Real-Time Tissue Elastography Versus FibroScan for Noninvasive Assessment of Liver Fibrosis in Chronic Liver Disease

Zusammenfassung

Ziel: Die Transiente Elastografie (FibroScan, [TE]) und Serum-Fibrosemarker, wie der FibroTest (FT), sind inzwischen etablierte Verfahren zur nicht invasiven Beurteilung des Leberfibrosestadiums. Eine kürzlich publizierte Studie hat vergleichbare Ergebnisse der Real-time-Elastografie (HI-RTE) mit der transienten Elastografie aufgezeigt. Das Ziel der vorliegenden Studie war es, 1. die bisher publizierten Elastizitäts-Scores der Real-time-Elastografie in einer unabhängigen Patientengruppe zu validieren und 2. diese Ergebnisse mit der transienten Elastografie und dem FibroTest in Bezug auf die nicht invasive Beurteilung des Leberfibrosestadiums zu vergleichen. Material und Methoden: 134 Patienten mit chronischer Lebererkrankung und entweder einer histologischen Beurteilung des Leberfibrosestadiums (n = 112) oder einer gesicherten Leberzirrhose (n = 22) wurden in die Studie eingeschlossen. Alle Patienten erhielten TE, HI-RTE und eine Blutentnahme zur Bestimmung des FibroTests. Die Kalkulation des Elastizitäts-Scores der Real-time-Elastografie erfolgte in Anlehnung an die 2 bisher hierzu publizierten Studien. Ergebnisse: Es zeigte sich eine signifikante Korrelation der Transienten Elastografie, Real-time-Elastografie und des FibroTests jeweils mit dem histologischen Fibrosestadium nach Chevallier (r = 0,78, 0,34, und 0,67; p < 0,01). Die diagnostische Genauigkeit gemessen mit der Fläche unter der ROC-Kurve betrug jeweils 84 %, 69 % und 85 % für die Diagnose einer signifikanten Fibrose (F ≥ 2) und 95 %, 65 % und 83 % für die Diagnose einer Leberzirrhose. Schlussfolgerung: Die Real-time-Elastografie kann in ihrer aktuellen Form die Transiente Elastografie zur nicht invasiven Beurteilung des Leberfibrosestadiums nicht ersetzen.

Abstract

Purpose: Transient elastography (FibroScan, [TE]) and serum fibrosis markers such as the FibroTest (FT) are established methods for the noninvasive staging of liver fibrosis. A study using real-time elastography (HI-RTE), which is integrated in a conventional ultrasound system, was recently published with comparable results to transient elastography. The aim of the present study was to validate real-time elastography using the formulas calculated in previous studies and to compare the results to transient elastography and FibroTest for the noninvasive assessment of liver fibrosis. Materials and Methods: One hundred and thirty-four patients with chronic liver disease and either histological assessment of liver fibrosis (n = 112) or proven liver cirrhosis (n = 22) were included in the study. All patients received TE, HI-RTE, and biochemical evaluation on the same day as presentation. The calculation of the elasticity score of real-time elastography was performed in accordance with the two previously published studies. Results: The Spearman correlation coefficient between transient elastography, real-time elastography and FibroTest with the histological Chevallier score was statistically significant with 0.78, 0.34, and 0.67, respectively (p < 0.01). The diagnostic accuracy expressed as areas under ROC curves was 0.84, 0.69 and 0.85 for the diagnosis of significant fibrosis (F ≥ 2), and 0.97, 0.65, and 0.83 for the diagnosis of cirrhosis, respectively. Conclusion: Real-time elastography in its present form cannot replace transient elastography for noninvasive assessment of liver fibrosis.

Key words

abdomen - ultrasound - laboratory tests - staging - technical aspects

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