Background: The accurate staging of liver fibrosis is crucial for managing chronic liver disease (CLD). Although magnetic resonance elastography (MRE) is the reference standard for noninvasive fibrosis assessment, its cost, specialized hardware, and operational demands restrict accessibility. In contrast, two-dimensional shear-wave elastography (2D-SWE) is more affordable, accessible, and widely integrated into routine ultrasound systems. Objective: Our aim was to determine the optimal 2D-SWE cut-offs for detecting significant fibrosis (≥F2) and evaluate its diagnostic performance across fibrosis stages. Methods: In this prospective study, 71 patients with suspected CLD underwent same-day MRE and 2D-SWE. MRE-defined cut-offs categorized fibrosis stages (≥3.5 kPa for significant fibrosis). Sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and likelihood ratios were calculated for various 2D-SWE thresholds. Results: At a 2D-SWE cut-off of 7.0 kPa, sensitivity for detecting ≥F2 fibrosis was 100% with a specificity of 85.7% and a positive likelihood ratio (LR+) of 7.0. Increasing the threshold to 8.0 kPa improved specificity to 91.8% while maintaining a sensitivity of 86.4% and achieving an AUROC of 0.89. For cirrhosis, a cut-off of 11.0 kPa achieved 100% sensitivity and 96.9% specificity. A 5.0 kPa cut-off reliably excluded abnormal stiffness with 89.1% sensitivity. Conclusions: Two-dimensional SWE is a reliable method for staging liver fibrosis. Thresholds of 7.0 kPa for screening significant fibrosis, 8.0 kPa for confirmation, and 11.0 kPa for diagnosing cirrhosis demonstrate high diagnostic accuracy. A 5.0 kPa cut-off effectively excludes abnormal liver stiffness.

Background: Existing non-invasive tests (NITs) for liver fibrosis offer moderate precision and accessibility but are often limited by complexity, reducing their practicality in routine clinical use. This study aimed to evaluate the diagnostic performance of current fibrosis assessment methods and develop a novel, simplified scoring system—the Aspartate Aminotransferase (AST)-Thrombocytopenia-Albumin (ATA) score—to enhance ease of use and clinical applicability. Methods: This study examined past cases of patients with chronic liver disease (CLD) by using magnetic resonance elastography (MRE) to evaluate fibrosis stages. Serum biomarkers were collected, and common fibrosis scores were calculated. Logistic regression identified potential predictors of significant fibrosis, forming the ATA score. Diagnostic performance was assessed, and internal validation was conducted via bootstrap resampling. Results: Among 70 patients, 31.4% had significant fibrosis. Hepatitis B was the most common cause (60.0%), followed by hepatitis C (18.6%) and nonalcoholic fatty liver disease (NAFLD, 15.7%). The ATA score demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.872, comparable to the AST-to-platelet ratio index (APRI; 0.858) and fibrosis-4 index (FIB-4; 0.847). The recommended cut-offs for identifying high-risk patients were ATA score ≥ 2 (specificity 95.8%, sensitivity 50.0%), APRI ≥ 0.50 (specificity 89.6%, sensitivity 68.2%), and FIB-4 ≥ 1.3 (specificity 58.3%, sensitivity 90.9%). Internal validation confirmed model robustness, with an optimism-corrected AUROC of 0.8551. Conclusions: The ATA score offers a straightforward and efficient method for detecting significant fibrosis, demonstrating comparable diagnostic capability to APRI and FIB-4, while being more user-friendly in clinical practice. A score of 0–1 indicates low risk, suitable for clinical follow-up, whereas a score of ≥2 suggests high risk, warranting further evaluation. Integrating the ATA score into clinical workflows can enhance early detection, optimize resource utilization, and improve patient care.

Objectives. This study is aimed at evaluating the diagnostic performance of clinical predictors and the Doppler ultrasonography in predicting esophageal varices (EV) in patients with hepatitis C-related cirrhosis and exploring the practical predictors of EV. Methods. We conducted a prospective study from July 2020 to January 2021, enrolling 65 patients with mild hepatitis C-related cirrhosis. We obtained clinical data and performed grayscale and the Doppler ultrasound to explore the predictors of EV. Esophagogastroduodenoscopy (EGD) was performed as the reference test by the gastroenterologist within a week. Results. The prevalence of EV in the study was 41.5%. Multivariable regression analysis revealed that gender (female, , ), platelet count (<150000 per ml, , ), splenic length (>11 cm, , ), and absent right hepatic vein (RHV) triphasicity ( , ) were significant predictors of EV. However, the diagnostic accuracy indices for isolated predictors were not good (–0.66). A combination of these four predictors increases the diagnostic accuracy in predicting the presence of EV ( , 95% CI 0.69-0.91). Furthermore, the Doppler assessment of the right hepatic vein waveform showed good reproducibility ( ). Conclusion. Combining clinical and Doppler ultrasound features can be used as a screening test for predicting the presence of EV in patients with hepatitis C-related cirrhosis. The practical predictors identified in this study could serve as an alternative to invasive EGD in EV diagnosis. Further studies are needed to explore the diagnostic accuracy of additional noninvasive predictors, such as elastography, to improve EV screening.

The concomitant occurrence of diabetes mellitus and cardiomyopathy secondary to occult malignant pheochromocytoma has rarely been reported. This case report describes the case of a 48-year-old female with a previous history of diabetes mellitus, hypertension, and cardiomyopathy who presented with fatigue and significant weight loss. Neither typical symptoms of pheochromocytoma nor metastatic symptoms were presented. Pheochromocytoma with extension to the liver was incidentally found from computed tomography of the abdomen and laboratory investigations during the work-up to identify the cause for the weight loss. Right adrenalectomy and a right hepatectomy were performed. Malignant pheochromocytoma was diagnosed based on pathology. All of her underlying conditions including diabetes mellitus, hypertension, and cardiomyopathy, were improved following the complete resection of the tumor. This case emphasizes the importance of early suspicion and diagnosis of malignant pheochromocytoma in individuals with atypical presentation of a chromaffin-secreting tumor.

Background: Colorectal cancer (CRC) is a leading malignancy, and colorectal liver metastases (CRLM) are common. Accurate detection is critical for staging and treatment planning. Although contrast-enhanced MRI is the reference standard, its use is limited by cost, longer examination time, and contraindications such as renal impairment or prior severe allergic reactions. This study aimed to evaluate the diagnostic performance of an abbreviated non-contrast liver MRI protocol for detecting CRLM and to compare performance between experienced and in-training readers. Materials and methods: In this retrospective study, 87 patients with CRC who underwent liver MRI between January 2014 and March 2024 were included. The abbreviated non-contrast protocol comprised T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI). Two independent readers evaluated the images using a 4-point confidence scale, which was dichotomized for analysis. Sensitivity, specificity, predictive values, and accuracy were calculated, and interobserver agreement was assessed using weighted kappa. Contrast-enhanced MRI served as the reference standard. Results: The abbreviated non-contrast MRI demonstrated high diagnostic performance. Sensitivity and specificity were 94.1% and 88.7% for the abdominal radiologist, and 91.2% and 96.2% for the oncologic imaging fellow. The area under the receiver operating characteristic curve (AUROC) was 0.93 and 0.94, respectively, with no significant difference between readers ( p = 0.494). Interobserver agreement was substantial (weighted κ = 0.74). Conclusion: Non-contrast MRI demonstrated reliable diagnostic performance with substantial interobserver agreement for CRLM detection, suggesting its potential clinical applicability. While contrast-enhanced MRI remains the standard, non-contrast MRI may be a feasible alternative in select cases. Further large-scale validation is necessary before broader clinical adoption.