Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases

Abstract

A proper diagnosis of cirrhosis is essential for the management of patients with chronic liver diseases. We assessed the accuracy of liver stiffness measurement by Fibroscan for the diagnosis of cirrhosis in 1,257 patients with chronic liver diseases of various causes enrolled in a prospective multicenter study as well as clarified causes of discrepancies between liver histology and Fibroscan. One hundred thirty-two patients had unsuitable biopsy specimens, and 118 had unreliable liver stiffness measurements. Because 232 patients overlapped with a previous study, analysis was performed in the 775 new patients then derived in the whole population (1,007; 165 cirrhosis). Diagnostic accuracy was assessed by receiver operator curve (ROC) analysis. Liver samples were re-analyzed in case of discrepancies. The area under the ROC (AUROC) was 0.95 (95% CI, 0.93-0.96) for the diagnosis of cirrhosis in either 775 or 1,007 patients. The cutoff value with optimal diagnosis accuracy was 14.6 kPa in 1,007 patients (positive and negative predictive values, 74% and 96%) with discrepancies among the etiological groups. Eighty patients were misclassified: (1) among 45 patients without cirrhosis with liver stiffness 14.6 kPa or greater, 27 (60%) had extensive fibrosis and 10 (22%) significant perisinusoidal fibrosis; and (2) among 35 patients with cirrhosis and liver stiffness less than 14.6 kPa, 10 (29%) had a macronodular pattern and 25 (71%) either none or mild activity. In conclusion, Fibroscan is a reliable method for the diagnosis of cirrhosis in patients with chronic liver diseases, better at excluding than at predicting cirrhosis using a threshold of 14.6 kPa. False-negatives are mainly attributable to inactive or macronodular cirrhosis. (HEPATOLOGY 2006;44:1511-1517

Assessment of Hepatic Fibrosis With Magnetic Resonance Elastography

“…The mean liver biopsy length was 2.0 ± 0.9 cm (range 0.9 -5.3 cm). The mean number of complete portal tracts available for assessment was 10 ± 4 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Stage of fibrosis was noted as 0 to 1 (40%), 2 to 3 (20%), and 4 (40%).…”

“…The stiffness of the liver is then proportional to the square of the shear wave velocity. From seven large cross-sectional investigations involving over 2000 individual patients with chronic viral hepatitis C or B in Europe, the sensitivity and specificity of ultrasound-based elastography for detecting stage 4 fibrosis (cirrhosis) was greater than 90% (18). The precision of these estimates is less well-established for patients with NAFLD (18) and chronic cholestatic liver disease (19).…”

“…From seven large cross-sectional investigations involving over 2000 individual patients with chronic viral hepatitis C or B in Europe, the sensitivity and specificity of ultrasound-based elastography for detecting stage 4 fibrosis (cirrhosis) was greater than 90% (18). The precision of these estimates is less well-established for patients with NAFLD (18) and chronic cholestatic liver disease (19). Since the region assessed with transient elastography encompasses a 1 × 4 cm cylindrical area (approximately 1/100 th of the entire hepatic parenchyma) with a measurement depth between 25 mm and 65 mm below the skin, and confined to the peripheral part of the right liver lobe, there is a potential for sampling errors.…”

Non-invasive assessment of liver fibrosis in chronic hepatitis C

“…For instance, in a population of 1,007 patients with different chronic liver diseases, a cutoff value of 14.6 kPa yielded positive and negative predictive values of 74 and 96%, respectively [76].…”

Liver stiffness changes during meal times

“…1 Previously, increased liver stiffness (LS) has been shown to reflect liver inflammation from acute hepatitis, 2,3 congestion from increased central venous pressure, 4 and extrahepatic cholestasis. 5 While food intake has also been previously demonstrated to increase LS, 6 the most recent article by Arena et al 7 further illustrates the timeframe and pattern of this increase in LS.…”