Calibration plots in external validation cohorts (A) French bariatric cohort (n=110). 2022 Nov 16;12(11):2822. doi: 10.3390/diagnostics12112822. Ther Adv Endocrinol Metab. Bariatr. Use of FAST in primary care will require investment in devices and personnel, although there are many examples of such models being introduced successfully. Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography 3@kJBOxxnV1zC Publication Arslanow et al. Can Fibroscan Detect Fatty Liver cure fatty liver The FBS was measured using an autoanalyzer (Cobas c 311, Switzerland). Google Scholar. CAS In the present study, an inverse association between FFM and hypermetabolism was shown. I called today my GI DR office again this was my 4th call asking what my CAP score was from my fibroscan. The ultrasound waves move at different speeds through normal liver tissue and areas of fibrosis. Please enable it to take advantage of the complete set of features! FibroScan has been in available in the European market since 2003 and was expanded to China, Canada, Brazil, Japan, and many other countries before being approved by the FDA in 2013. 2019 May;156(6):1717-1730. doi: 10.1053/j.gastro.2019.01.042. Epub 2021 Sep 14. Resting metabolic rate is an important predictor of serum adiponectin concentrations: Potential implications for obesity-related disorders. 31(1), E24E29 (2008). J. Nutr. Delsoglio, M. et al. 10(5), 524529 (2004). Hepatic steatosis and metabolic risk factors among patients with FAST=FibroScan-aspartate aminotransferase. Mansour, A., Motamed, S., Hekmatdoost, A. et al. and JavaScript. Univariate logistic regression analysis was used to identify potential variables that have an effect on hypermetabolism. If you have questions about your care, contact your healthcare provider. 100(3), 10781087 (2015). Today, in most studies, as well as in clinical practice, resting energy expenditure (REE), also known as resting metabolic rate (RMR), is used as an estimate of BMR, because it requires less restrictive conditions18,20. MeSH Google Scholar. The effect of omega3 fatty acid supplementation on PPAR and UCP2 expressions, resting energy expenditure, and appetite in athletes. Interpretation: Lifestyle factors can influence the progression of non-alcoholic fatty liver disease. The short version of the international physical activity questionnaire (IPAQ) was used to measure the physical activity of participants28. Would you like email updates of new search results? A p-value<0.05 was considered statistically significant. J. The intercept compares the mean of all predicted risks with the mean observed risk and indicates the extent that predictions are systematically too low or too high. endobj 2012 Feb;36(1):13-20. doi: 10.1016/j.clinre.2011.08.001. AUROC=area under the receiver operating curve. Between September, 2017, and March, 2018, a total of 95 eligible participants (64.40% male) with both T2DM and NAFLD were included, while 32.63% of them were classified as hypermetabolic. CAS A CAP score that falls anywhere between 238 to 260 dB/m represents 11-33% fatty change in the liver. VW-SW reports personal fees from Echosens during the conduct of the study; and personal fees from 3V-BIO, AbbVie, Allergan, Boehringer Ingelheim, Gilead Sciences, Janssen, Novartis, Novo Nordisk, Perspectum Diagnostics, Pfizer, Terns, Bristol-Myers Squibb, and Merck; and grants from Gilead Sciences, outside the submitted work. CAPis a quantitative surrogate of liver steatosis expressed in decibel per meter (db/m). /Filter /FlateDecode Welle, S. & Nair, K. Relationship of resting metabolic rate to body composition and protein turnover. Call your healthcare provider if you have any questions. A fibrosis score of F3 (10 to 14 kPa) indicates severe scarring which has spread and disrupts normal blood flow. I had a fibroscan done last month with a 17 Kpa (cirrhosis). FibroScan Fat Results - Tawazun Health FibroScan: What Is It And What To Expect? - Netmeds 13(1), 112 (2021). Taghadomi Masoumi, Z. et al. (D) Screen failure rate, missed cases rate, and proportion of patients identified, versus FAST scores values. Diagnostic abilities of FAST score, fatty liver index, CAP, and BMI for fatty liver in patients with MAFLD and NAFLD . BMC Sports Sci. Arrese, M. & Barrera, F. Concurrent