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Tu1020 Cutoff Values of Liver Elasticity Measured by ARFI (Acoustic Radiation Force Impulse) Elastometry for Fibrosis Staging in Patients With Chronic Liver Disease (CLD)
Tu1018
130 patients who underwent liver biopsy (inclusion criteria: at least 6 portal tracts and specimen length 10mm) and an additional 15 patients with sonographically confirmed liver cirrhosis were included. We performed an average of 7 measurements with ARFI (inclusion criteria: standard deviation less than 30% of the individual mean ARFI value) in the right liver employing an intercostal approach, and compared the results with the Ludwig fibrosis score (F0-F4) of the histopathological results to define cutoff values. Results: A total of 116 patients (age: 51.0±14.8 y; BMI: 25.6 ±4.6 kg/m2; mean ARFI: 1.81±0.82 m/s; APRI: 1.68±4.80; portal tracts: 10.9±4.2; length of specimen: 29.1±9.4mm; Ludwig grade of fibrosis: F0=9, F1=29, F2=32, F3=13, F4=33) with CLD were included. 29 patients with a high standard deviation had to be excluded. A significant correlation was found between ARFI values and histopathological hepatic fibrosis with spearman's rho (r=0.697; p<0.001). Furthermore, the APRI score (ALT/platelet ratio) showed a significant correlation with mean ARFI values (r=0.473; p<0.001). With the aid of the Youden index the ARFI cutoff values for the severe stages of liver fibrosis (F≥2, F≥3, F≥4) were optimized (Table). Conclusion: ARFI is an accurate and non-invasive method for the assessment of hepatic fibrosis in patients with CLD. ARFI excludes severe liver fibrosis stages with good predictive values. Table: ARFI cutoff values for the severe liver fibrosis stages
AASLD Abstracts
Chronic Hepatitis B (CHB) Management Based on Standard Guidelines: Primary Care Physicians (Pcp) and Specialist Care Examined Kevin C. Ku, Nghi B. Ha, Vincent G. Nguyen, Jiayi Li, Mindie H. Nguyen Purpose: Prior studies have underlined the need for increased hepatitis B screening and awareness, especially in certain high-risk populations, but few examine the prevalence of adequate evaluation and management of CHB between PCP and specialists according to standard guidelines. Our goal was to examine adherence to current guidelines on the management of CHB between primary care physicians (PCP) and specialists. Methods: We retrospectively studied 253 CHB patients who were evaluated by PCP only (n=63) or by specialist (n=190) for CHB at a community multispecialty medical center between March 2007 and June 2009. Criteria for CHB management and treatment eligibility were based on AASLD 2009 guideline and US Panel 2008 algorithm. Adequate evaluation for CHB was defined as having done testing for hepatitis B e antigen (HBeAg), HBV DNA PCR and alanine aminotransferase (ALT) six months from initial presentation. First-line antiviral agents for CHB include pegylated interferon, entecavir and tenofovir. Due to high rates of antiviral resistance, lamivudine is not a recommended first-line therapy for CHB. Results: The majority of patients were Asians (90%) and male (54%) with a mean age of 43±11.6 years. As shown in Figure 1, more patients underwent more thorough laboratory testing for CB evaluation by specialists than those seen by their PCP only. Adequate laboratory evaluation (≥3 tests) was significantly higher among specialists (62% vs. 33%, p<0.0001) (Figure 1). Compared to PCPs, specialist were more likely to order laboratory testing for ALT (94% vs. 86%, p= 0.05), HBeAg (67% vs. 41%, p<0.0001) and HBV DNA (83% vs. 52%, p<0.0001). Of those who were started on treatment by specialists (n=56, 30%) and PCPs (n=8, 13%), lamivudine was prescribed much more often by PCPs compared to specialists (33% vs. 2%, p=0.05). Conclusion: Patients evaluated by specialists for CHB are more likely to undergo more complete laboratory evaluation and if eligible, they were also more likely to be treated with newer first-line agents for CHB than those evaluated by PCP only. Long-term clinical significance of this lack of adequate evaluation in patients not evaluated by specialists should be further studied.
