Ultraschall Med 2011; 32(1): 40-45
DOI: 10.1055/s-0029-1245525
Originalarbeiten/Original Article

© Georg Thieme Verlag KG Stuttgart · New York

What Did We Learn from the First 3,459 Cases of Liver Stiffness Measurement by Transient Elastography (FibroScan®)?

Was haben wir von den ersten 3459 Lebersteifheitsmessungen durch transiente Elastografie (FibroScan®) gelernt?I. Sporea1 , R. L. Sirli1 , A. Deleanu1 , R. Iulia1 , A. Tudora1 , I. Dan1 , A. Popescu1
  • 1Gastroenterology, University of Medicine and Pharmacy Timisoara, Romania
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Publikationsverlauf

received: 8.11.2009

accepted: 25.5.2010

Publikationsdatum:
05. Juli 2010 (online)

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Zusammenfassung

Ziel: Die chronische virale Hepatitis kann man durch invasive oder nicht invasive Methoden einschätzen. Das Ziel dieser Arbeit war die Evaluation der Indikationen und Ergebnisse der transienten elastografischen (TE) Untersuchung der Leber von Patienten mit chronischer Hepatitis und Zirrhose. Material und Methoden: Im Rahmen der Evaluation wurden alle Lebersteifheitsmessungen (LSM) (FibroScan®) bewertet, die über einen Zeitraum von 2 Jahren durchgeführt wurden (2007 – 2009). Ergebnisse: 3459 TE-Bewertungen wurden hauptsächlich für die Einschätzung von Hepatitis C, HBV-Infektion (chronische Hepatitis und inaktive HBV-Träger), bivirale Hepatitis (B + C oder B + D), Zirrhose sowie an 176 normalen Probanden (um die normalen LSM-Werte zu ermitteln) durchgeführt. Von den 3459 Bewertungen konnten wir in 183 Fällen (5,3 %) keine gültige LSM erhalten, 93,9 % dieser Fälle wegen Übergewichtigkeit (BMI > 25 kg/m2). In 527 Fällen (16 %) war die Erfolgsrate ER (Erfolgsrate: Anzahl der gültigen Messungen/Gesamtzahl der Messungen) < 60 %. Die TE-Reproduzierbarkeit der Ergebnisse wurde in 287 Fällen analysiert. Die Reproduzierbarkeit der Ergebnisse einzelner Untersucher waren die ICC-Werte 0,985, 0,949 bzw. 0,874 und die gesamten ICC-Werte 0,982. Es wurden 596 Fälle von Zirrhose bewertet. Ein Höchstwert von 23,3 kPa wurde ermittelt, um die Anwesenheit von Ösophagusvarizen mindestens 2. Grades vorherzusagen. Schlussfolgerung: LSM mittels TE ist eine vielversprechende, nicht invasive Bewertungsmethode, die man in zahlreichen klinischen Situationen anwenden kann. In manchen klinischen Situationen ist diese Methode gut (Verdacht auf LC, Vorhersage signifikanter Fibrose), in anderen weniger etabliert (HBV chronische Hepatitis, Schwere des portalen Bluthochdrucks).

Abstract

Purpose: Chronic viral hepatopathies can be evaluated through invasive or noninvasive methods. The aim of this paper was to assess the indications and results of transient elastographic (TE) evaluation of the liver in patients with chronic viral hepatitis and cirrhosis. Materials and Methods: We retrospectively assessed all the liver stiffness measurements (LSM) (FibroScan®) performed over a two-year period (2007 – 2009). Results: 3,459 TE evaluations were made mainly for the assessment of: HCV hepatitis, HBV infection (chronic hepatitis and inactive HBV carriers), biviral hepatitis (B + C or B + D), cirrhosis and in 176 normal subjects (to establish the normal values of LSM). From the 3,459 FS evaluations, we could not obtain valid LSM in 183 cases (5.3 %). 93.9 % of the patients in the failure group were overweight (BMI > 25 kg/m2). In 527 cases (16 %) the SR (success rate = number of valid measurements/total number of measurements) was < 60 %. TE reproducibility was analyzed in 287 cases. The ICCs for the three operators were 0.985, 0.949, and 0.874 respectively, and the overall ICC was 0.982. 596 cases of cirrhosis were evaluated. A cut-off value of 23.3kPa was found to predict the presence of at least grade 2 esophageal varices. Conclusion: LSM by means of TE is a promising noninvasive evaluation method, which can be used in numerous clinical situations, some in which its value is well established (suspicion of LC, predicting significant fibrosis) and some in which its value is less known (HBV chronic hepatitis, inactive HBV carriers or severity of portal hypertension).

