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Typical contrast-enhanced ultrasonographic findings of malignant breast tumors (JABTS FLOW-CEUS01 study -part 4-)
Abstracts Summary: Many ophthalmic emergencies may present with vague initial symptoms or be associated to systemic conditions. In such cases, most of general doctors may require complementary exams, making the accurate radiologic diagnosis essential to early treatment. Radiologists must be alert to ocular anatomy in every head and neck study, notably when clinical complaint is related to vision, in CNS and sinuses pathologies and in the context of trauma, inflammatory or infectious diseases. That’s the way we can make the difference helping to preserve these patient’s visual function or, even, in their lives. Peyronie disease: How can I see the non calcified plaque? Osmar Saito University of Sao Paulo, Sao Paulo, Brazil Teaching points: 1. To describe the main clinical aspects of Peyronie disease; 2. To point out the main findings in X ray, ultrasound (US), Elastography and MRI; 3. Which complications can occur lately? Content: Peyronies disease is an uncommon disorder that develops a fibrous plaque in the sheaths covering the penis corpora cavernosa. During the erection the penis usually bend towards the inelastic fibrous plaque. Erectile dysfunction may be related to pain, veno-occlusive dysfunction, or bending of the penis. After a time the plaque can calcifies. Soft tissue radiography of the penis can detect calcified plaques. Penile sonography is the first choice for identification of small lesions, but soft plaques are very difficult to detect. US and MRI detects the number of plaques, their size, and the exact position of the lesions in the penis. Nowadays elastography imaging may be very usefull for detecting those non calcified plaques as the hard plaque can be seen as a hard area in the elastogram. MR imaging of Peyronie disease shows a focal thickening of the tunica albuginea and is best seen on T2weighted images. An inflammed Peyronie plaque enhances after an intravenous administration of gadolinium and can be detected by Doppler US.
Retinoblastoma nerve optic invasion: How color doppler can improve diagnosis better than MRI Osmar Saito, M Chammas, G Cerri University of Sao Paulo, Sao Paulo, Brazil Purpose/Aim: 1. We intend to review the retinoblastoma main findings by means of ultrasound and MRI; 2. to compare imaging findings (ultrasound and MRI) and anatomopathological findings after enucleation; 3. to evaluate which method can detect best the optical nerve invasion. Materials and Methods: 1. 18 monocular retinoblastoma tumors were evaluated by means of ultrasound with color Doppler and MRI at Clinicas Hospital of University of S~ao Paulo 2. The mean age were 24 month year old 3. All patients underwent ultrasound examination with 16 MHz probe Toshiba applio 500 GE MRI 1,5 tesla 4. All patiens underwent general anaesthesia before MRI and Ultrasound 5. Color Doppler evaluated the arterial systolic velocity and vein velocity inside optic nerve in the normal and tumor eye; 6. We also calculated IP and RI in the central retina artery and vein; 7. All tumors were evaluated by T1, T2 with gadolinium injection.
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Results: 1. All 18 patients had monocular retinoblastoma were enucleated and anatomopathogical study were made in order to detect optic nerve invasion; 2. 11 patients had optic nerve invasion (61%); 3. 4 patients had optic nerve invasion detected by MRI (retrobulbar enhancement and optic nerve thickening (36 %); 4. 9 had increased velocity vein (81%); 5. Central retina arterial velocity and central retina vein velocity were higher in tumor than in normal eyes (p < 0.001 on both); 6. the larger tumor volume, the higher was central retina vein velocity (p = 0.03). Conclusion: 1. Retinoblastoma eyes have faster flow; 2. Lower PI is related to nerve optic invasion. Clinical Relevance Statement: Retinoblastoma is a highly malignant ocular neoplasm that shows a tendency to optic nerve invasion which implies in a poorer prognosis for the patient. The diagnosis of nerve invasion at presentation is important for prognostic and management. Retinoblastoma invasion of the optic nerve may not be detected by MRI. Due to the scant space inside lamina cribrosa to harbor artery, vein and tumor cells, it seems logical to study blood flow in retinoblastoma, aiming to detect nerve invasion. As stated before the use of color Doppler can predict small nerve optic invasion even better than MRI.