nonalcoholic fatty liver disease and type 2 diabetes: Diagnostic and therapeutic considerations. [/Pattern /DeviceRGB] endobj J. Phys. This site needs JavaScript to work properly. Critical revision, R.J. Acquisition of data, S.M.S.J. << In addition, among biochemical markers, subjects with non-hypermetabolism had a significantly higher level of low-density lipoprotein cholesterol (LDL-C), as compared with hypermetabolic cases (98.00 [68.00118.00] vs. 71.00 [61.00105.00], p=0.041). These measurements help your healthcare provider learn more about your liver disease. Filed Under: FibroScan Tagged With: FibroScan Testing, FibroScan Testing in California, FibroScan Testing near me, gastroenterologist clinic, gastroenterologist clinic in California, gastroenterologist clinic near me, gastroenterologist in California, gastroenterologist near me, inSite Digestive Health Care. Endocrinol. Ther. Hunter, G. R. et al. [ ] 2012 Jul;32(6):911-8. doi: 10.1111/j.1478-3231.2012.02820.x. Epub 2019 Jan 25. J. Clin. It uses ultrasound technology to measure the stiffness of your liver tissue. The Fatty Liver Foundation, its officers or contributors expressly disclaim responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. BMR has been reported to increase by 57% in individuals with T2DM21,22. There is also evidence showing that resistance training programs increases REE71,72,73,74. A FibroScan can reveal fatty changes to the liver (steatosis) and scarring. 34(2), 166170 (2018). After overnight fasting, intravenous blood was drawn to measure enzymes and biomarkers. ]RH8zBE%4&7\%jo05$. Hypermetabolismwas definedas an elevated measured REE>110% of predicted REE31. FibroScan, also called transient elastography, measures the speed of ultrasound waves as they move through the liver. Depending on where you get a FibroScan may determine the scoring system used in your diagnosis. Proc. Products in the FibroScanrange are Class IIa medical devices as defined by Directive 93/42/EEC (EC 0459). Metab. In accordance with our findings, Ali et al.63 and Snodgrass et al.64 showed a direct relationship between BMR and blood pressure. In addition, JFC has a patent pending for protein-based biomarkers of fatty liver disease. Driving Nonalcoholic Steatohepatitis Forward Using the FibroScan Aspartate Aminotransferase Score, But Obey the Traffic Lights. The Controlled Attenuation Parameter (CAP) specifically targets liver steatosis using a process based on transient elastography. Find the liver disease you have in the first column on the left. NAFLD in type 1 diabetes: Overrated or underappreciated? FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study Echosens and UK National Institute for Health Research. J. Appl. /AIS false 78(6), 21402146 (1995). The information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. 82(1), 2125 (2005). 8 . Resting energy expenditure is not increased in mildly hyperglycaemic obese diabetic patients. /Font << The AUROCs of the CAP for 5%, >33% and >66% steatosis were 0.79, 0.76 and 0.70, respectively. Please do not use it to ask about your care. Agarwal, R. Smoking, oxidative stress and inflammation: Impact on resting energy expenditure in diabetic nephropathy. Here are some helpful terms to know related to your FibroScan results: Fibrosis (fy-BROH-sis): Scarring in your liver. Roll-out is further aided by the free availability of the equation, which is also accessible through an app. Your doctor may also order other tests to evaluate your liver, such as blood tests, other imaging scans, or biopsies. TE was performed using the Fibroscan apparatus. References are available in our bibliography. /ca 1.0 .k/1t|s)5q\^m89/X{E@kT/X[=xzm{cD/xVc!-wqzg0K)cS@/Ua[6z^ncqol0x?oK\:QO8kn".bU*_L*_R4/plHlXq 9#Ok-hfz;0[[\;TPu57 They may use blood tests or a certain type of MRI to measure scarring and fatty changes in your liver. CAP is a guiding point for doctors and patients to improve monitoring of lifestyle change and therapeutic intervention. FibroScan with CAP for fatty liver disease assessment - Echosens A high performance liquid chromatography analyzer (Tosoh, Japan) was used to measure the levels of HbA1c. Image, Download Hi-res Understanding Your Liver Elastography (FibroScan) Results PB reports personal fees from EchoSens during the conduct of the study. J. Nutr. Jouinot, A. et al. The FAT in the liver is measured by the Controlled Attenuation Parameter - CAP. Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Diabetes Care 40(3), 419430 (2017). What is FibroScan, and How Can It Help With Fatty Liver? Effect of bariatric surgeries on metabolic rate, a systematic review and meta-analyses. Our scientists pursue every aspect of cancer researchfrom exploring the biology of genes and cells, to developing immune-based treatments, uncovering the causes of metastasis, and more. The height and weight of the participants were measured with the accuracy of 0.1cm and 0.1kg, respectively. [2] The table below, adopted from MSK, considers different scores in the context of different liver diseases and can be used to help determine fibrosis score. FibroScan with CAP for fatty liver disease assessment - ECHOSENS Epub 2019 Jan 25. Global epidemiology of nonalcoholic fatty liver diseaseMeta-analytic assessment of prevalence, incidence, and outcomes. PMC Nonalcoholic fatty liver disease as trigger of cardiovascular and metabolic complication in metabolic syndrome. | Clinical and Translational Gastroenterology, 2016. Correlation between Fibroscan and laboratory tests in non-alcoholic The cross-sectional design of the current study made it impossible to draw a conclusion on causality. It has been shown that individuals with both T2DM and NAFLD are more likely to experience progressive liver failure, liver fibrosis, cardiovascular diseases and diabetes complications, leading to the increased risk of morbidity and mortality11,12,13. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. ISSN 2045-2322 (online). A systematic review of literature. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). | Clinical and Translational Gastroenterology, 2016. 20(1), 18 (2020). Yabiku, K. Efficacy of sodium-glucose cotransporter 2 inhibitors in patients with concurrent type 2 diabetes mellitus and non-alcoholic steatohepatitis: A review of the evidence. The NFSA score was calculated based on age, hyperglycemia, body mass index, platelets, albumin and serum aminotransferase levels. What it measures: fibrosis, steatosisWho should take it: undiagnosed and diagnosed NAFLD/NASH patientsWhere to get it: specialty care centers, hospitals, some primary care providers. A score of less than 1.3 may be considered low-risk, while a Fib4 score of more than 3.25 could mean you're at a high risk for liver fibrosis. >> Inactivity and obesity are two of the biggest contributors to liver disease that is not due to heavy alcohol use. 8600 Rockville Pike However, there is inadequate evidence regarding the threshold of blood glucose in which REE is increased38. Noureddin N, Alkhouri N, Brown KA, Noureddin M. Hepatology. The speed of the shear wave is measured as it travels through your liver, generating two scores to determine overall liver health. A 'normal' Fibroscan range tends to be between 2-7 with an average result being roughly around 5. Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D, Guha IN, Cobbold JF, Deeks JJ, Paradis V, Bedossa P, Newsome PN. You will find your fibrosis score in the third column from the left. Ravussin, E. et al. J. Clin. Adiponectin, alanine transaminase, physical activity, diastolic blood pressure and fat free mass were independently associated with hypermetabolism in subjects with NAFLD and T2DM. Ann. Canadian Institutes of Health Research/Canada. FibroScan works similarly to an ultrasound, emitting a small pulse of energy, called a shear wave. Melby, C. et al. Fatty Liver Foundation copyright 2023 all rights reserved. Int. Please do not write your name or any personal information on this feedback form. If patients remain undiagnosed and untreated, they may go on to develop irreversible cirrhosis of the liver. PNN and JJD were supported by the NIHR Birmingham BRC. and transmitted securely. Almost all drugs for NASH currently being assessed in clinical trials aim to treat the inflammatory activity associated with NASH, and therefore the population being considered for treatment are patients with active NASH (non-alcoholic fatty liver disease activity score 4) and significant fibrosis (stage F2). /MediaBox [0 0 612 