Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD)

Yoneda, Masato; Fujita, Koji; Inamori, Masahiko; Nakajima, Atsushi; Tamano, Masaya; Hiraishi, Hideyuki

doi:10.1136/gut.2007.126417

Cited by 240 publications

(173 citation statements)

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“…36 LSM values increase with increasing stages of fibrosis in NAFLD. 37 Significant correlation was also demonstrated between LSM and stages of fibrosis, 38 which was also reproduced in our study.…”

Section: Discussionsupporting

confidence: 70%

“…Transient elastography, though not well validated for measuring fibrosis in NAFLD, has been used in liver disease of different etiologies. [36][37][38] Despite being used in NAFLD, the issue of whether steatosis and inflammation influence the stiffness value is not yet settled. 27 However, studies that included liver diseases of various etiologies report nonuniformity of cutoff values for exclusion of cirrhosis among different etiologies.…”

Section: Discussionmentioning

confidence: 99%

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Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease

et al. 2010

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There is a paucity of community-based epidemiological data on nonalcoholic fatty liver (NAFL) among nonaffluent populations in developing countries. Available studies are radiological and/or biochemical and lack histological assessment, limiting their strength. We conducted a prospective epidemiological study comprising a 1:3 subsample of all adult (>18 years) inhabitants of a rural administrative unit of West Bengal, India. Subjects positive for hepatitis B virus and/or hepatitis C virus infection and consuming any amount of alcohol were excluded. Diagnosis of NAFL was by dual radiological screening protocol consisting of ultrasonographic and computed tomographic examination of the liver. Transient elastographic examination and liver biopsy were performed in a subset to identify significant liver disease. The risk factors of having NAFL were analyzed. A total of 1,911 individuals were analyzed, 7% of whom were overweight and 11% of whom had abdominal obesity. The prevalence of NAFL, NAFL with elevated alanine aminotransferase, and cryptogenic cirrhosis was 8.7%, 2.3%, and 0.2%, respectively. Seventy-five percent of NAFL subjects had a body mass index (BMI) <25 kg/m 2 , and 54% were neither overweight nor had abdominal obesity. The subjects with the highest risk of having NAFL were those with a BMI >25 kg/m 2 (odds ratio 4.3, 95% confidence interval 1.6-11.5). Abdominal obesity, dysglycemia (fasting plasma glucose >100 mg/dL or elevated homeostatic model assessment of insulin resistance), and higher income were the other risk factors. Even having a normal BMI (18.5-24.9 kg/m 2 ) was associated with a 2-fold increased risk of NAFL versus those with a BMI <18.5 kg/m 2

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease

et al. 2010

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“…TE accurately predicts the presence of fibrosis and cirrhosis in several clinical settings, [7][8][9][10][11][12] including HIV/HCV-coinfection. [13][14][15] Besides, LS provides additional information in the setting of ESLD.…”

mentioning

confidence: 99%

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

Merchante

Rivero‐Juárez

Téllez³

et al. 2012

Hepatology

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on behalf of the Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS 40 kPa (P 5 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P 5 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P 5 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P 5 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P 5 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P 5 0.08) was of borderline significance. Conclusion: LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score. (HEPATOLOGY 2012;56:228-238)

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“…Using the 5th and 95th centiles normal values were set between 3.3-7.8 KPa in women and 3.8-8 KPa in men. In the main studies of TE in chronic liver disease [13][14][15][16][17][18] the mean cutoff for significant fibrosis was established between 7 and 8 KPa, (Table 2), which is higher than the 95th centile of normal subjects. TE can thus reliably distinguish normal individuals from patients with significant fibrosis, although overlap exists with mild fibrosis.…”

mentioning

confidence: 99%

Is transient elastography a useful tool for screening liver disease?

Poggio¹,

Colombo²

2009

WJG

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Transient elastography (TE) is a new non invasive tool for measuring liver stiffness, which is correlated to the histologic stage of liver fibrosis. Several studies in chronic liver disease (CLD) have determined a good accuracy of TE in predicting significant fibrosis and an optimal accuracy in predicting cirrhosis. Normal liver stiffness ranges between 3.3-7.8 KPa and using a cut off of 7.1 KPa, significant fibrosis and cirrhosis can be excluded with a very high negative predictive value (NPV). Positive predictive value (PPV) for the diagnosis of cirrhosis is lower using just a single scan but increases to 90% if high stiffness values are confirmed by a second independent scan. However the presence of fatty liver and metabolic syndrome slightly increases the readings and may reduce the accuracy of the test. It is uncertain if this increase is related to the presence of steatofibrosis or if it is caused by steatosis itself. TE can be used in screening patients attending the liver clinics to identify those with significant fibrosis or cirrhosis and may be particularly useful in discriminating HBV inactive carriers from chronic hepatitis B patients. TE, however, is not reliable in predicting the presence of esophageal varices in cirrhotics. Another potential indication for TE is the systematic screening of populations at high risk for CLD, such as intravenous drug users and alcoholics, but further studies are needed to determine its diagnostic accuracy in these settings. INTRODUCTIONTransient elastography (TE) is a new non invasive tool for measuring liver stiffness, which is correlated to the histologic stage of liver fibrosis [1] . The device (Fibroscan) generates an elastic wave by means of a vibrator applied to the thoracic wall at the level of the right liver lobe. The vibrator produces a shot and a low amplitude shear wave propagating through the liver parenchyma. The velocity of propagation is directly proportional to liver stiffness and is automatically calculated by the instrument. The range of measurements, expressed in kilopascals, varies from 2.5 to 74 KPa.Many studies have been published on the use of TE in patients with already diagnosed chronic liver disease (CLD) but few have addressed the issue of its possible use as a first line examination in the liver clinic or in facilities where patients at risk of liver disease are attending. HOW TO TAKE AND INTERPRET THE MEASUREMENTSIn order to obtain valid and reproducible measurements the probe should be placed at the center of the right liver lobe, two intercostal spaces below the upper liver margin and at the level of the anterior or middle axillary line. If measurements are taken below this point and too close to the lower liver edge both the percentage of valid shots and the median stiffness tend to decrease [2] . Ultrasound assistance to locate the upper liver margin is usually unnecessary if the patient is reasonably thin because the liver can be recognized by percussion alone. The device incorporates an M-mode window enabling the ope...

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Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD)

Cited by 240 publications

References 4 publications

Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease

Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

Is transient elastography a useful tool for screening liver disease?

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