Liver stiffness measurement (LSM) based on transient elastography (TE, FibroScan) is gaining in popularity for noninvasive assessment of liver fibrosis. However, LSM has limitations, which have not yet been thoroughly evaluated. We prospectively investigated the frequency and determinants of LSM failure and unreliable results over a 5-year period, based on 13,369 examinations (134,239 shots). LSM failure was defined as zero valid shots, and unreliable examinations were defined as fewer than 10 valid shots, an interquartile range (IQR)/LSM greater than 30%, or a success rate less than 60%. LSM failure occurred in 3. recently reported to define normality. 3 Liver stiffness measured by means of TE correlates with hepatic fibrosis stages, both in chronic hepatitis C 4,5 and in other chronic liver diseases. [6][7][8][9][10][11][12][13][14] The diagnostic accuracy of liver stiffness measurement (LSM) is excellent for cirrhosis, 15-17 and, among noninvasive methods, TE appears to be the most accurate for early detection of cirrhosis. 18 Because TE is a user-friendly technique that can be performed rapidly (less than 5 minutes) at the bedside, with immediate results and high patient acceptance, it is likely to become an important tool in clinical practice in the near future. [19][20][21][22] However, TE has limitations: LSM results may be influenced by acute liver injury (as reflected by ALT flares), with a risk of overestimating liver stiffness, 6,23,24 and also by extrahepatic cholestasis. 25 In addition, LSM is difficult in patients who are obese or who have narrow intercostal spaces, and impossible in patients with ascites (in whom the diagnosis of cirrhosis is obvious). The TE interpreta-

No abstract

No abstract

No abstract

No abstract

No abstract

Relatively high percentages of real-life, treatment-experienced patients with HCV genotype 1 infection and cirrhosis respond to the combination of peginterferon and ribavirin with telaprevir or boceprevir. However, side effects are frequent and often severe. Baseline levels of albumin and platelet counts can be used to guide treatment decisions. ClinicalTrials.gov number: NCT01514890.

Liver stiffness measurement using FibroScan is a novel rapid and non-invasive technique that evaluates liver fibrosis. In some cases, however, no elasticity measurement is obtained. The aim of this prospective study was to assess the prevalence and factors associated with failure (no value obtained after 10 measurements) of liver stiffness measurement in patients with chronic liver disease. Two thousand one hundred and fourteen liver stiffness measurements were analyzed. Failure was observed in 96 cases (4.5%). Failure was not associated with operator, gender, or transaminase level. By multivariate analysis, the only factor associated with failure was body mass index greater than 28 (odds ratio, 10.0 degrees; 95% confidence interval, 5.7-17.9, P=0.001). In conclusion, liver stiffness is a good method for the evaluation of liver fibrosis that is feasible in more than 95% of patients. Other non-invasive methods such as biochemical methods or liver biopsy could therefore be used only in patients with failure of FibroScan examination.