Tu1021 Follow-up Assessment of Liver Stiffness by ARFI (Acoustic Radiation Force Impulse) Elastometry in Patients With Chronic Viral Hepatitis B or C Infection Joerg Sturm, Deike Strobel, Steffen Zopf, Markus F. Neurath, Ruediger S. Goertz Background: ARFI elastometry values of the liver correlate well with fibrosis stages. Longterm suppression of chronic viral hepatitis has been shown to significantly improve liver fibrosis. ARFI should therefore be investigated for its potential to monitor therapy outcome. Aims: To evaluate the association between liver stiffness measured by ARFI elastometry and the long-term efficacy of antiviral treatment in patients with chronic viral hepatitis. Methods: 37 patients (26 males and 11 females; age: 46±11years) with chronic viral hepatitis B (n= 15) or hepatitis C (n=22) underwent liver biopsy (Ludwig fibrosis score: F0=1; F1=16; F2= 13; F3=2; F4=5) and ARFI elastometry of the right hepatic lobe via an intercostal approach. Follow-up assessment of ARFI values in relation to therapy outcome was performed approximately 2 years after baseline evaluation. 24 patients (group A) with a good outcome (hepatitis C: no detection of HCV-RNA [sustained virological response]; hepatitis B: sufficient suppression of HBV-DNA or reduction to below 4.0 log copies/ml 6 months after beginning antiviral treatment), and 13 patients (group B) receiving no treatment, showing non-response to treatment or a relapse, were compared in terms of mean shear wave velocities. Results: The 37 patients had a baseline mean ARFI value of 1.50±0.55 m/s as compared with 1.52±0.65 m/s after an average post-treatment period of 2.3±0.3 years. The Pearson Correlation Coefficient revealed a significant correlation between baseline ARFI values and histopathological liver fibrosis (r=0.687; p<0.001). We also found a significant decline in ARFI values in group A (1.47±0.47 m/s vs. 1.31±0.45 m/s; p=0.018). In group B liver stiffness values increased, but fell just short of a statistically significant difference (1.57±0.70 vs. 1.93±0.77 m/s; p=0.086). Conclusion: ARFI elastometry is a useful tool for the evaluation of liver stiffness and follow-up assessment of treatment outcome in patients with chronic viral hepatitis B or C.
Tu1019 A “Real World” Controlled Study of Liver Stiffness Measured by ARFI (Acoustic Radiation Force Impulse) Elastography in Hospitalised Patients With Decompensated Alcoholic Liver Disease (ALD): A New Paradigm in Assessment of Severity and Prognosis ? David I. Sherman, Kesavan Kandiah, Minal Jagtiani Sangwaiya, Amar Sharif, Philip J. Shorvon Background: Acoustic Radiation Force Impulse (ARFI, Virtual Touch©) elastography is a novel validated technique for measuring liver stiffness (LS), with advantages over transient elastography including greater accuracy in ascitic or obese patients. However, elastography has not been well studied in acutely ill patients with decompensated chronic liver disease (CLD). Following an initial observation that higher LS was seen in the sickest inpatients, we report our experience in a consecutive controlled cohort in a secondary care setting. Aims: 1) To establish whether LS is significantly different in patients hospitalised for decompensated CLD from outpatient controls with proven cirrhosis; 2) To investigate correlation between ARFI and severity scores such as DF, GAH, Lille, Child Pugh and MELD. Methods: ARFI was performed by a single radiologist, using a standard 10 observation technique. A total of 108 patients were studied: 1) 60 hospitalised patients (13 AAH-acute alcoholic hepatitis with Bili > 80; 19 DALD-decompensated ALD; 12 DCLD-decompensated CLD; 10 ALC-alcoholics without severe liver disease; 6 acute hepatitis), representing 39% of 152 consecutive cases seen by the liver service; and 2) 48 age and sex matched CLD controls (all never hospitalised, 33 with biopsy-proven advanced fibrosis/cirrhosis; 15 with clear clinical/radiological/endoscopic evidence of advanced CLD). Means + SD of groups were compared by ANOVA, and correlations by Pearson's coefficient. Results: Validation: technical ARFI failure was less than 5%, IQR/median less than 0.5 in 93%, SDs did not differ between groups 1 and 2. Compared with CLD controls, significantly higher mean shear velocity (SV) was seen in both a) all 32 decompensated ALD patients (AAH+ALD - 2.9+/-0.8 vs 2.4+/0.8 m/sec, 99% CI 0.2 - 1.0, p=0.001) and b) all 44 decompensated CLD patients (AAH+DALD+DCLD - 2.8+/-0.8 vs 2.4+/-0.8 m/sec, 99% CI 0.0 - 0.8, p=0.006). In hospitalised patients with ALD (AAH+DALD+ALC) significant correlations were seen between mean SV and both DF (r=0.55, p<0.001) and GAH (r=0.38, p=0.01), but not with Lille score. Strong correlations were shown in all inpatients between SV and Child-Pugh score (r=0.52, p<0.001), and also with MELD score (r=0.42, p=0.002), but not in controls. Conclusion: In this “real world” study, ARFI elastography is an accurate and highly reproducible tool in assessing severity and prognosis in acutely ill patients with decompensated CLD, as shown by a) increased LS in hospitalised ALD / CLD patients compared with cirrhotic controls, and importantly b) further increases in LS reflect severity and adverse prognosis as shown by standard scores. As higher LS scores appear to reflect disease processes beyond fibrosis, the usefulness of this “real” measurement as an alternative to current “surrogate” prognostic markers merits further analysis in larger studies.