792] Effects of anti-diabetic treatments in type 2 diabetes and fatty liver disease. gold standard solution for comprehensive management of liver health, Enhance FibroScan liver disease assessment with biological markers, Your everyday FibroScancompanion free application, Optimize clinical workflows with real-time secure data transmission. Pharmacol. Hepatic steatosis and metabolic risk factors among patients with chronic hepatitis B: The multicentre, prospective CAP-Asia study Yong Wen Leow, Wah Kheong Chan * , George Boon Bee Goh, Vincent Wai Sun Wong, Jian Gao Fan, Young Seok Kim, Seung Up Kim, Atsushi Nakajima, Wai Kay Seto, I. Cheng Lee, Yi Hsiang Huang , Yoon Jun Kim, Jang Jae Young . BMC Gastroenterol. Diagnostic Accuracy of Noninvasive Markers of Steatosis, NASH, and Liver Fibrosis in HIV-Monoinfected Individuals at Risk of Nonalcoholic Fatty Liver Disease (NAFLD) Am. In obese individuals with T2DM, NAFLD, metabolic syndrome and other chronic diseases, increased inflammation and cytokine production, as well as the increased level of reactive oxygen species (ROS) production, play a potential role in increasing BMR, as this process causes mitochondrial disturbance and leads to excess heat generation and a higher level of metabolism17,36. Am. FibroScan Fat Results What does the FAT (CAP) Score mean? Emerg. While the present study found no association between inflammatory markers (CRP and TNF-) and hypermetabolism, the effect of inflammatory markers cannot be completely ruled out; this is because, in this study, we did not examine all inflammatory markers such as IL-6, etc. The French (E) and Turkish (G) NAFLD external validation cohorts are well calibrated; their calibration curve is nearly linear, their intercept is close to zero (CIs include zero), and their slope is close to one (CIs include one). Zhou, M. et al. The FibroScan-aspartate aminotransferase score can stratify - Nature Nutr. Hepatol. Diabetes Care 27(10), 24162421 (2004). At a cut-off of 283 dB/m, the CAP was 76% sensitive, 79% specific, and had positive and negative predictive values of 87% and 64%, respectively. Sci. A.M. Study conception and design, Acquisition of data, Analysis and interpretation of data, Drafting of manuscript, Critical revision, S.M. Endocrinol. Nutr. Gougeon, R. et al. Sport Nutr. Increased 24-h energy expenditure in type 2 diabetes. This can happen if you have: FibroScan may give less accurate results, or no results at all if you have: Your healthcare provider may use imaging tests, such as ultrasound, CT, or MRI, to see your liver. Your doctor will talk with you about your results and give you more information during your appointment. Sci Rep. 2022 Dec 19;12(1):21897. doi: 10.1038/s41598-022-25931-7. We have over 20 locations across California, which makes it easy and convenient for our patients to schedule their appointments. CAP is unique, patented and validated for liver steatosis assessment2,3: 822 international and peer-reviewed articles support the use of CAP. Nutrients 11(8), 1830 (2019). Investig. Bookshelf Effect of acute resistance exercise on postexercise energy expenditure and resting metabolic rate. If you have more than one liver disease, you may not be able to use the table. 12(5), 840845 (2004). Fontvieille, A. et al. Clayton-Chubb D, Kemp W, Majeed A, Lubel JS, Hodge A, Roberts SK. Validation of controlled attenuation parameter measured by fibroscan as a novel surrogate marker for the evaluation of metabolic derangement. The first 5min were excluded from the analysis. | Clinical and Translational Gastroenterology, 2016. Bookshelf >> Liver biopsy is crucial for selecting patients with non-alcoholic steatohepatitis (NASH) for inclusion in clinical trials and, by implication, for treatment after new drugs are licensed. The enzyme-linked immunosorbent assay (ELISA) kit (Roche, Germany) was used to measure the serum concentration of liver enzymes, creatinine, high-sensitive C-reactive protein (hs-CRP) and lipids. J. Obes. Twenty-four-hour energy expenditure in Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus. Mertens, J. et al. Sugimoto K, Lee DH, Lee JY, Yu SJ, Moriyasu F, Sakamaki K, Oshiro H, Takahashi H, Kakegawa T, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Choi BI, Itoi T. Radiology. J