Typical contrast-enhanced ultrasonographic findings of malignant breast tumors (JABTS FLOW-CEUS01 study -part 4-) Megumi Satoh,1,2,3 Takashi Nakamura,3 Toshiko Hirai,3 Yukio Mitsuzuka,3 Aya Noro,3 Yumi Imayoshi,3 Terumi Kaga,3 Midori Noma,3 Hiroaki Shima,3 Kumiko Kato,3 Mutumi Nishida2 1 Division of Medical Imaging and Technology Department of Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan, 2 Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan, 3 Flow Imaging Research Group, The Japan Association of Breast and Thyroid Sonology, Tokyo Background and Objectives: In a multi-center study (JABTS FLOWCEUS01, UMINID: 000026289), the Flow Imaging Research Group, the Japan Association of Breast and Thyroid Sonology (JABTS) evaluated the difference of contrast-enhanced patterns between benign and malignant breast tumors by contrast-enhanced ultrasonography (CEUS). The purpose of this study was to select and present typical CEUS images of malignant breast tumors from the results of a multicenter study. Methods: CEUS was performed by using the ultrasound contrast agent perflubutane (SonazoidÒ ); the ultrasound scanners were equipped with a high-frequency linear transducer. In this study, a total of 188 tumors (malignant: 148, benign: 40) were evaluated by three blind readers. This study was approved by the Ethics Committee and Institutional Review Board of Hokkaido University Hospital. Results: One hundred and fourteen tumors of the 148 malignant tumors (77.0%) were correctly diagnosed by three blind readers as malignant. Of these 114 tumors, we present typical cases in which there was high consensus on the findings. Case Presentation: Case 1 (Invasive carcinoma of no special type (NST)): B-mode ultrasonography (US) image showed microlobulated margin and hypoechoic pattern with parallel orientation. CEUS image showed irregular margin and strong enhancement, with clear internal defect. Case 2 (Invasive carcinoma of NST): B-mode US image showed irregular shape, hypoechoic pattern, and a thick rim. CEUS image
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showed irregular shape, irregular margin, and strong heterogeneous enhancement, with wider range than those of the B-mode US image. Case 3 (Invasive carcinoma of NST): B-mode US image showed hypoechoic mass with angular margin. CEUS image showed irregular shape, irregular margin, and strong homogeneous enhancement, with wider range than those of the B-mode US image. Case 4 (Invasive lobular carcinoma): B-mode US image showed irregular shape and hypoechoic pattern with a thick rim. CEUS image showed irregular shape, strong heterogeneous enhancement with wider range than those of the B-mode US image and plunging or penetrating vessels. Case 5 (Ductal carcinoma in situ): B-mode US image showed irregular shape and hypoechoic pattern with parallel orientation. CEUS showed irregular shape and strong heterogeneous enhancement with wider range than those of the B-mode US image. Conclusions: We clarified that the typical CEUS images of malignant breast tumors, were irregular enhancement, and a wider enhancement range than those of B-mode US. Another suggested finding associated with malignancy was plunging or penetrating vessels.
