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.