Budd-Chiari syndrome differential diagnosis: Difference between revisions

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{{Budd-Chiari syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Budd-Chiari_syndrome]]
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==Overview==
==Differential diagnosis==
Budd-Chiari syndrome should be differentiated from other causes of [[hepatic failure]] like [[viral hepatitis]] and [[liver cirrhosis]], [[splenic vein thrombosis]], [[portal vein thrombosis]] and [[inferior vena cava obstruction]] that may have similar presentation with right upper quadrant abdominal pain and [[ascites]]. The differential diagnosis is as follows:
 
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Condition
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating signs and symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating Tests
|-
| style="background:#DCDCDC; + " | '''Budd-Chiari Syndrome'''
|
* [[Abdominal pain]]
* [[Diarrhea]]
* [[Ascites]]
|
* [[Doppler ultrasound]] and [[CT]] of the [[abdomen]] shows absence of the [[hepatic vein]] filling
* [[Abdominal]] [[Computed tomography|CT scan]] will show a rapid clearing of the [[Caudate lobe of liver|caudate lobe]] of the [[liver]]
|-
| style="background:#DCDCDC; + " |'''Cirrhosis'''
|
* [[Abdominal pain]] and [[bloating]]
* [[Menstrual disorder|Menstrual irregularities]]
* [[Symptoms]] of [[hypogonadism]]:
** [[Erectile dysfunction|Impotence]]
** [[Infertility]]
** [[Testicular atrophy]]
** Loss of [[libido]]
** Easy bruisability
 
