Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C

Umberto Arena ¹, Francesco Vizzutti ¹, Juan Abraldes ², Giampaolo Corti ³, Cristina Stasi ³, Stefania Moscarella ¹, Stefano Milani ⁴, Elisabetta Lorefice ⁴, Antonio Petrarca ¹, Giacomo Laffi ¹, Roberto Giulio Romanelli ¹, Jaime Bosch ², Fabio Marra ¹ and Massimo Pinzani ^5*

¹ Dipartimento di Medicina Interna, Universit� di Firenze, Italy
² Liver Unit, Hospital Clinic, University of Barcelona, Spain
³ Malattie Infettive e Tropicali Universit� di Firenze, Italy
⁴ Dipartimento di Fisiopatologia Clinica, Universit� di Firenze, Italy
⁵ Dipartimento di Medicina Interna, Unive, Italy

^* To whom correspondence should be addressed. E-mail: m.pinzani{at}dmi.unifi.it.

Accepted 15 April 2008

Abstract

Background: Transient elastography (TE) has received increasing attention as a means to evaluate of disease progression in chronic liver disease patients. Aim: To assess the value of TE for the prediction of fibrosis stage.

Methods: Liver biopsy and TE were performed in 150 consecutive patients with chronic HCV-related hepatitis (92 men and 58 women, age 50.6±12.5) on the same day. Necro-inflammatory activity and the degree of steatosis at biopsy were also evaluated.

Results: The AUC for the prediction of significant fibrosis (F2), advanced fibrosis (F3) or cirrhosis were 0.91, 0.99, and 0.98, respectively. Calculation of multilevel likelihood ratios (LRs) showed that values of TE <6 or 12, <9 or 12, and <12 or 18, clearly indicated the absence or the presence of significant fibrosis, advanced fibrosis, and cirrhosis, respectively. Intermediate values could not be reliably associated with the absence or presence of the target condition. The presence of inflammation significantly affected TE measurements in non-cirrhotic patients (P<0.0001), even after adjusting for the fibrosis stage. Importantly, TE measurements were not influenced by the degree of steatosis.

Conclusions: TE is more suitable for the identification of patients with advanced fibrosis than of those with cirrhosis or significant fibrosis. In subjects in which LRs are not optimal to provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. Necro-inflammatory activity, but not steatosis, strongly and independently influences TE measurement in non-cirrhotic patients.