Key words

transient elastography - noninvasive evaluation - liver fibrosis

References

  • 1 Sandrin L, Fourquet B, Hasquenoph J M et al. Transient elastography: a new non-invasive method for assessment of hepatic fibrosis.  Ultrasound Med Biol. 2003;  29 1705-1713
    Google Scholar
  • 2 Castéra L, Vergniol J, Foucher J et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C.  Gastroenterology. 2005;  128 343-350
    Google Scholar
  • 3 Foucher J, Chanteloup E, Vergniol J et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study.  Gut. 2006;  55 403-408
    Google Scholar
  • 4 Berends M A, Snoek J, Jong E M et al. Biochemical and biophysical assessment of MTX-induced liver fibrosis in psoriasis patients: FibroTest predicts presence and FibroScan predicts the absence of significant liver fibrosis.  Liver Int. 2007;  27 639-645
    Google Scholar
  • 5 Lupşor de M, Badea R, Stefánescu H et al. Analysis of Histopathological Changes that Influence Liver Stiffness in Chronic Hepatitis C. Results from a Cohort of 324 patients.  J Gastrointest Liver Dis. 2008;  17 155-163
    Google Scholar
  • 6 Rockey D C. Noninvasive Assessment of Liver Fibrosis and Portal Hypertension with Transient Elastography.  Gastroenterology. 2008;  134 8-14
    Google Scholar
  • 7 Ogawa E, Furusyo N, Toyoda K et al. Transient elastography for patients with chronic hepatitis B and C virus infection: Non-invasive, quantitative assessment of liver fibrosis.  Hepatol Res. 2007;  37 1002-1010
    Google Scholar
  • 8 Guido M, Rugge M. Liver biopsy sampling in chronic viral hepatitis.  Semin Liver Dis Feb. 2004;  24 89-97
    Google Scholar
  • 9 Fraquelli M, Rigamonti C, Casazza G et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease.  Gut. 2007;  56 968-973
    Google Scholar
  • 10 Castera L, Foucher J, Bernard P H et al. Prevalence and factors associated with liver stiffness measurement failure and unreliable results using fibroscan: a 5 year experience in 13 369 examinations.  J Hepatol. 2009;  50 S52
    Google Scholar
  • 11 Ziol M, Handra-Luca A, Kettaneh A et al. Non-invasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C.  Hepatology. 2005;  41 48-54
    Google Scholar
  • 12 Ganne-Carrié N, Ziol M, Ledinghen de V et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases.  Hepatology. 2006;  44 1511-1517
    Google Scholar
  • 13 Coco B, Oliveri F, Maina A M et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases.  J Viral Hepat. 2007;  14 360-369
    Google Scholar
  • 14 Foucher J, Castéra L, Bernard P H et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations.  Eur J Gastroenterol Hepatol. 2006;  18 411-412
    Google Scholar
  • 15 Corpechot C, El Naggar A, Poujol-Robert A et al. Assessment of biliary fibrosis by transient eleastography in patients with PBC and PSC.  Hepatology. 2006;  43 1118-1124
    Google Scholar
  • 16 Lédinghen de V, Douvin C, Kettaneh A et al. Diagnosis of hepatic fibrosis and cirrhosis by transient elastography in HIV/hepatitic C virus-coinfected patients.  J Acquir Immune Defic Syndr. 2006;  41 175-179
    Google Scholar
  • 17 Lucidarme D, Foucher J, Le Bail B et al. Factors of accuracy of transient elastography (fibroscan) for the diagnosis of liver fibrosis in chronic hepatitis C.  Hepatology. 2009;  49 1083-1089
    Google Scholar
  • 18 Boursier J, Konaté A, Gorea G et al. Reproducibility of liver stiffness measurement by ultrasonographic elastometry.  lin Gastroenterol Hepatol. 2008;  6 1263-1269
    Google Scholar
  • 19 Roulot D, Czernichow S, Le Clésiau H et al. Liver stiffness values in apparently healthy subjects: Influence of gender and metabolic syndrome.  J Hepatol. 2008;  48 606-613
    Google Scholar
  • 20 Corpechot C, El Naggar A, Poupon R. Gender and liver: is the liver stiffness weaker in weaker sex?.  Hepatology. 2006;  44 513-514
    Google Scholar
  • 21 Arena U, Vizzutti F, Abraldes J G et al. Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C.  Gut. 2008;  57 1288-1293
    Google Scholar
  • 22 Marcellin P, Ziol M, Bedossa P et al. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B.  Liver Int. 2009;  29 242-247
    Google Scholar
  • 23 Vergara S, Macías J, Rivero A et al. The use of transient elastometry for assessing liver fibrosis in patients with HIV and hepatitis C virus co-infection.  Clin Infect Dis. 2007;  45 969-974
    Google Scholar
  • 24 Yoneda M, Fujita K, Inamori M et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD).  Gut. 2007;  56 1330-1331
    Google Scholar
  • 25 Gómez-Domínguez E, Mendoza J, Rubio S et al. Transient elastography: a valid alternative to biopsy in patients with chronic liver disease.  Aliment Pharmacol Ther. 2006;  24 513-518
    Google Scholar
  • 26 Talwalkar J A, Kurtz D M, Schoenleber S J et al. Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis.  Clin Gastroenterol Hepatol. 2007;  5 1214-1220
    Google Scholar
  • 27 Friedrich-Rust M, Ong M F, Martens S et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis.  Gastroenterol. 2008;  134 960-974
    Google Scholar
  • 28 Hilleret M N, Cheveau A, Renversez J C et al. Usefulness of FibroTest and FibroScan for the diagnosis of HBs inactive carriage.  J Hepatol. 2009;  50 S138
    Google Scholar
  • 29 Castera L, Bernard P H, Le Bail B et al. What is the best non-invasive method for early prediction of cirrhosis in chronic hepatitis C? Prospective comparison between Fibroscan and serum markers (Lok index, APRI, AST/ALT ratio, platelet count and Fibrotest).  Hepatology. 2007;  46 581A
    Google Scholar
  • 30 Chan H L, Wong G L, Choi P C et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B.  Journal of Viral Hepatitis. 2009;  16 36-44
    Google Scholar
  • 31 Castéra L, Le Bail B, Roudot-Thoraval F et al. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: Comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores.  J Hepatol. 2009;  50 59-68
    Google Scholar
  • 32 Bureau C, Metivier S, Peron J M et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease.  Aliment Pharmacol Ther. 2008;  27 1261-1268
    Google Scholar

Prof. Ioan Sporea

Gastroenterology, University of Medicine and Pharmacy Timisoara

Iosif Bulbuca 156

300731 Timisoara

Romania

Telefon: ++ 40/2 56/30 94 55

Fax: ++ 40/2 56/48 80 03

eMail: isporea@umft.ro

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