* Decompensated [[cirrhosis]] may present with
** [[Jaundice]]
** Increase in [[abdominal]] girth due to [[ascites]]
** [[Itch|Pruritus]]
* Signs of [[upper gastrointestinal bleeding]]:
** [[Hematemesis]]
** [[Hematochezia]]
** [[Melena]]
** [[Symptoms]] due to [[hepatic encephalopathy]]:
** [[Altered mental status]]
** [[Confusion]]
** [[Sleep]] disturbances
|
[[Ultrasound]] findings in cirrhosis are as follows:<ref name="pmid22357834">{{cite journal |vauthors=Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM |title=Does this patient with liver disease have cirrhosis? |journal=JAMA |volume=307 |issue=8 |pages=832–42 |year=2012 |pmid=22357834 |doi=10.1001/jama.2012.186 |url=}}</ref><ref name="pmid3533689">{{cite journal |vauthors=Becker CD, Scheidegger J, Marincek B |title=Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography |journal=Gastrointest Radiol |volume=11 |issue=4 |pages=305–11 |year=1986 |pmid=3533689 |doi= |url=}}</ref><ref name="pmid2526349">{{cite journal |vauthors=Di Lelio A, Cestari C, Lomazzi A, Beretta L |title=Cirrhosis: diagnosis with sonographic study of the liver surface |journal=Radiology |volume=172 |issue=2 |pages=389–92 |year=1989 |pmid=2526349 |doi=10.1148/radiology.172.2.2526349 |url=}}</ref><ref name="pmid3891495">{{cite journal |vauthors=Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW |title=Is ultrasonography useful in the assessment of diffuse parenchymal liver disease? |journal=Gastroenterology |volume=89 |issue=1 |pages=186–91 |year=1985 |pmid=3891495 |doi= |url=}}</ref><ref name="pmid3532188">{{cite journal |vauthors=Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G |title=Cirrhosis: value of caudate to right lobe ratio in diagnosis with US |journal=Radiology |volume=161 |issue=2 |pages=443–5 |year=1986 |pmid=3532188 |doi=10.1148/radiology.161.2.3532188 |url=}}</ref><ref name="pmid10341686">{{cite journal |vauthors=Simonovský V |title=The diagnosis of cirrhosis by high resolution ultrasound of the liver surface |journal=Br J Radiol |volume=72 |issue=853 |pages=29–34 |year=1999 |pmid=10341686 |doi=10.1259/bjr.72.853.10341686 |url=}}</ref><ref name="pmid22144108">{{cite journal |vauthors=Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S |title=Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities |journal=Hepatology |volume=54 |issue=6 |pages=1987–97 |year=2011 |pmid=22144108 |doi=10.1002/hep.24545 |url=}}</ref><ref name="pmid22424438">{{cite journal |vauthors= |title=EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma |journal=J. Hepatol. |volume=56 |issue=4 |pages=908–43 |year=2012 |pmid=22424438 |doi=10.1016/j.jhep.2011.12.001 |url=}}</ref>
*Changes in [[liver]] contour: shrunken, irregular appearance
*Non [[Homogenization|homogeneous]] appearance of the [[Liver|hepatic]] tissue
*Increased [[Liver|surface]] [[Nodule (medicine)|nodularity]]
*Increase in echogenecity from focal fatty [[Infiltration (medical)|infiltration]]
*[[Atrophy]] of the right lobe and [[Hypertrophy (medical)|hypertrophy]] of the [[Caudate lobe of liver|caudate]] or left lobe
*[[Splenomegaly]]
*[[Ascites]]
*[[Varices]]
*[[Hepatic vein|Hepatic]] or [[portal vein]] [[thrombosis]]
Abdominal [[MRI]] may also be helpful in the [[diagnosis]] of [[portal hypertension]]. Findings on [[MRI]] suggestive of cirrhosis with [[portal hypertension]] include:<ref name="ProcopetBerzigotti2017">{{cite journal|last1=Procopet|first1=Bogdan|last2=Berzigotti|first2=Annalisa|title=Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy|journal=Gastroenterology Report|volume=5|issue=2|year=2017|pages=79–89|issn=2052-0034|doi=10.1093/gastro/gox012}}</ref><ref name="AagaardJensen1982">{{cite journal|last1=Aagaard|first1=J|last2=Jensen|first2=LI|last3=Sorensen|first3=TI|last4=Christensen|first4=U|last5=Burcharth|first5=F|title=Recanalized umbilical vein in portal hypertension|journal=American Journal of Roentgenology|volume=139|issue=6|year=1982|pages=1107–1110|issn=0361-803X|doi=10.2214/ajr.139.6.1107}}</ref><ref name="ChoPatel1995">{{cite journal|last1=Cho|first1=K C|last2=Patel|first2=Y D|last3=Wachsberg|first3=R H|last4=Seeff|first4=J|title=Varices in portal hypertension: evaluation with CT.|journal=RadioGraphics|volume=15|issue=3|year=1995|pages=609–622|issn=0271-5333|doi=10.1148/radiographics.15.3.7624566}}</ref><ref name="BandaliMirakhur2017">{{cite journal|last1=Bandali|first1=Murad Feroz|last2=Mirakhur|first2=Anirudh|last3=Lee|first3=Edward Wolfgang|last4=Ferris|first4=Mollie Clarke|last5=Sadler|first5=David James|last6=Gray|first6=Robin Ritchie|last7=Wong|first7=Jason Kam|title=Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy|journal=World Journal of Gastroenterology|volume=23|issue=10|year=2017|pages=1735|issn=1007-9327|doi=10.3748/wjg.v23.i10.1735}}</ref>
*[[Cirrhosis|Cirrhotic liver]], as shrinkage and [[atrophy]] in [[liver]]
*Re-canalized [[umbilical vein]]--[[pathognomonic]]
*Dilated [[portal vein]] and/or [[splanchnic]] veins
*[[Esophageal varices]]
*[[Collaterals]] in any [[Abdominal organs|abdominal organ]]
*[[Splenomegaly]]
*[[Ascites]]
Transient [[elastography]] and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of [[fibrosis]] in various [[liver]] diseases: <ref name="pmid20581229">{{cite journal |vauthors=Castera L, Pinzani M |title=Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? |journal=Gut |volume=59 |issue=7 |pages=861–6 |year=2010 |pmid=20581229 |doi=10.1136/gut.2010.214650 |url=}}</ref><ref name="pmid22239521">{{cite journal |vauthors=Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E |title=Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis |journal=J. Viral Hepat. |volume=19 |issue=2 |pages=e212–9 |year=2012 |pmid=22239521 |doi=10.1111/j.1365-2893.2011.01537.x |url=}}</ref><ref name="pmid18395077">{{cite journal |vauthors=Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E |title=Performance of transient elastography for the staging of liver fibrosis: a meta-analysis |journal=Gastroenterology |volume=134 |issue=4 |pages=960–74 |year=2008 |pmid=18395077 |doi=10.1053/j.gastro.2008.01.034 |url=}}</ref><ref name="pmid15690481">{{cite journal |vauthors=Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M |title=Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C |journal=Hepatology |volume=41 |issue=1 |pages=48–54 |year=2005 |pmid=15690481 |doi=10.1002/hep.20506 |url=}}</ref><ref name="pmid14698338">{{cite journal |vauthors=Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R |title=Transient elastography: a new noninvasive method for assessment of hepatic fibrosis |journal=Ultrasound Med Biol |volume=29 |issue=12 |pages=1705–13 |year=2003 |pmid=14698338 |doi= |url=}}</ref><ref name="pmid23558397">{{cite journal |vauthors=Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F |title=EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology |journal=Ultraschall Med |volume=34 |issue=2 |pages=169–84 |year=2013 |pmid=23558397 |doi=10.1055/s-0033-1335205 |url=}}</ref><ref name="pmid25911335">{{cite journal |vauthors= |title=EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis |journal=J. Hepatol. |volume=63 |issue=1 |pages=237–64 |year=2015 |pmid=25911335 |doi=10.1016/j.jhep.2015.04.006 |url=}}</ref><ref name="pmid21205132">{{cite journal |vauthors=Castera L, Bedossa P |title=How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy? |journal=Liver Int. |volume=31 Suppl 1 |issue= |pages=13–7 |year=2011 |pmid=21205132 |doi=10.1111/j.1478-3231.2010.02380.x |url=}}</ref><ref name="pmid23732714">{{cite journal |vauthors=Chou R, Wasson N |title=Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review |journal=Ann. Intern. Med. |volume=158 |issue=11 |pages=807–20 |year=2013 |pmid=23732714 |doi=10.7326/0003-4819-158-11-201306040-00005 |url=}}</ref><ref name="pmid26779260">{{cite journal |vauthors=Khallafi H, Qureshi K |title=Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach |journal=Interdiscip Perspect Infect Dis |volume=2015 |issue= |pages=809289 |year=2015 |pmid=26779260 |pmc=4686715 |doi=10.1155/2015/809289 |url=}}</ref><ref name="pmid23954643">{{cite journal |vauthors=Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA |title=Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=12 |pages=1573–84.e1–2; quiz e88–9 |year=2013 |pmid=23954643 |pmc=3900882 |doi=10.1016/j.cgh.2013.07.034 |url=}}</ref> 
*The FibroScan (transient elastography) uses elastic waves to determine [[liver]] stiffness which theoretically may be converted into a liver score.
*The FibroScan produces an [[ultrasound]] image of the [[liver]] (from 20-80mm) along with a pressure reading (in kPa).
*Transient [[elastography]] is much faster than a [[biopsy]] (usually lasts 2.5-5 minutes) and is completely painless.
*Findings on transient [[elastography]] may show reasonable correlation with the severity of cirrhosis:<ref>{{cite journal |author=Foucher J, Chanteloup E, Vergniol J, ''et al'' |title=Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study |journal=Gut |volume=55|issue=3 |pages=403-8 |year=2006 |pmid=16020491 |doi=10.1136/gut.2005.069153}}</ref><ref name="pmid22733854">{{cite journal |author=Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X |title=Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B |journal=[[Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine]] |volume=31 |issue=7 |pages=1053–60 |year=2012|pmid=22733854 |doi= |url=}}</ref>
**Increasing [[Scar|scarring]] of the [[liver]] is associated with increasing "stiffness" of the [[Tissue (biology)|tissue]].
|-
| style="background:#DCDCDC; + " | '''Splenic vein thrombosis'''
|[[Signs]] and [[Symptom|symptoms]] of:
* Upper [[abdominal pain]] radiating to the back
* [[Vomiting]]
* Hypoactive [[bowel sounds]]
* [[Fever]]
* [[Shock]]
* [[Cullen's sign]]
* [[Grey-Turner's sign]]
|
* [[Ultrasound]] of the [[abdomen]] and [[Computed tomography|CT scan]] will show evidence of a [[splenic vein thrombosis]]
* Normal [[Hepatic vein|hepatic venous]] pressure gradient is present
|-
| style="background:#DCDCDC; + " | '''Portal vein thrombosis'''
|
* [[Symptoms]] depend on the underlying cause:
* If [[pancreatitis]] is present, the patient may develop:
** Upper [[abdominal pain]] radiating to the back
** Vomiting
** Hypoactive [[bowel sounds]]
** [[fever]]
** [[shock]]
** [[Cullen's sign]]
** [[Grey-Turner's sign]]
* If the cause is [[ascending cholangitis]], [[symptoms]] include:
** [[Fever]]
** [[Rigors]]
** [[Right upper quadrant (abdomen)|Right upper quadrant]] [[pain]]
** Dark [[urine]]
** Pale [[stools]]
* If [[abdominal]] [[sepsis]] is the cause, [[symptoms]] include:
* [[Fever]]
* [[Abdominal pain]]
* [[Medical sign|Signs]] of [[peritonitis]]
|
* [[Doppler ultrasound]] and [[abdominal]] [[Computed tomography|CT scan]] show a [[portal vein]] filling defect and absence of flow in the [[portal vein]].  
* MR or direct [[Angiogram|angiography]] show a normal [[Hepatic vein|hepatic venous]] pressure gradient.
|-
| style="background:#DCDCDC; + " | '''Schistosomiasis'''
|
* Patients may have a history of travel to [[endemic]] areas
* Constitutional [[symptoms]] such as
** [[Malaise]]
** [[Rigors]]
** [[Anorexia]]
** [[Weight loss]]
** [[Vomiting]]
** [[diarrhea|Diarrhea]]
** [[Headache]]
** [[Muscular aches]]
** [[Weakness]]
** [[Abdominal pain]]
** [[Urticaria]]
** [[Fever]]
** [[Lymphadenopathy]]
|
* MR or direct [[Angiogram|angiography]] shows a normal [[Hepatic vein|hepatic venous]] pressure gradient
|-
| style="background:#DCDCDC; + " | '''Inferior vena cava obstruction'''
|
* Signs and symptoms of [[renal cell carcinoma]]:
* [[Hematuria]]
* [[Flank pain]]
* [[Flank]] or [[abdominal]] mass
* [[Weight loss]]
* [[Hypertension]]
|
* [[Ultrasound]] of the abdomen shows evidence of [[inferior vena cava]] obstruction
|-
| style="background:#DCDCDC; + " | '''Nodular regenerative hyperplasia'''
|None
|
* [[Liver biopsy]] shows small regenerative [[Nodule (medicine)|nodules]] with little or no [[fibrosis]] on reticulin staining
|-
| style="background:#DCDCDC; + " | '''Idiopathic portal hypertension (hepatoportal sclerosis)'''
|None
|
* [[Liver biopsy]] shows no evidence of cirrhosis
|}


