Original article—liver, pancreas, and biliary tract
Assessment of Fibrosis by Transient Elastography Compared With Liver Biopsy and Morphometry in Chronic Liver Diseases

https://doi.org/10.1016/j.cgh.2008.02.038Get rights and content

Background & Aims: Liver stiffness measurement (LSM) with transient elastography (Fibroscan) can accurately diagnose advanced liver fibrosis, but its performance in early liver fibrosis is less satisfactory. We aimed to study the diagnostic performance of LSM for histologic bridging fibrosis and cirrhosis in various chronic liver diseases and to investigate the effects of liver fibrosis distribution on LSM. Methods: We prospectively studied consecutive patients with chronic liver diseases undergoing liver biopsy and transient elastography examinations. Morphometric analysis was performed to evaluate the distribution of liver fibrosis. Results: One hundred thirty-three patients (50% chronic hepatitis B, 14% chronic hepatitis C, and 24% nonalcoholic fatty liver disease) were studied. Morphometric analysis revealed a higher correlation between LSM and pericellular fibrosis (r = 0.43) than periportal (r = 0.21) or perivenular fibrosis (r = 0.25). Area under receiver operating characteristic curve (ROC) of LSM for bridging fibrosis was 0.87 (95% confidence interval, 0.81–0.93) and for cirrhosis was 0.89 (95% confidence interval, 0.83–0.94). Higher LSM was associated with higher serum ALT level. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM. The area under ROC curve of LSM for cirrhosis was lower among patients who had ALT above the upper limit of normal (0.86) as compared with that of patients with normal ALT levels (0.93, P = .03). Conclusions: Transient elastography can diagnose severe fibrosis because of its good correlation with pericellular fibrosis. Transient elastography might overestimate liver fibrosis when ALT is elevated.

Section snippets

Patients

We prospectively recruited consecutive adult patients with chronic liver diseases who were clinically indicated for liver biopsy examination in our hospital in 12 months from July 2006–June 2007. The indications of liver biopsy were identifying the etiology of liver disease and assessing the severity of liver fibrosis and inflammation before treatment. We excluded patients who were chronic drinkers (with regular consumption of at least 20 g of alcohol weekly), and who had decompensated liver

Patients

One hundred eighty-two patients underwent liver biopsy within the study period; 133 (73%) patients fulfilled the criteria for data analysis. Thirty-seven patients were excluded because of inadequate liver biopsy samples size (<1.5 cm and/or <6 portal tracts), 10 patients were excluded because of unsuccessful LSM (3 patients were overweight and 6 patients were obese), and 2 patients were excluded for both reasons (both patients were obese). Overall, 38 of the 182 patients (21%) had a BMI ≥28 kg/m

Discussion

In this study, we demonstrated that LSM with transient elastography (Fibroscan) had good correlation with histologic liver fibrosis in patients with chronic liver diseases. With morphometric analysis, we showed that LSM correlated better with pericellular fibrosis than periportal or perivenular fibrosis. This phenomenon might explain why LSM is accurate in detecting bridging fibrosis and cirrhosis but not milder degree of liver fibrosis. LSM tends to overestimate the liver fibrosis in patients

References (42)

  • P. Bedossa et al.

    An algorithm for grading of activity in chronic hepatitis C

    Hepatology

    (1996)
  • E.M. Brunt et al.

    Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions

    Am J Gastroenterol

    (1999)
  • L. Sandrin et al.

    Transient elastography: a new noninvasive method for assessment of hepatic fibrosis

    Ultrasound Med Biol

    (2003)
  • A.Y. Hui et al.

    Histological progression of nonalcoholic fatty liver disease in Chinese patients

    Aliment Pharmacol Ther

    (2005)
  • Y.F. Liaw et al.

    Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2005 update

    Liver Int

    (2005)
  • A.S. Lok et al.

    Chronic hepatitis B

    Hepatology

    (2007)
  • A.A. Bravo et al.

    Liver biopsy

    N Engl J Med

    (2001)
  • L. Castera et al.

    Pain experienced during percutaneous liver biopsy

    Hepatology

    (1999)
  • Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C

    Hepatology

    (1994)
  • A.Y. Hui et al.

    Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model

    Am J Gastroenterol

    (2005)
  • T.C. Poon et al.

    Prediction of liver fibrosis and cirrhosis in chronic hepatitis B infection by serum proteomic fingerprinting: a pilot study

    Clin Chem

    (2005)
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    Dr Francis K. L. Chan received an independent research grant and a consulting fee from Pfizer and paid lecture fees by TAP Pharmaceuticals. Dr Joseph J. Y. Sung received consulting fees from the National Health Research Institutes of Taipei, The Hong Kong Police Force, Lippincott Williams & Wilkins, and the Hong Kong College of Physicians and paid lecture fees by AstraZeneca Hong Kong Limited, GSK Pharmaceuticals International, and the American Society for Gastrointestinal Endoscopy. Dr Henry L. Y. Chan is a member of the advisory boards of Novartis and Schering-Plough.

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