Clinical

Transient elastography detects cirrhosis in chronic liver disease

Last Updated: 2006-03-09 15:00:23 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - FibroScan, a noninvasive elastography technique that measures liver stiffness, accurately detects cirrhosis in patients with chronic liver disease, according to a report in the March issue of Gut.

"This paper should be very useful in clinical practice for the management of cirrhotic patients," Dr. Victor de Ledinghen from Hopital Haut Leveque, Bordeaux, France told Reuters Health.

The FibroScan system applies a low amplitude, low frequency vibration to the tissue, which propagates an elastic shear wave through the liver. The speed of the propagation, which increases with increasing tissue hardness, is measured with pulsed ultrasound.

Recently, Dr. de Ledinghen and colleagues reported that FibroScan detects liver fibrosis and cirrhosis in patients coinfected with HIV and HCV (See Reuters Health report, "Elastography noninvasively assesses hepatic fibrosis in HIV/HVC patients" 2006-02-24 13:16:48.)

In the current study, the researchers investigated the accuracy of the system in detecting cirrhosis in 711 patients with chronic liver disease. Median liver stiffness was significantly higher in patients with cirrhosis (31.1 kilopascals) than in patients with severe fibrosis (18.7 kPa), the authors report.

Based on the stiffness measurement distributions, the researchers established cutoff levels of 7.2 kPa for moderate fibrosis, 12.5 kPa for severe fibrosis, and 17.6 kPa for cirrhosis. "With a cutoff value of 17.6 kPa, negative and positive predictive values for the diagnosis of cirrhosis were 92% and 91%, respectively," the team writes.

For patients with severe fibrosis, the investigators also established cutoffs for the presence of stage 2/3 esophageal varices (27.5 kPa), cirrhosis Child BC (37.5 kPa), hepatocellular carcinoma (53.7 kPa), and esophageal bleeding (62.7 kPa).

"The results of the present study conducted prospectively in a large cohort of patients with chronic liver disease showed that transient elastography is an efficient technique for the diagnosis of cirrhosis and its severity," the researchers conclude.

"A longitudinal cohort study needs to be performed to predict the complications of cirrhosis using FibroScan so that screening for complications of cirrhosis, and close follow-up, could be performed," they add.

"FibroScan is, so far, the best non-invasive method for the evaluation of liver fibrosis and cirrhosis and for the evaluation of the severity of cirrhosis," Dr. de Ledinghen said. "At this time, many studies are ongoing for other liver diseases: HCV transplanted patients, alcoholic patients, and so on. FibroScan could be very useful for the follow-up of patients."

Gut 2006;55:403-408.