How many HCV cirrhotic patients go below cirrhotic cut-off values in transient elastography after direct acting agents treatment? Alin Lazar, Ioan Sporea, Raluca Lupusoru, Alina Popescu, Alexandra Deleanu, Isabel Dan, Roxana Sirli Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania Introduction: Liver stiffness (LS) measurements by Transient Elastography (TE) has been accepted as a tool for fibrosis assessment. The aim of the study was to evaluate what happens with liver stiffness values after DAA (Direct-acting antivirals) therapy, in patients with compensated HCV cirrhosis, who had sustained virologic response (SVR) and to highlight in how many LS values become lower than the accepted cut-off for cirrhosis. Material & Method: A number of 167 patients with compensated HCV cirrhosis who had LS > 12 kPa at baseline, underwent a 12 weeks DAA therapy (Viekirax/Exviera) and had SVR. 56 of them were followed up by TE 24 weeks after EOT (end of treatment) and also 48 weeks after EOT (SVR 48). A subgroup of 28 patients were followed up 96 weeks after EOT (SVR 96). LS values were assessed by means of TE (FibroScan, Echosens) at the start of treatment (ST), at SVR 12 (12 weeks from EOT), SVR 24, SVR 48 and SVR 96, respectively. In each session, 10 valid liver stiffness measurements (LSM) were obtained and reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M) 30%. Results: LS mean values at SVR12 were significantly lower as compared to ST (16.6 § 6.87 kPa vs 21.3 § 8.8, p = 0.002). As compared to SVR12, at SVR24 the mean LS values remained stable (16.6 § 6.87 vs 16.9 § 6.87 kPa, p = 0.81) and at SVR48 the values continued to decrease, but without statistical significance (14.6 § 5.3 vs 16.6 § 6.87 kPa, p = 0.08). LS was < 12 kPa in 14% of patients at SVR12, in 16% of patients at SVR24 and in 27% patients at SVR48. In the subgroup of 28 patients evaluated at SVR96, the mean LS values decreased significantly as compared to SVR12 (11.6 § 4.6 vs. 15.5 § 6.2 kPa, p = 0.009), and 46% had LS < 12 kPa. Conclusion: In compensated HCV cirrhotic patients, the mean LS values significantly decreased at SVR12, remained stable at SVR24 and decreased at SVR48; 14 % patients had LS values < 12 kPa at SVR12, 16% at SVR 24 and 27% at SVR 48. In the subgroup of patients followed up at SVR96, almost half had LS values lower than 12 kPa. Keywords: liver stiffness, direct-acting antivirals, compensated HCV cirrhosis.
Volume 45, Number S1, 2019 Pancreatic stiffness values using a point shear wave elastography technique in patients with healthy pancreas Alexandru Popa, Roxana Sirli, Ruxandra Mare, Alina Popescu, Mirela Danila, Ioan Sporea Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Timi¸soara, Romania, Timisoara, Timis, Rom^ ania Background: In the current literature, there is only a small number of studies that have evaluated the utility of point share wave elastography for pancreatic assessment. Objective: To assess the feasibility of Virtual Touch Quantification (VTQ) elastography for pancreas assessment, as well as the mean pancreatic stiffness values in healthy subjects. Material and Method: We included 70 subjects (52.8% women, 47.2% men, average BMI = 25.9 § 4.9 kg/m2, average age 46.8 § 18.4 years) with a normal pancreatic ultrasound aspect and with no history of pancreatic disease or diabetes, in whom elastography measurements were performed with a Siemens Acuson S2000 Virtual Touch ultrasound system (Siemens AG, Erlangen, Germany) using a 4CI transducer. For each patient, 10 valid VTQ measurements of the pancreatic parenchyma were performed under fasting conditions. Reliable measurements were defined as a median value of ten pancreas stiffness measurements with a success rate 60% and an interquartile range interval < 30%. Results: Out of 70 subjects, reliable measurements were acquired in 61 subjects (87.1%) by means of VTQ elastography. The mean pancreas stiffness values in healthy subjects was 1.26 m/s § 0.1 m/s, CI 95% (1.24-1.28). There were no significant differences between the mean pancreas stiffness in men vs. women 1.25 m/s § 0.09 m/s, CI 95% (1.21-1.28) vs. 1.28 m/s § 0.1 m/s CI 95% (1.25-1.31) (p = 0.103). Conclusion: VTQ can be a useful tool for pancreas quantification characterized by a good feasibility (87.1%) in healthy subjects. The mean pancreas stiffness values in healthy individuals was 1.26 m/s § 0.1m/s. Keywords: point share wave elastography, pancreas assessment, healthy subjects. The prevalence of liver fibrosis stages assessed by Transient Elastography: a single center study Alin Lazar, Ioan Sporea, Alexandra Deleanu, Isabel Dan, Roxana Sirli Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania Objective: The aim of the study was to highlight the prevalence of liver fibrosis stages assessed by means of transient elastography (TE) in large cohort of patients in a single study centre. Material & Method: 22400 liver stiffness (LS) assessments by mean of TE have been performed in our Department during an 11 years period (2007-2018). The study included patients with chronic liver diseases of various etiology. In each patient, 10 valid LS measurements were obtained either with M probe or with XL probe. If no valid LS measurements could be obtained, the evaluation was declared as failure. Reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M) 30%, and a Success Rate (SR) 60%. To discriminate between LS stages by TE we used the following cut-offs (1): F2 - 7 kPa; F3 - 9.5 kPa and F4 - 12 kPa. Results: The feasibility in our cohort was 90.1%, 2238 of 22400 measurements (9.9%) were failed or unreliable. Based on TE cut-off values, the severity of liver fibrosis in our group was as follows: F < 2: 9783 patients (48.5%); F2: 3132 patients (15.6%); F3: 1714 patients (8.5%) and F4: 5533 patients (27.4%). Conclusion: Transient elastography had a feasibility of 90.1% in this large cohort, almost half of the patients (48.5%) having at most mild fibrosis, and approximately one quarter having cirrhosis (27.4%).