Tu1022 Is the Correlation of Liver Stiffness Assessed by Acoustic Radiation Force Impulse Elastography (ARFI) Influenced by the Aminotransferases Level? - an International Multicenter Study Simona Bota, Ioan Sporea, Roxana Sirli, Hironori Tanaka, Hiroko Iijima, Radu Badea, Monica Lupsor, Carmen Fierbinteanu Braticevici, Ana Petrisor, Hidetsugu Saito, Hirotoshi Ebinuma, Mireen Friedrich-Rust, Christoph Sarrazin, Hirokazu Takahashi, Naofumi Ono, Fabio Piscaglia, Alberto Borghi, Mirko D'Onofrio, Anna Gallotti, Markus PeckRadosavljevic, Arnulf Ferlitsch, Alina Popescu, Mirela Danila Introduction: ARFI elastography is a new method for the evaluation of liver fibrosis. Transient elastography is influenced by elevated aminotransferase-levels. Aim: to establish if, the correlation between the liver stiffness (LS) values measured by ARFI and the severity of histological fibrosis (liver biopsy-LB) is influenced by the eleveted aminotransferases. Methods: Our retrospective study included 1125 patients(p) from 10 centers (5 countries) from Europe and Asia with chronic hepatitis: 779 with HCV and 172 HBV chronic hepatitis, 12 with HBV+HCV coinfection and 162 with chronic hepatopathies of nonviral etiology. We performed LB (evaluated according to the Metavir score) and ARFI measurements. We performed 10 valid ARFI measurements in each patient and a median value was calculated, expressed in meters/second (m/s). Results: There was a direct, strong correlation (r=0.597) between the LS values assessed by means of ARFI and fibrosis (p<0.0001). The mean LS values assessed by ARFI for the same stage of histological fibrosis increased with the alanine aminotransferases (ALT) level (table 1). In this large cohort of patients with chronic hepatopathies, the best ARFI cut-off value to predict liver cirrhosis (F4) was 1.57 m/s (AUROC= 0.845). The percentage of non-cirrhotic patients in whom LS values as assessed by ARFI were >1.57m/s was significant higher in patients with ALT levels >5xULN as compared with those with ALT≤5xULN: 21/49p (42.8%) vs. 179/834p (21.4%)(p=0.0009). Conclusions: The data from this international multicenter study suggest that in patients with high values of aminotransferases (>5 x ULN), LS values as assessed by ARFI are significantly higher for the same stage of fibrosis than in patients with normal ALT. Currently in patients with aminotransferases >5 x ULN we should not rely on ARFI evaluation until we are able to calculate a correction factor for ARFI measurements.
