Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study
- J Foucher1,
- E Chanteloup1,
- J Vergniol1,
- L Castéra1,
- B Le Bail2,
- X Adhoute1,
- J Bertet1,
- P Couzigou1,
- V de Lédinghen3
- 1Service d’Hépato-Gastroentérologie, Centre d’Investigation de la Fibrose hépatique, Hôpital Haut Lévêque, CHU Bordeaux, Pessac, France
- 2INSERM E362 IFR 66, Université Victor Segalen, Bordeaux, France, and Laboratoire d’Anatomie-Pathologique, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
- 3Service d’Hépato-Gastroentérologie, Centre d’Investigation de la Fibrose hépatique, Hôpital Haut Lévêque, CHU Bordeaux, Pessac, France, and INSERM E362 IFR 66, Université Victor Segalen, Bordeaux, France
- Correspondence to:
Professor V de Lédinghen
Service d’Hépato-Gastroentérologie, Hôpital Haut Lévêque, Avenue Magellan, 33604 Pessac, France;
- Accepted 22 June 2005
- Revised 16 May 2005
- Published Online First 14 July 2005
Background: Transient elastography (FibroScan) is a new, non-invasive, rapid, and reproducible method allowing evaluation of liver fibrosis by measurement of liver stiffness. In cirrhotic patients, liver stiffness measurements range from 12.5 to 75.5 kPa. However, the clinical relevance of these values is unknown. The aim of this prospective study was to evaluate the accuracy of liver stiffness measurement for the detection of cirrhosis in patients with chronic liver disease.
Methods: A total of 711 patients with chronic liver disease were studied. Aetiologies of chronic liver diseases were hepatitis C virus or hepatitis B virus infection, alcohol, non-alcoholic steatohepatitis, other, or a combination of the above aetiologies. Liver fibrosis was evaluated according to the METAVIR score.
Results: Stiffness was significantly correlated with fibrosis stage (r = 0.73, p<0.0001). Areas under the receiver operating characteristic curve (95% confidence interval) were 0.80 (0.75–0.84) for patients with significant fibrosis (F>2), 0.90 (0.86–0.93) for patients with severe fibrosis (F3), and 0.96 (0.94–0.98) for patients with cirrhosis. Using a cut off value of 17.6 kPa, patients with cirrhosis were detected with a positive predictive value and a negative predictive value (NPV) of 90%. Liver stiffness was significantly correlated with clinical, biological, and morphological parameters of liver disease. With an NPV >90%, the cut off values for the presence of oesophageal varices stage 2/3, cirrhosis Child-Pugh B or C, past history of ascites, hepatocellular carcinoma, and oesophageal bleeding were 27.5, 37.5, 49.1, 53.7, and 62.7 kPa, respectively.
Conclusion: Transient elastography is a promising non-invasive method for detection of cirrhosis in patients with chronic liver disease. Its use for the follow up and management of these patients could be of great interest and should be evaluated further.
- HCV, hepatitis C virus
- HBV, hepatitis B virus
- ROC, receiver operating characteristic
- AUROC, area under the ROC curve
- AST, aspartate aminotransferase
- ALT, alanine aminotransferase
- liver stiffness
- portal hypertension
- oesophageal varices
- liver biopsy
- hepatocellular carcinoma
Published online first 14 July 2005
Conflict of interest: None declared.