Retinoblastoma nerve optic invasion: How color doppler can improve diagnosis better than MRI Osmar Saito, M Chammas, G Cerri University of Sao Paulo, Sao Paulo, Brazil Purpose/Aim: 1. We intend to review the retinoblastoma main findings by means of ultrasound and MRI; 2. to compare imaging findings (ultrasound and MRI) and anatomopathological findings after enucleation; 3. to evaluate which method can detect best the optical nerve invasion. Materials and Methods: 1. 18 monocular retinoblastoma tumors were evaluated by means of ultrasound with color Doppler and MRI at Clinicas Hospital of University of S~ao Paulo 2. The mean age were 24 month year old 3. All patients underwent ultrasound examination with 16 MHz probe Toshiba applio 500 GE MRI 1,5 tesla 4. All patiens underwent general anaesthesia before MRI and Ultrasound 5. Color Doppler evaluated the arterial systolic velocity and vein velocity inside optic nerve in the normal and tumor eye; 6. We also calculated IP and RI in the central retina artery and vein; 7. All tumors were evaluated by T1, T2 with gadolinium injection.
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Results: 1. All 18 patients had monocular retinoblastoma were enucleated and anatomopathogical study were made in order to detect optic nerve invasion; 2. 11 patients had optic nerve invasion (61%); 3. 4 patients had optic nerve invasion detected by MRI (retrobulbar enhancement and optic nerve thickening (36 %); 4. 9 had increased velocity vein (81%); 5. Central retina arterial velocity and central retina vein velocity were higher in tumor than in normal eyes (p < 0.001 on both); 6. the larger tumor volume, the higher was central retina vein velocity (p = 0.03). Conclusion: 1. Retinoblastoma eyes have faster flow; 2. Lower PI is related to nerve optic invasion. Clinical Relevance Statement: Retinoblastoma is a highly malignant ocular neoplasm that shows a tendency to optic nerve invasion which implies in a poorer prognosis for the patient. The diagnosis of nerve invasion at presentation is important for prognostic and management. Retinoblastoma invasion of the optic nerve may not be detected by MRI. Due to the scant space inside lamina cribrosa to harbor artery, vein and tumor cells, it seems logical to study blood flow in retinoblastoma, aiming to detect nerve invasion. As stated before the use of color Doppler can predict small nerve optic invasion even better than MRI.
