In multivariate analysis including fibrosis, HAH, and steatosis, fibrosis was the only histological parameter significantly correlated with LSM  FibroScan and ultrasonography in the prediction of hepatic fibrosis in patients with chronic viral hepatitis Pearson correlation no attention paid to Bonferroni or alpha correction  12 factors.
Terrebonne Dating Site patients with chronic liver disease, the assessment of the patient should include age, liver-related comorbidity, aetiology and duration of the liver disease, grading inflammationfatty infiltration, risk of malignant transformation, fibrosis, general comorbidity and many other factors.
Such factors are important as they guide management and indicate prognosis. Therefore, the assessment of liver fibrosis is only one of many other important factors to determine before treatment.
However, the focus on the assessment of liver fibrosis seems to be overstated and many studies lack the design of multivariate analysis. Factors influencing liver elasticity in healthy subjects depend mainly on blood volume and perfusion parameters that are reported by surgeons during daily routine.
Studies have reported a positive correlation of LS with central venous pressure[ 30 ], therefore knowledge of co-existing cardiac and pulmonary disease is necessary for interpretation of results. In addition, it is also reported that food intake could significantly increase the LS in adults[ 3132 ], children[ 33 ] and the patients with chronic or resolved hepatitis C virus HCV infection[ 34 ], therefore, elastography should be performed in fasting conditions.
However, there is controversy on the influence of respiration on LS. Yun et al[ 35 ] reported that LS was significantly elevated during expiration especially in patients without liver cirrhosis while Goertz et al[ 32 ] did not find differences on the LS in deep Terrebonne Dating Site, deep expiration and during Valsalva maneuver.
In liver cirrhosis, the degree and architecture of fibrosis is presumed to be the most important factor influencing LS elasticity. The factors influencing liver elasticity in intermediate significant fibrosis are still not known in detail.
The factors influencing liver elasticity in patients with inflammatory disease at least to some degreeindependent of fibrosis, are acute hepatitis, any flare of transaminase values, acute-on chronic hepatitis[ 3637 ], cholestasis[ 38 ] and acute liver failure[ 39 ]. Other factors influencing liver elasticity Terrebonne Dating Site patients with fatty liver hepatic steatosis with or without inflammatory activity, with or Terrebonne Dating Site fibrosis, have also been described[ 41 - 47 ].
The multivariate intercorrelation of factors influencing liver elasticity under different circumstances is not known. Since multiple factors have shown to influence LS measurements, interpretation of results has to be performed taking into account all these risk factors. However, substantial limitations are obvious.
Firstly, it is an invasive method with a significant complication rate[ 50 ]. A review of the literature regarding possible complications has recently been published[ 51 ].
Secondly, LB has shown some sampling variability[ 52 ]. LB has also shown some intra- and inter-observer variability[ 5859 ]. Thirdly, there is a high inter-observer variability during microscopic evaluation[ 58 ].
Therefore, one difficulty for the evaluation of non-invasive markers of fibrosis is the use of LB as a reference method.
Taking into account the limitations of LB, a perfect non-invasive method cannot be distinguished from an unacceptable fibrosis marker. Thus a new reference marker is needed.
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However, more studies using liver related mortality as the endpoint are still awaited to identify the best non-invasive methods[ 3 ]. Serum marker of liver fibrosis One important non-invasive method for Terrebonne Dating Site of the severity of fibrosis includes serum markers[ 65 - 68 ].
Gerver - Vitre (Ille-et-vilaine), 4 Av De Terrebonne , SIREN
Terrebonne Dating Site far, many serum biomarkers, both direct and indirect, have been evaluated for their ability to stage liver fibrosis[ 69 - 71 ]. Direct serum markers, reflecting either the deposition or Terrebonne Dating Site removal of extracellular matrix in the liver, include: 1 collagens such as type IV collagen, procollagen III N-peptide, collagenases; 2 inhibitors of collagens such as matrix metalloproteases and tissue inhibitory metalloprotease-1; and 3 glycoproteins such as serum hyaluronate, laminin, and YKL The usefulness of these markers has been assessed mostly in patients with CHC[ 70 - 72 ] and hyaluronate has been the most extensively studied direct marker[ 7374 ].
These direct and indirect markers, when used individually, are useful for the diagnosis or the exclusion of cirrhosis but have limited accuracy for the diagnosis of clinically significant fibrosis[ 75 ].
Therefore, more sophisticated algorithms or indices combining the results of groups of markers have been developed to improve the diagnostic accuracy. Among these indices, Fibrotest Terrebonne Dating Site been the one most extensively studied[ 69 ].
ELF has been evaluated in a recently published study[ 86 ] that included patients.
Advantages and limitations The practical advantages of analysing serum biomarkers to measure fibrosis include their high applicability and high inter-laboratory reproducibility[ 8788 ]. However, the direct markers of liver fibrosis Terrebonne Dating Site not routinely available in most hospital settings, and none of the serum markers are liver specific-their results can be influenced Fermierii care se intalnesc cu site ul comorbidity.
Similarly, acute hepatitis can produce false-positive results in the marker measuring the level of aminotransferases, such as aspartate-to-platelet ratio index APRIForns index, FIB-4, or Fibrometer tests. Magnetic resonance elastography In recent years, magnetic resonance elastography MRE has been developed as a non-invasive functional magnetic resonance imaging MRI method for assessing and staging liver fibrosis, using a modified phase-contrast method to image the propagation characteristics of shear waves in the liver[ 9091 ].
So far, there is only limited data on the accuracy of MRE. Several studies[ 92 - 96 ] have evaluated the usefulness of MRE for the assessment of LS among patients with chronic liver disease and have shown that increased shear stiffness measured on MRE is associated with increased severity of the fibrotic process. In addition, MRE has relatively high sensitivity and specificity for predicting the stage of hepatic fibrosis.
It has shown at least equivalent diagnostic performance Terrebonne Dating Site fibrosis staging compared with TE with fewer limitations regarding its application in patients with a large amount of ascites or who are obese[ 92 - 95 ]. The reason for the difference in cut-off values obtained in the two studies may potentially be explained by the differently manufactured scanners used for MRE acquisition, case mixes, imaging protocols, and Terrebonne Dating Site procedures.
A meta-analysis has been recently published[ 97 ]. Advantages and limitations Compared with TE, dynamic MRE has the potential to assess larger volumes almost the entire liver and to provide full three-dimensional information about the viscoelastic properties of tissues[ 98 ], moreover, due to the theoretical advantages, MRE is capable of application to patients with obesity or ascites.
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However, MRE cannot be performed on the liver of patients with iron overload because of signal-to-noise limitations and it is too costly and time-consuming to use in routine practice[ 72 ]. TE does not display a conventional ultrasound image.