Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease

Abstract

Objective: Transient elastography (TE) is gaining popularity as a non-invasive method for predicting liver fibrosis, but intraobserver and interobserver agreement and factors influencing TE reproducibility have not been adequately assessed. This study investigated these aspects. Setting: Tertiary referral liver unit. Patients: Over a 4-month period, 200 patients with chronic liver disease (CLD) with varying aetiology consecutively underwent TE and liver biopsy. Interventions: TE was performed twice by two different operators either concomitantly or within 3 days of the bioptic procedure (METAVIR classification). Main outcome measures: Intraobserver and interobserver agreement were analysed using the intraclass correlation coefficient (ICC) and correlated with different patient-related and liver disease-related covariates. Results: 800 TE examinations were performed, with an indeterminate result rate of 2.4%. The overall interobserver agreement ICC was 0.98 (95% CI 0.977 to 0.987). Increased body mass index (.25 kg/m 2 ), steatosis, and low staging grades (fibrosis (F) stage ,2) were significantly associated with reduced ICC (p,0.05). Intraobserver agreement ICC was 0.98 for both raters. Using receiver operating characteristic curves, three diagnostic TE thresholds were identified: .7.9 kPa for F>2, .10.3 for F>3 and .11.9 for F = 4. TE values assessed by the two raters fell within the same cut-off of fibrosis in 88% of the cases for F>2, in 92% for F>3 and 91% for F = 4. Conclusions: TE is a highly reproducible and user-friendly technique for assessing liver fibrosis in patients with CLD. However, because TE reproducibility is significantly reduced (p,0.05) in patients with steatosis, increased BMI and lower degrees of hepatic fibrosis, caution is warranted in the clinical use of TE as a surrogate for liver biopsy.

Non-invasive assessment of liver fibrosis in chronic hepatitis C

“…Indeed, as previously mentioned, the extent of necro-inflammatory activity has been shown to influence TE measurements in patients with viral hepatitis with a steady increase of liver stiffness values in parallel with the degree of histological activity [66,70,100]. Consistent with these results, the risk of overestimating liver stiffness values has been reported in case of ALT flares in patients with acute viral hepatitis or chronic hepatitis B [101][102][103], as well as in cases of extrahepatic cholestasis [104] or congestive heart failure [105].…”

“…TE reproducibility has been shown to be excellent for both inter-observer and intraobserver agreement, with intra-class correlation coefficients (ICC) of 0.98 [66,67]. However, inter-observer agreement was significantly reduced in patients with lower degrees of hepatic fibrosis, with hepatic steatosis, and with increased body mass index [66], as well as for liver stiffness values \9 kPa [67].…”

Liver stiffness in the hepatitis B virus carrier: A non-invasive marker of liver disease influenced by the pattern of transaminases

“…Transient elastog raphy [1] is an easy to perfor m, reproducible method for the rapid and objective evaluation of LS in clinical practice [2,16] and it is proposed as a reliable, non-invasive, surrogate marker of fibrosis [3][4][5][6][7]17,18] . In fact, LS is a physical parameter that correlates primarily with fibrosis, but it is influenced also by other factors that modify the elasticity of the liver, such as significant variations of inflammatory infiltrate, edema and vascular congestion of the liver [8][9][10]19] .…”

A grapefruit a day for patients infected with hepatitis C?

“…[2][3][4][5] CYP3A4 is responsible for the metabolism of more than 50% of approved drugs, and consumption of grapefruit-containing products has the potential to cause dangerous food-drug interactions with many medications HCV patients may be taking. 6 Grapefruit is classified by the U.S. Food and Drug Administration as a moderate inhibitor of CYP3A4, which is defined as any agent that increases the systemic exposure of drugs metabolized through this pathway by two-fold to five-fold.…”