Typical contrast-enhanced ultrasonographic findings of malignant breast tumors (JABTS FLOW-CEUS01 study -part 4-) Megumi Satoh,1,2,3 Takashi Nakamura,3 Toshiko Hirai,3 Yukio Mitsuzuka,3 Aya Noro,3 Yumi Imayoshi,3 Terumi Kaga,3 Midori Noma,3 Hiroaki Shima,3 Kumiko Kato,3 Mutumi Nishida2 1 Division of Medical Imaging and Technology Department of Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan, 2 Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan, 3 Flow Imaging Research Group, The Japan Association of Breast and Thyroid Sonology, Tokyo Background and Objectives: In a multi-center study (JABTS FLOWCEUS01, UMINID: 000026289), the Flow Imaging Research Group, the Japan Association of Breast and Thyroid Sonology (JABTS) evaluated the difference of contrast-enhanced patterns between benign and malignant breast tumors by contrast-enhanced ultrasonography (CEUS). The purpose of this study was to select and present typical CEUS images of malignant breast tumors from the results of a multicenter study. Methods: CEUS was performed by using the ultrasound contrast agent perflubutane (SonazoidÒ ); the ultrasound scanners were equipped with a high-frequency linear transducer. In this study, a total of 188 tumors (malignant: 148, benign: 40) were evaluated by three blind readers. This study was approved by the Ethics Committee and Institutional Review Board of Hokkaido University Hospital. Results: One hundred and fourteen tumors of the 148 malignant tumors (77.0%) were correctly diagnosed by three blind readers as malignant. Of these 114 tumors, we present typical cases in which there was high consensus on the findings. Case Presentation: Case 1 (Invasive carcinoma of no special type (NST)): B-mode ultrasonography (US) image showed microlobulated margin and hypoechoic pattern with parallel orientation. CEUS image showed irregular margin and strong enhancement, with clear internal defect. Case 2 (Invasive carcinoma of NST): B-mode US image showed irregular shape, hypoechoic pattern, and a thick rim. CEUS image
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showed irregular shape, irregular margin, and strong heterogeneous enhancement, with wider range than those of the B-mode US image. Case 3 (Invasive carcinoma of NST): B-mode US image showed hypoechoic mass with angular margin. CEUS image showed irregular shape, irregular margin, and strong homogeneous enhancement, with wider range than those of the B-mode US image. Case 4 (Invasive lobular carcinoma): B-mode US image showed irregular shape and hypoechoic pattern with a thick rim. CEUS image showed irregular shape, strong heterogeneous enhancement with wider range than those of the B-mode US image and plunging or penetrating vessels. Case 5 (Ductal carcinoma in situ): B-mode US image showed irregular shape and hypoechoic pattern with parallel orientation. CEUS showed irregular shape and strong heterogeneous enhancement with wider range than those of the B-mode US image. Conclusions: We clarified that the typical CEUS images of malignant breast tumors, were irregular enhancement, and a wider enhancement range than those of B-mode US. Another suggested finding associated with malignancy was plunging or penetrating vessels.
How many HCV cirrhotic patients go below cirrhotic cut-off values in transient elastography after direct acting agents treatment? Alin Lazar, Ioan Sporea, Raluca Lupusoru, Alina Popescu, Alexandra Deleanu, Isabel Dan, Roxana Sirli Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania Introduction: Liver stiffness (LS) measurements by Transient Elastography (TE) has been accepted as a tool for fibrosis assessment. The aim of the study was to evaluate what happens with liver stiffness values after DAA (Direct-acting antivirals) therapy, in patients with compensated HCV cirrhosis, who had sustained virologic response (SVR) and to highlight in how many LS values become lower than the accepted cut-off for cirrhosis. Material & Method: A number of 167 patients with compensated HCV cirrhosis who had LS > 12 kPa at baseline, underwent a 12 weeks DAA therapy (Viekirax/Exviera) and had SVR. 56 of them were followed up by TE 24 weeks after EOT (end of treatment) and also 48 weeks after EOT (SVR 48). A subgroup of 28 patients were followed up 96 weeks after EOT (SVR 96). LS values were assessed by means of TE (FibroScan, Echosens) at the start of treatment (ST), at SVR 12 (12 weeks from EOT), SVR 24, SVR 48 and SVR 96, respectively. In each session, 10 valid liver stiffness measurements (LSM) were obtained and reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M) 30%. Results: LS mean values at SVR12 were significantly lower as compared to ST (16.6 § 6.87 kPa vs 21.3 § 8.8, p = 0.002). As compared to SVR12, at SVR24 the mean LS values remained stable (16.6 § 6.87 vs 16.9 § 6.87 kPa, p = 0.81) and at SVR48 the values continued to decrease, but without statistical significance (14.6 § 5.3 vs 16.6 § 6.87 kPa, p = 0.08). LS was < 12 kPa in 14% of patients at SVR12, in 16% of patients at SVR24 and in 27% patients at SVR48. In the subgroup of 28 patients evaluated at SVR96, the mean LS values decreased significantly as compared to SVR12 (11.6 § 4.6 vs. 15.5 § 6.2 kPa, p = 0.009), and 46% had LS < 12 kPa. Conclusion: In compensated HCV cirrhotic patients, the mean LS values significantly decreased at SVR12, remained stable at SVR24 and decreased at SVR48; 14 % patients had LS values < 12 kPa at SVR12, 16% at SVR 24 and 27% at SVR 48. In the subgroup of patients followed up at SVR96, almost half had LS values lower than 12 kPa. Keywords: liver stiffness, direct-acting antivirals, compensated HCV cirrhosis.