Tu1020 Cutoff Values of Liver Elasticity Measured by ARFI (Acoustic Radiation Force Impulse) Elastometry for Fibrosis Staging in Patients With Chronic Liver Disease (CLD) Joerg Sturm, Ruediger S. Goertz, Lukas Pfeifer, David Wachter, Markus F. Neurath, Deike Strobel Background: ARFI is a new and non-invasive technique for the quantification of tissue stiffness. However, ARFI evaluation of the liver has yet to demonstrate its clinical benefit in comparison to liver biopsy, which is generally accepted as the gold standard for the assessment of hepatic fibrosis. Aims: To calculate cutoff values for fibrosis staging in patients with CLD by comparing ARFI elasticity values and histopathological findings. Methods:
AASLD Abstracts
S-1012
130 patients who underwent liver biopsy (inclusion criteria: at least 6 portal tracts and specimen length 10mm) and an additional 15 patients with sonographically confirmed liver cirrhosis were included. We performed an average of 7 measurements with ARFI (inclusion criteria: standard deviation less than 30% of the individual mean ARFI value) in the right liver employing an intercostal approach, and compared the results with the Ludwig fibrosis score (F0-F4) of the histopathological results to define cutoff values. Results: A total of 116 patients (age: 51.0±14.8 y; BMI: 25.6 ±4.6 kg/m2; mean ARFI: 1.81±0.82 m/s; APRI: 1.68±4.80; portal tracts: 10.9±4.2; length of specimen: 29.1±9.4mm; Ludwig grade of fibrosis: F0=9, F1=29, F2=32, F3=13, F4=33) with CLD were included. 29 patients with a high standard deviation had to be excluded. A significant correlation was found between ARFI values and histopathological hepatic fibrosis with spearman's rho (r=0.697; p<0.001). Furthermore, the APRI score (ALT/platelet ratio) showed a significant correlation with mean ARFI values (r=0.473; p<0.001). With the aid of the Youden index the ARFI cutoff values for the severe stages of liver fibrosis (F≥2, F≥3, F≥4) were optimized (Table). Conclusion: ARFI is an accurate and non-invasive method for the assessment of hepatic fibrosis in patients with CLD. ARFI excludes severe liver fibrosis stages with good predictive values. Table: ARFI cutoff values for the severe liver fibrosis stages
AASLD Abstracts
Chronic Hepatitis B (CHB) Management Based on Standard Guidelines: Primary Care Physicians (Pcp) and Specialist Care Examined Kevin C. Ku, Nghi B. Ha, Vincent G. Nguyen, Jiayi Li, Mindie H. Nguyen Purpose: Prior studies have underlined the need for increased hepatitis B screening and awareness, especially in certain high-risk populations, but few examine the prevalence of adequate evaluation and management of CHB between PCP and specialists according to standard guidelines. Our goal was to examine adherence to current guidelines on the management of CHB between primary care physicians (PCP) and specialists. Methods: We retrospectively studied 253 CHB patients who were evaluated by PCP only (n=63) or by specialist (n=190) for CHB at a community multispecialty medical center between March 2007 and June 2009. Criteria for CHB management and treatment eligibility were based on AASLD 2009 guideline and US Panel 2008 algorithm. Adequate evaluation for CHB was defined as having done testing for hepatitis B e antigen (HBeAg), HBV DNA PCR and alanine aminotransferase (ALT) six months from initial presentation. First-line antiviral agents for CHB include pegylated interferon, entecavir and tenofovir. Due to high rates of antiviral resistance, lamivudine is not a recommended first-line therapy for CHB. Results: The majority of patients were Asians (90%) and male (54%) with a mean age of 43±11.6 years. As shown in Figure 1, more patients underwent more thorough laboratory testing for CB evaluation by specialists than those seen by their PCP only. Adequate laboratory evaluation (≥3 tests) was significantly higher among specialists (62% vs. 33%, p<0.0001) (Figure 1). Compared to PCPs, specialist were more likely to order laboratory testing for ALT (94% vs. 86%, p= 0.05), HBeAg (67% vs. 41%, p<0.0001) and HBV DNA (83% vs. 52%, p<0.0001). Of those who were started on treatment by specialists (n=56, 30%) and PCPs (n=8, 13%), lamivudine was prescribed much more often by PCPs compared to specialists (33% vs. 2%, p=0.05). Conclusion: Patients evaluated by specialists for CHB are more likely to undergo more complete laboratory evaluation and if eligible, they were also more likely to be treated with newer first-line agents for CHB than those evaluated by PCP only. Long-term clinical significance of this lack of adequate evaluation in patients not evaluated by specialists should be further studied.
