic liver injuries that often result in liver cirrhosis with its associated complications such as portal hypertension and hepatocellular carcinoma. Liver biopsy still represents the reference standard for Fibrosis staging, although transient elastography is increasingly used for non-invasive monitoring of Fibrosis progression. However, this method is not generally available and is associated with technical limitations emphasizing the need for serological biomarkers staging of liver Fibrosis. The enhanced liver Fibrosis (ELF) score was shown to accurately predict significant liver Fibrosis in different liver diseases, although extracellular matrix components detected by this score may not only mirror the extent of liver Fibrosis but also inflammatory processes. Methods: In this prospective biopsy-controlled study we evaluated the utility of the ELF score in comparison to transient elastography to predict different stages of Fibrosis in 102 patients with chronic liver diseases. Results: Both techniques revealed similar area under receiver operating characteristic curve values for prediction of advanced Fibrosis stages. Compared to transient elastography, the ELF score showed a broader overlap between low and moderate Fibrosis stages and a stronger correlation with inflammatory liver injury. Conclusions: Both the ELF score as well as transient elastography allowed for high quality Fibrosis staging. However, the ELF score was less discriminative in low and moderate Fibrosis stages and appeared more strongly influenced by inflammatory liver injury. This should be considered when making clinical interpretations on the basis of ELF score values.
Naim Alkhouri - One of the best experts on this subject based on the ideXlab platform.
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Accuracy of Noninvasive Fibrosis Scores in Predicting the Presence of Fibrosis in Patients after Liver Transplantation.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2017Co-Authors: Mohammad Nasser Kabbany, Praveen Kumar Conjeevaram Selvakumar, John Guirguis, John Rivas, Zade Akras, Rocio Lopez, Ibrahim A. Hanouneh, Bijan Eghtesad, Naim AlkhouriAbstract:OBJECTIVES Several scoring systems have been developed to noninvasively predict the presence of advanced Fibrosis in patients with chronic liver disease. Hepatitis C virus and nonalcoholic fatty liver disease are the 2 most common indications for orthotopic liver transplant and are associated with disease recurrence that can lead to Fibrosis progression. Here, we evaluated the performance of commonly used Fibrosis scores in assessing the presence of advanced Fibrosis in patients after orthotopic liver transplant. MATERIALS AND METHODS Our study consisted of consecutive patients with hepatitis C virus or nonalcoholic fatty liver disease who underwent a liver biopsy after transplant and had laboratory measurements within 1 week of biopsy. Graft Fibrosis was determined by an experienced pathologist (stage F0-F4). Advanced Fibrosis was defined as stage F3-F4. The following Fibrosis scores were calculated for each patient: aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase/platelet ratio index, and Fibrosis-4 index. RESULTS We analyzed 93 patients with median age of 59 years (25th and 75th percentile of 53 and 64 y) and median body mass index of 31.8 kg/m² (25th and 75th percentile of 27 and 37.6 kg/m²). Of total patients, 41 (44%) were diabetic. Median time to liver biopsy posttransplant was 27.7 months (25th and 75 percentile of 10.8 and 59.9 mo). We found that 54 patients (58%) had no Fibrosis, 15 (16.1%) had F1, 8 (8.6%) had F2, 7 (7.5%) had F3, and 9 (9.7%) had F4. Overall, advanced Fibrosis (F3-F4) was present in 16 patients. Aspartate aminotransferase/alanine amino-transferase ratio, aspartate aminotransferase/platelet ratio index, and Fibrosis-4 index were not significantly different between patients with and without advanced Fibrosis (all P > .05). The calculated Fibrosis scores had poor diagnostic accuracy for presence of advanced Fibrosis posttransplant. CONCLUSIONS Commonly used liver Fibrosis scores are not accurate in predicting the presence of advanced Fibrosis in patients after liver transplant.
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combined paediatric nafld Fibrosis index and transient elastography to predict clinically significant Fibrosis in children with fatty liver disease
Liver International, 2013Co-Authors: Naim Alkhouri, Rocio Lopez, Emad Sedki, Anna Alisi, Massimo Pinzani, Ariel E Feldstein, Valerio NobiliAbstract:Background Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to steatohepatitis, to Fibrosis and cirrhosis. The paediatric NAFLD Fibrosis index (PNFI) and transient elastography (TE) are potential noninvasive markers for Fibrosis. To prospectively evaluate the performance of PNFI and TE in assessing clinically significant Fibrosis in children with biopsy-proven NAFLD. Methods Our cohort consisted of 67 consecutive children with biopsy-proven NAFLD. The stage of Fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. Fibrosis ≥ 2 was considered clinically significant. PNFI was calculated using age, waist circumference and triglycerides. TE was performed using the Fibroscan apparatus. Results Ten patients had Fibrosis stage 2–3 and 57 patients had stage 0–1. Both PNFI and TE values were significantly higher in patients with significant Fibrosis (P < 0.05). The area under the receiver operating characteristic (ROC) curve for predicting significant Fibrosis of PNFI and TE were 0.747 and 1.00 respectively (P = 0.005). The combined use of PNFI and TE could predict the presence or absence of clinically significant Fibrosis in 98% of children with NAFLD. Conclusions In children with NAFLD, the combination of PNFI and TE can be used to accurately assess the presence of clinically significant liver Fibrosis. This will help to identify patients who should undergo liver biopsy because the confirmation of advanced Fibrosis would lead to closer follow-up and screening for cirrhosis-related complications.
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A combination of the pediatric NAFLD Fibrosis index and enhanced liver Fibrosis test identifies children with Fibrosis.
Clinical Gastroenterology and Hepatology, 2010Co-Authors: Naim Alkhouri, Rocio Lopez, Massimo Pinzani, Ariel E Feldstein, Christine Carter–kent, William Rosenberg, Giorgio Bedogni, Valerio NobiliAbstract:Background & Aims Nonalcoholic fatty liver disease (NAFLD) encompasses diseases from simple steatosis, to steatohepatitis, to Fibrosis, and cirrhosis. The pediatric NAFLD Fibrosis index (PNFI) and the enhanced liver Fibrosis (ELF) test are potential noninvasive markers for Fibrosis. We prospectively evaluated the performance of PNFI and ELF in assessing Fibrosis in children with biopsy-proven NAFLD. Methods We analyzed 111 consecutive children with NAFLD. The stage of Fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. PNFI was calculated based on age, waist circumference, and levels of triglycerides. The ELF test was used to determine levels of hyaluronic acid, the amino-terminal propeptide of type III collagen, and tissue inhibitor of metalloproteinase-1. Results Some degree of Fibrosis was detected in 68.5% of patients (62 had stage 1, 5 had stage 2, and 9 had stage 3). PNFI and ELF test values was higher among patients with Fibrosis ( P Conclusions In children with NAFLD, the combined results from the PNFI and ELF test can accurately assess the presence of liver Fibrosis and identify patients that should be evaluated by liver biopsy.
