Transient Elastography Detects Cirrhosis in Chronic Liver Disease

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Transient Elastography Detects Cirrhosis in Chronic Liver Disease

By Will Boggs, MD

NEW YORK (Reuters Health) Mar 09 - 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.

http://www.medscape.com/viewarticle/525628

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