Gastroenterol Hepatol. There are three stages if fatty liver as per CAP value: S1, S2, S3. NASH+NAS4+F2=NASH, elevated non-alcoholic fatty liver disease activity score (4), and advanced fibrosis (stage 2). In spite of the prevalence of T2DM and NAFLD and the importance of estimating appropriate energy expenditure, there is not much literature on exploring factors affecting metabolism in such diseases. Metab. The controlled attenuation parameter (CAP): a novel tool for the non-invasive evaluation of steatosis using Fibroscan. Tanase, D. M. et al. Some studies suggested that the involvement of adiponectin in energy homeostasis probably mediated through the regulation of uncoupling proteins (UCPs), a family of transporters that present in the mitochondria inner membrane. image, Download .pdf (.32 Furthermore, our small sample size might have affected the results. Your fibrosis result may be over-estimated (your liver may have less scarring than what your fibrosis result says) if you have: Your FibroScan results may also be less accurate if you have: Fibrosis score F0 to F1: No liver scarring or mild liver scarring, Fibrosis score F2: Moderate liver scarring, Fibrosis score F3: Severe liver scarring Fibrosis score. Development of alternatives to estimate resting metabolic rate from anthropometric variables in paralympic swimmers. The CAP score is measured in decibels per meter (dB/m). Your fibrosis result is a measurement of the amount of scarring in your liver. PubMed Central 162(4), 14881492 (2000). Enhance FibroScan liver disease assessment with biological markers, The non-invasive solution for comprehensive management of liver health, Enhance your FibroScan capabilities for improved management of fatty liver patients, Optimize clinical workflows with real-time secure data transmission. Plot of the screen failure rate (equal to 1positive predictive value) and missed cases rate (equal to 1sensitivity) versus all possible FAST score values. However, this cohort size is quite small (n=83). Metab. The rest of this resource explains your FibroScan results in more detail, including how your healthcare provider uses your results to determine your steatosis grade and fibrosis score. According to the results of multivariable logistic regression analysis (Table 2), hypermetabolism was positively associated with adiponectin (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.021.34, p=0.030), physical activity (OR 1.13, 95% CI 1.0021.28, p=0.046), ALT (OR 1.06, 95% CI 1.0061.12, p=0.031) and diastolic blood pressure (OR 1.07, 95% CI 1.011.13, p=0.021). ADS CAS https://doi.org/10.1038/s41598-023-30945-w, DOI: https://doi.org/10.1038/s41598-023-30945-w. Kablawi D, Aljohani F, Palumbo CS, Restellini S, Bitton A, Wild G, Afif W, Lakatos PL, Bessissow T, Sebastiani G. Crohns Colitis 360. Liver scarring is a serious condition and can lead to life-threatening complications if not addressed. In terms of drug consumption, there was a significant difference in the usage percentage of dipeptidyl peptidase 4 (DPP-4) inhibitors between the two groups (it was 51.6% in hypermetabolism subjects, while it was 15.6% in non-hypermetabolism subjects, p<0.001). Read across the rest of that row from left to right. Sci Rep 13, 3669 (2023). The continuous variables with normal distribution were presented as meanstandard deviation (SD) and those with non-normal distribution were presented as median (interquartile range [IQR]). The results were 4.0 Kpa and CAP score of 179. Advantages of CAP include its ease of measurement, operator-independence and simultaneous availability with LSM for fibrosis assessment. MathSciNet 14 0 obj 105(2), 141150 (2014). The median BMI of the participants was 30.20 (27.8033.30) kg/m2, while 52.63% of them were obese (BMI>30kg/m2). Lancet Gastroenterol Hepatol. The authors are thanks to the patients who participated in the study. Understanding Your Liver Elastography (FibroScan) Results If patients remain undiagnosed and untreated, they may go on to develop irreversible cirrhosis of the liver. Metab. QMA reports grants from European Commission during the conduct of the study and speaker fees/advisory board fees from Acuitas Medical, E3Bio, Eli Lilly & Company, Galmed, Grunthal, Imperial