Tu1021 Follow-up Assessment of Liver Stiffness by ARFI (Acoustic Radiation Force Impulse) Elastometry in Patients With Chronic Viral Hepatitis B or C Infection Joerg Sturm, Deike Strobel, Steffen Zopf, Markus F. Neurath, Ruediger S. Goertz Background: ARFI elastometry values of the liver correlate well with fibrosis stages. Longterm suppression of chronic viral hepatitis has been shown to significantly improve liver fibrosis. ARFI should therefore be investigated for its potential to monitor therapy outcome. Aims: To evaluate the association between liver stiffness measured by ARFI elastometry and the long-term efficacy of antiviral treatment in patients with chronic viral hepatitis. Methods: 37 patients (26 males and 11 females; age: 46±11years) with chronic viral hepatitis B (n= 15) or hepatitis C (n=22) underwent liver biopsy (Ludwig fibrosis score: F0=1; F1=16; F2= 13; F3=2; F4=5) and ARFI elastometry of the right hepatic lobe via an intercostal approach. Follow-up assessment of ARFI values in relation to therapy outcome was performed approximately 2 years after baseline evaluation. 24 patients (group A) with a good outcome (hepatitis C: no detection of HCV-RNA [sustained virological response]; hepatitis B: sufficient suppression of HBV-DNA or reduction to below 4.0 log copies/ml 6 months after beginning antiviral treatment), and 13 patients (group B) receiving no treatment, showing non-response to treatment or a relapse, were compared in terms of mean shear wave velocities. Results: The 37 patients had a baseline mean ARFI value of 1.50±0.55 m/s as compared with 1.52±0.65 m/s after an average post-treatment period of 2.3±0.3 years. The Pearson Correlation Coefficient revealed a significant correlation between baseline ARFI values and histopathological liver fibrosis (r=0.687; p<0.001). We also found a significant decline in ARFI values in group A (1.47±0.47 m/s vs. 1.31±0.45 m/s; p=0.018). In group B liver stiffness values increased, but fell just short of a statistically significant difference (1.57±0.70 vs. 1.93±0.77 m/s; p=0.086). Conclusion: ARFI elastometry is a useful tool for the evaluation of liver stiffness and follow-up assessment of treatment outcome in patients with chronic viral hepatitis B or C.
Tu1019 A “Real World” Controlled Study of Liver Stiffness Measured by ARFI (Acoustic Radiation Force Impulse) Elastography in Hospitalised Patients With Decompensated Alcoholic Liver Disease (ALD): A New Paradigm in Assessment of Severity and Prognosis ? David I. Sherman, Kesavan Kandiah, Minal Jagtiani Sangwaiya, Amar Sharif, Philip J. Shorvon Background: Acoustic Radiation Force Impulse (ARFI, Virtual Touch©) elastography is a novel validated technique for measuring liver stiffness (LS), with advantages over transient elastography including greater accuracy in ascitic or obese patients. However, elastography has not been well studied in acutely ill patients with decompensated chronic liver disease (CLD). Following an initial observation that higher LS was seen in the sickest inpatients, we report our experience in a consecutive controlled cohort in a secondary care setting. Aims: 1) To establish whether LS is significantly different in patients hospitalised for decompensated CLD from outpatient controls with proven cirrhosis; 2) To investigate correlation between ARFI and severity scores such as DF, GAH, Lille, Child Pugh and MELD. Methods: ARFI was performed by a single radiologist, using a standard 10 observation technique. A total of 108 patients were studied: 1) 60 hospitalised patients (13 AAH-acute alcoholic hepatitis with Bili > 80; 19 DALD-decompensated ALD; 12 DCLD-decompensated CLD; 10 ALC-alcoholics without severe liver disease; 6 acute hepatitis), representing 39% of 152 consecutive cases seen by the liver service; and 2) 48 age and sex matched CLD controls (all never hospitalised, 33 with biopsy-proven advanced fibrosis/cirrhosis; 15 with clear clinical/radiological/endoscopic evidence of advanced CLD). Means + SD of groups were compared by ANOVA, and correlations by Pearson's coefficient. Results: Validation: technical ARFI failure was less than 5%, IQR/median less than 0.5 in 93%, SDs did not differ between groups 1 and 2. Compared with CLD controls, significantly higher mean shear velocity (SV) was seen in both a) all 32 decompensated ALD patients (AAH+ALD - 2.9+/-0.8 vs 2.4+/0.8 m/sec, 99% CI 0.2 - 1.0, p=0.001) and b) all 44 decompensated CLD patients (AAH+DALD+DCLD - 2.8+/-0.8 vs 2.4+/-0.8 m/sec, 99% CI 0.0 - 0.8, p=0.006). In hospitalised patients with ALD (AAH+DALD+ALC) significant correlations were seen between mean SV and both DF (r=0.55, p<0.001) and GAH (r=0.38, p=0.01), but not with Lille score. Strong correlations were shown in all inpatients between SV and Child-Pugh score (r=0.52, p<0.001), and also with MELD score (r=0.42, p=0.002), but not in controls. Conclusion: In this “real world” study, ARFI elastography is an accurate and highly reproducible tool in assessing severity and prognosis in acutely ill patients with decompensated CLD, as shown by a) increased LS in hospitalised ALD / CLD patients compared with cirrhotic controls, and importantly b) further increases in LS reflect severity and adverse prognosis as shown by standard scores. As higher LS scores appear to reflect disease processes beyond fibrosis, the usefulness of this “real” measurement as an alternative to current “surrogate” prognostic markers merits further analysis in larger studies.
