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                <text>Ferraioli G; Berzigotti A; Barr RG; Choi BI; Cui XW; Dong Y; Gilja OH; Lee JY; Lee DH; Moriyasu F; Piscaglia F; Sugimoto K; Wong GL; Wong VW; Dietrich CF</text>
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                <text>New ultrasound methods that can be used to quantitatively assess liver fat content have recently been developed. These quantitative ultrasound (QUS) methods are based on the analysis of radiofrequency echoes detected by the transducer, allowing calculation of parameters for quantifying the fat in the liver. In this position paper, after a section dedicated to the importance of quantifying liver steatosis in patients with non-alcoholic fatty liver disease and another section dedicated to the assessment of liver fat with magnetic resonance, the current clinical studies performed using QUS are summarized. These new methods include spectral-based techniques and techniques based on envelope statistics. The spectral-based techniques that have been used in clinical studies are those estimating the attenuation coefficient and those estimating the backscatter coefficient. Clinical studies that have used tools based on the envelope statistics of the backscattered ultrasound are those performed by using the acoustic structure quantification or other parameters derived from it, such as the normalized local variance, and that performed by estimating the speed of sound. Experts’ opinions are reported.</text>
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                <text>The assessment of steatosis (liver fat content) is relevant in patients suspected of, or diagnosed with, chronic liver diseases. Steatosis is usually a diffuse process within the liver tissue, but a non-uniform distribution can sometimes be observed (focal fatty changes or zonal/regional steatosis, focal or segmental sparing).</text>
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                <text>38; Biology. All rights reserved.</text>
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                <text>110 consecutive patients with increased skin-to-liver distance scheduled for US assessment of CLD were reviewed for study completion time, liver stiffness values (LS), attenuation imaging, and shear wave dispersion slope. The ROI was placed 2 cm below the liver capsule. The study included patients with NAFLD/NASH (68), hepatitis C (30), prior Fontan surgery (1), elevated liver function tests (5), alcohol abuse (3), hepatitis B (2), and primary biliary cirrhosis (1). IQR/M values were obtained. Comparison of less experienced sonographers (LES) and more experienced sonographers (MES) were evaluated through Student’s t test for independent data. Pearson coefficient r of correlation among quantitative variables was calculated.</text>
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                <text>To assess chronic liver disease (CLD) using multiparametric US in a private practice setting in a cohort of patients with increased skin-to-liver distance.</text>
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                <text>Assessment of chronic liver disease by multiparametric ultrasound: results from a private practice outpatient facility.</text>
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                <text>ELASTOGRAPHY; NAFLD; Shear wave elastography; Liver stiffness; NASH; MANAGEMENT; Attenuation coefficient; Shear wave dispersion; FIBROSIS; GUIDELINES; HEPATIC STEATOSIS; RADIATION FORCE IMPULSE; RADIOLOGISTS; SOCIETY; STIFFNESS</text>
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                <text>PURPOSE: To assess chronic liver disease (CLD) using multiparametric US in a private practice setting in a cohort of patients with increased skin-to-liver distance.  METHODS: 110 consecutive patients with increased skin-to-liver distance scheduled  for US assessment of CLD were reviewed for study completion time, liver stiffness  values (LS), attenuation imaging, and shear wave dispersion slope. The ROI was  placed 2 cm below the liver capsule. The study included patients with NAFLD/NASH  (68), hepatitis C (30), prior Fontan surgery (1), elevated liver function tests (5),  alcohol abuse (3), hepatitis B (2), and primary biliary cirrhosis (1). IQR/M values  were obtained. Comparison of less experienced sonographers (LES) and more  experienced sonographers (MES) were evaluated through Student's t test for  independent data. Pearson coefficient r of correlation among quantitative variables  was calculated. RESULTS: The mean time to perform the exam was 129.7 ± 62.1 s. There  was a statistically significant difference between LES and MES. The mean IQR/M for  LS was 12.3 ± 5.5% m/s. Overall, in a cohort of difficult patients, 4.5% of LS  values were not reliable. Fat quantification using attenuation imaging had a mean  value of 0.60 ± 0.15 dB/cm/MHz (range 0.35-0.98 cm/dB/MHz) with an IQR/M of  14.7 ± 9.2%. Less reliable measurements of steatosis were obtained in 4.5% of  patients. The mean shear wave dispersion slope was 12.74 ± 4.05 (m/s)/kHz (range  7.7-27.5 (m/s)/kHz) with an IQR/M of 38.7 ± 20.2% (range 3-131%). 20.9% of patients  had values suggestive of compensated advanced chronic liver disease (cACLD).  CONCLUSION: Multiparametric US can provide assessment of CLD in less than 3 min in  most patients and identify patients at risk for cACLD.</text>
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