Innovations, MedImmune, NewGene, Inventiva, Janssen, Raptor Farmer, NGMBio, Madriglal, and Servier; personal fees and speaker fees/advisory board fees from Allergan/Tobira, Genfit SA, Gilead, and Intercept Pharma Europe; personal fees from Kenes, Novartis Pharma AG, and Bristol-Myers Squibb; grants and speaker fees/advisory board fees from Pfizer; and grants from GlaxoSmithKline and AbbVie, outside the submitted work. A CAP score of 5% or lower indicates a healthy liver, while a CAP score of 5% to 33% with a steatosis grade of S1 indicates a mild fatty liver. CAP provides a convenient and patient-friendly method to assess lipid turnover during lifestyle and dietary interventions to combat NAFLD. | Clinical and Translational Gastroenterology, 2016. Dietary Sodium and Nonalcoholic Fatty Liver Disease: A Systematic Review Non-alcoholic fatty liver disease and the interface between primary and secondary care. Our highly-specialized educational programs shape leaders to be at the forefront of cancer care and research. NAFLD (Non-Alcoholic Fatty Liver Disease) Fibrosis Score Estimates amount of scarring in the liver based on several laboratory tests. You may have less scarring than your results suggest. 7(3), 476487 (2016). /Contents 12 0 R Sci. Many people with liver disease(s) have a result that is higher than the normal range. << eCollection 2022. F0 = no scarring F1 = mild fibrosis F2 = moderate fibrosis F3 = severe fibrosis F4 = cirrhosis or advanced fibrosis Article This score will be used by your doctor to grade your steatosis (fatty change). J. Accessibility 76(1), 133137 (1994). This means that your actual fibrosis score (the score that your healthcare provider tells you) may not match the fibrosis score in the table. FibroScan is a type of liver elastography. << Li, G. & Zhong, L. Genetic variations in adiponectin levels and dietary patterns on metabolic health among children with normal weight versus obesity: The BCAMS study. 286(4), F606F616 (2004). Fibroscan results? - Liver disease Article MS, CF, LS, VM, JJD, and PNN were involved in study design and data analysis and data interpretation. 2020 Apr;5(4):e3. 2022 Apr 15;17(4):e0266859. Starling, R. D. Energy expenditure and aging: Effects of physical activity. Pediatr. Among anthropometric measures, including height, weight, BMI, fat mass, fat percent, fat free mass (FFM), total body water (TBW) and WC, only TBW was significantly higher in subjects with non-hypermetabolism, as compared with hypermetabolism subjects (46.158.09 vs. 42.098.47, p=0.027). 11(Suppl), S208S217 (2001). No studies have evaluated 24-h urinary sodium excretion and ultrasound or elastography in the same subjects. These devices are designed for use in a medical practice in order to measure liver stiffness and ultrasound attenuation in patients with liver disease. Res. Would you like email updates of new search results? FibroScan is a specialized ultrasound machine for your liver. FibroScan can be used on patients in need of staging of their NAFLD/NASH, whether their condition is suspected or biopsy-confirmed. Demographic, anthropometric and biochemical characteristics of the participants with non-hypermetabolism (n=64) and hypermetabolism (n=31) are presented and compared in Table 1. Factors related to hypermetabolism in individuals with type 2 diabetes mellitus and non-alcoholic fatty liver disease. 26(4), 426433 (2011). doi: 10.1093/crocol/otad004. These clinical trials aim to include those patients considered to be at greatest risk of disease progression and liver-related morbidity and mortality, factors that are defined by the presence and severity of liver fibrosis. Int. Epub 2020 Aug 5. The first score measures liver stiffness and the second score measures liver fat. Younossi, Z. M. et al. Written informed consent was obtained from all participants. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. ADS endobj The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. QMA was supported by the NIHR Newcastle BRC. Controlled attenuation parameter-insulin resistance (CIR) score to predict non-alcoholic steatohepatitis. Advantages of CAP include its ease of measurement, operator-independence and simultaneous availability with LSM for fibrosis assessment. Rathaus, M. & Bernheim, J. >> Google Scholar.