Non-invasive structure-function assessment of the liver by 2D time-harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

J Gastroenterol Hepatol. 2019 Sep;34(9):1611-1619. doi: 10.1111/jgh.14629. Epub 2019 Mar 10.


Background and aim: Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (LiMAx) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression.

Methods: LiMAx test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue.

Results: LiMAx values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) LiMAx values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]).

Conclusion: Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

Keywords: LiMAx; dynamic liver function test; liver fibrosis; liver stiffness; time-harmonic elastography; ultrasound elastography.

MeSH terms

  • Acetamides / administration & dosage*
  • Adult
  • Aged
  • Aged, 80 and over
  • Aspartate Aminotransferases / blood
  • Carbon Isotopes / administration & dosage*
  • Case-Control Studies
  • Disease Progression
  • Elasticity Imaging Techniques*
  • Female
  • Hepatectomy
  • Humans
  • Liver / diagnostic imaging*
  • Liver / metabolism*
  • Liver / surgery
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / metabolism*
  • Liver Cirrhosis / surgery
  • Liver Function Tests*
  • Male
  • Middle Aged
  • Platelet Count
  • Predictive Value of Tests
  • Reproducibility of Results
  • Severity of Illness Index
  • Young Adult


  • Acetamides
  • Carbon Isotopes
  • methacetin
  • Aspartate Aminotransferases