Volume 45, Number S1, 2019 Pancreatic stiffness values using a point shear wave elastography technique in patients with healthy pancreas Alexandru Popa, Roxana Sirli, Ruxandra Mare, Alina Popescu, Mirela Danila, Ioan Sporea Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Timi¸soara, Romania, Timisoara, Timis, Rom^ ania Background: In the current literature, there is only a small number of studies that have evaluated the utility of point share wave elastography for pancreatic assessment. Objective: To assess the feasibility of Virtual Touch Quantification (VTQ) elastography for pancreas assessment, as well as the mean pancreatic stiffness values in healthy subjects. Material and Method: We included 70 subjects (52.8% women, 47.2% men, average BMI = 25.9 § 4.9 kg/m2, average age 46.8 § 18.4 years) with a normal pancreatic ultrasound aspect and with no history of pancreatic disease or diabetes, in whom elastography measurements were performed with a Siemens Acuson S2000 Virtual Touch ultrasound system (Siemens AG, Erlangen, Germany) using a 4CI transducer. For each patient, 10 valid VTQ measurements of the pancreatic parenchyma were performed under fasting conditions. Reliable measurements were defined as a median value of ten pancreas stiffness measurements with a success rate 60% and an interquartile range interval < 30%. Results: Out of 70 subjects, reliable measurements were acquired in 61 subjects (87.1%) by means of VTQ elastography. The mean pancreas stiffness values in healthy subjects was 1.26 m/s § 0.1 m/s, CI 95% (1.24-1.28). There were no significant differences between the mean pancreas stiffness in men vs. women 1.25 m/s § 0.09 m/s, CI 95% (1.21-1.28) vs. 1.28 m/s § 0.1 m/s CI 95% (1.25-1.31) (p = 0.103). Conclusion: VTQ can be a useful tool for pancreas quantification characterized by a good feasibility (87.1%) in healthy subjects. The mean pancreas stiffness values in healthy individuals was 1.26 m/s § 0.1m/s. Keywords: point share wave elastography, pancreas assessment, healthy subjects. The prevalence of liver fibrosis stages assessed by Transient Elastography: a single center study Alin Lazar, Ioan Sporea, Alexandra Deleanu, Isabel Dan, Roxana Sirli Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania Objective: The aim of the study was to highlight the prevalence of liver fibrosis stages assessed by means of transient elastography (TE) in large cohort of patients in a single study centre. Material & Method: 22400 liver stiffness (LS) assessments by mean of TE have been performed in our Department during an 11 years period (2007-2018). The study included patients with chronic liver diseases of various etiology. In each patient, 10 valid LS measurements were obtained either with M probe or with XL probe. If no valid LS measurements could be obtained, the evaluation was declared as failure. Reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M) 30%, and a Success Rate (SR) 60%. To discriminate between LS stages by TE we used the following cut-offs (1): F2 - 7 kPa; F3 - 9.5 kPa and F4 - 12 kPa. Results: The feasibility in our cohort was 90.1%, 2238 of 22400 measurements (9.9%) were failed or unreliable. Based on TE cut-off values, the severity of liver fibrosis in our group was as follows: F < 2: 9783 patients (48.5%); F2: 3132 patients (15.6%); F3: 1714 patients (8.5%) and F4: 5533 patients (27.4%). Conclusion: Transient elastography had a feasibility of 90.1% in this large cohort, almost half of the patients (48.5%) having at most mild fibrosis, and approximately one quarter having cirrhosis (27.4%).