Tu1022 Is the Correlation of Liver Stiffness Assessed by Acoustic Radiation Force Impulse Elastography (ARFI) Influenced by the Aminotransferases Level? - an International Multicenter Study Simona Bota, Ioan Sporea, Roxana Sirli, Hironori Tanaka, Hiroko Iijima, Radu Badea, Monica Lupsor, Carmen Fierbinteanu Braticevici, Ana Petrisor, Hidetsugu Saito, Hirotoshi Ebinuma, Mireen Friedrich-Rust, Christoph Sarrazin, Hirokazu Takahashi, Naofumi Ono, Fabio Piscaglia, Alberto Borghi, Mirko D'Onofrio, Anna Gallotti, Markus PeckRadosavljevic, Arnulf Ferlitsch, Alina Popescu, Mirela Danila Introduction: ARFI elastography is a new method for the evaluation of liver fibrosis. Transient elastography is influenced by elevated aminotransferase-levels. Aim: to establish if, the correlation between the liver stiffness (LS) values measured by ARFI and the severity of histological fibrosis (liver biopsy-LB) is influenced by the eleveted aminotransferases. Methods: Our retrospective study included 1125 patients(p) from 10 centers (5 countries) from Europe and Asia with chronic hepatitis: 779 with HCV and 172 HBV chronic hepatitis, 12 with HBV+HCV coinfection and 162 with chronic hepatopathies of nonviral etiology. We performed LB (evaluated according to the Metavir score) and ARFI measurements. We performed 10 valid ARFI measurements in each patient and a median value was calculated, expressed in meters/second (m/s). Results: There was a direct, strong correlation (r=0.597) between the LS values assessed by means of ARFI and fibrosis (p<0.0001). The mean LS values assessed by ARFI for the same stage of histological fibrosis increased with the alanine aminotransferases (ALT) level (table 1). In this large cohort of patients with chronic hepatopathies, the best ARFI cut-off value to predict liver cirrhosis (F4) was 1.57 m/s (AUROC= 0.845). The percentage of non-cirrhotic patients in whom LS values as assessed by ARFI were >1.57m/s was significant higher in patients with ALT levels >5xULN as compared with those with ALT≤5xULN: 21/49p (42.8%) vs. 179/834p (21.4%)(p=0.0009). Conclusions: The data from this international multicenter study suggest that in patients with high values of aminotransferases (>5 x ULN), LS values as assessed by ARFI are significantly higher for the same stage of fibrosis than in patients with normal ALT. Currently in patients with aminotransferases >5 x ULN we should not rely on ARFI evaluation until we are able to calculate a correction factor for ARFI measurements.
Tu1020 Cutoff Values of Liver Elasticity Measured by ARFI (Acoustic Radiation Force Impulse) Elastometry for Fibrosis Staging in Patients With Chronic Liver Disease (CLD) Joerg Sturm, Ruediger S. Goertz, Lukas Pfeifer, David Wachter, Markus F. Neurath, Deike Strobel Background: ARFI is a new and non-invasive technique for the quantification of tissue stiffness. However, ARFI evaluation of the liver has yet to demonstrate its clinical benefit in comparison to liver biopsy, which is generally accepted as the gold standard for the assessment of hepatic fibrosis. Aims: To calculate cutoff values for fibrosis staging in patients with CLD by comparing ARFI elasticity values and histopathological findings. Methods:
AASLD Abstracts
S-1012