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
[[Category:Needs content]]
[[Category:Needs content]]
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
{{WS}}
{{WH}}

Latest revision as of 22:12, 8 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2] Amandeep Singh M.D.[3]

Overview

Differential diagnosis

Budd-Chiari syndrome should be differentiated from other causes of hepatic failure like viral hepatitis and liver cirrhosis, splenic vein thrombosis, portal vein thrombosis and inferior vena cava obstruction that may have similar presentation with right upper quadrant abdominal pain and ascites. The differential diagnosis is as follows:

Condition Differentiating signs and symptoms Differentiating Tests
Budd-Chiari Syndrome
Cirrhosis

Ultrasound findings in cirrhosis are as follows:[1][2][3][4][5][6][7][8]

Abdominal MRI may also be helpful in the diagnosis of portal hypertension. Findings on MRI suggestive of cirrhosis with portal hypertension include:[9][10][11][12]

Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of fibrosis in various liver diseases: [13][14][15][16][17][18][19][20][21][22][23] 

  • The FibroScan (transient elastography) uses elastic waves to determine liver stiffness which theoretically may be converted into a liver score.
  • The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa).
  • Transient elastography is much faster than a biopsy (usually lasts 2.5-5 minutes) and is completely painless.
  • Findings on transient elastography may show reasonable correlation with the severity of cirrhosis:[24][25]
Splenic vein thrombosis Signs and symptoms of:
Portal vein thrombosis
Schistosomiasis
Inferior vena cava obstruction
Nodular regenerative hyperplasia None
Idiopathic portal hypertension (hepatoportal sclerosis) None

References

  1. ↑ Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM (2012). "Does this patient with liver disease have cirrhosis?". JAMA. 307 (8): 832–42. doi:10.1001/jama.2012.186. PMID 22357834.
  2. ↑ Becker CD, Scheidegger J, Marincek B (1986). "Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography". Gastrointest Radiol. 11 (4): 305–11. PMID 3533689.
  3. ↑ Di Lelio A, Cestari C, Lomazzi A, Beretta L (1989). "Cirrhosis: diagnosis with sonographic study of the liver surface". Radiology. 172 (2): 389–92. doi:10.1148/radiology.172.2.2526349. PMID 2526349.
  4. ↑ Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW (1985). "Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?". Gastroenterology. 89 (1): 186–91. PMID 3891495.
  5. ↑ Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G (1986). "Cirrhosis: value of caudate to right lobe ratio in diagnosis with US". Radiology. 161 (2): 443–5. doi:10.1148/radiology.161.2.3532188. PMID 3532188.
  6. ↑ Simonovský V (1999). "The diagnosis of cirrhosis by high resolution ultrasound of the liver surface". Br J Radiol. 72 (853): 29–34. doi:10.1259/bjr.72.853.10341686. PMID 10341686.
  7. ↑ Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S (2011). "Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities". Hepatology. 54 (6): 1987–97. doi:10.1002/hep.24545. PMID 22144108.
  8. ↑ "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma". J. Hepatol. 56 (4): 908–43. 2012. doi:10.1016/j.jhep.2011.12.001. PMID 22424438.
  9. ↑ Procopet, Bogdan; Berzigotti, Annalisa (2017). "Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy". Gastroenterology Report. 5 (2): 79–89. doi:10.1093/gastro/gox012. ISSN 2052-0034.
  10. ↑ Aagaard, J; Jensen, LI; Sorensen, TI; Christensen, U; Burcharth, F (1982). "Recanalized umbilical vein in portal hypertension". American Journal of Roentgenology. 139 (6): 1107–1110. doi:10.2214/ajr.139.6.1107. ISSN 0361-803X.
  11. ↑ Cho, K C; Patel, Y D; Wachsberg, R H; Seeff, J (1995). "Varices in portal hypertension: evaluation with CT". RadioGraphics. 15 (3): 609–622. doi:10.1148/radiographics.15.3.7624566. ISSN 0271-5333.
  12. ↑ Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam (2017). "Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy". World Journal of Gastroenterology. 23 (10): 1735. doi:10.3748/wjg.v23.i10.1735. ISSN 1007-9327.
  13. ↑ Castera L, Pinzani M (2010). "Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?". Gut. 59 (7): 861–6. doi:10.1136/gut.2010.214650. PMID 20581229.
  14. ↑ Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E (2012). "Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis". J. Viral Hepat. 19 (2): e212–9. doi:10.1111/j.1365-2893.2011.01537.x. PMID 22239521.
  15. ↑ Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E (2008). "Performance of transient elastography for the staging of liver fibrosis: a meta-analysis". Gastroenterology. 134 (4): 960–74. doi:10.1053/j.gastro.2008.01.034. PMID 18395077.
  16. ↑ Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M (2005). "Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C". Hepatology. 41 (1): 48–54. doi:10.1002/hep.20506. PMID 15690481.
  17. ↑ Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R (2003). "Transient elastography: a new noninvasive method for assessment of hepatic fibrosis". Ultrasound Med Biol. 29 (12): 1705–13. PMID 14698338.
  18. ↑ Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F (2013). "EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology". Ultraschall Med. 34 (2): 169–84. doi:10.1055/s-0033-1335205. PMID 23558397.
  19. ↑ "EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis". J. Hepatol. 63 (1): 237–64. 2015. doi:10.1016/j.jhep.2015.04.006. PMID 25911335.
  20. ↑ Castera L, Bedossa P (2011). "How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy?". Liver Int. 31 Suppl 1: 13–7. doi:10.1111/j.1478-3231.2010.02380.x. PMID 21205132.
  21. ↑ Chou R, Wasson N (2013). "Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review". Ann. Intern. Med. 158 (11): 807–20. doi:10.7326/0003-4819-158-11-201306040-00005. PMID 23732714.
  22. ↑ Khallafi H, Qureshi K (2015). "Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach". Interdiscip Perspect Infect Dis. 2015: 809289. doi:10.1155/2015/809289. PMC 4686715. PMID 26779260.
  23. ↑ Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA (2013). "Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis". Clin. Gastroenterol. Hepatol. 11 (12): 1573–84.e1–2, quiz e88–9. doi:10.1016/j.cgh.2013.07.034. PMC 3900882. PMID 23954643.
  24. ↑ Foucher J, Chanteloup E, Vergniol J; et al. (2006). "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study". Gut. 55 (3): 403–8. doi:10.1136/gut.2005.069153. PMID 16020491.
  25. ↑ Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X (2012). "Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B". Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 31 (7): 1053–60. PMID 22733854.

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