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Unified interpretation of liver stiffness measurement by M and XL probes in non-alcoholic fatty liver disease
  1. Vincent Wai-Sun Wong1,2,
  2. Marie Irles3,
  3. Grace Lai-Hung Wong1,2,
  4. Sarah Shili3,
  5. Anthony Wing-Hung Chan4,
  6. Wassil Merrouche3,
  7. Sally She-Ting Shu1,2,
  8. Juliette Foucher3,
  9. Brigitte Le Bail5,6,
  10. Wah Kheong Chan7,
  11. Henry Lik-Yuen Chan1,2,
  12. Victor de Ledinghen3,6
  1. 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
  2. 2 State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
  3. 3 Centre d’Investigation de la Fibrose Hépatique, Bordeaux University Hospital, Pessac, France
  4. 4 Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, New Territories, Hong Kong
  5. 5 Pathology Unit, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
  6. 6 INSERM U1053, Bordeaux University, Bordeaux, France
  7. 7 Department of Medicine, Gastroenterology and Hepatology Unit, University of Malaya, Kuala Lumpur, Malaysia
  1. Correspondence to Dr Vincent Wai-Sun Wong, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; wongv{at} and Prof Victor de Ledinghen, Centre d’Investigation de la Fibrose Hépatique, Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, 33604 Pessac, France; victor.deledinghen{at}


Objective The latest model of vibration-controlled transient elastography (VCTE) automatically selects M or XL probe according to patients’ body built. We aim to test the application of a unified interpretation of VCTE results with probes appropriate for the body mass index (BMI) and hypothesise that this approach is not affected by hepatic steatosis.

Design We prospectively recruited 496 patients with non-alcoholic fatty liver disease who underwent VCTE by both M and XL probes within 1 week before liver biopsy.

Results 391 (78.8%) and 433 (87.3%) patients had reliable liver stiffness measurement (LSM) (10 successful acquisitions and IQR:median ratio ≤0.30) by M and XL probes, respectively (p<0.001). The area under the receiver operating characteristic curves was similar between the two probes (0.75–0.88 for F2–4, 0.83–0.91 for F4). When used in the same patient, LSM by XL probe was lower than that by M probe (mean difference 2.3 kPa). In contrast, patients with BMI ≥30 kg/m2 had higher LSM regardless of the probe used. When M and XL probes were used in patients with BMI <30 and ≥30 kg/m2, respectively, they yielded nearly identical median LSM at each fibrosis stage and similar diagnostic performance. Severe steatosis did not increase LSM or the rate of false-positive diagnosis by XL probe.

Conclusion High BMI but not severe steatosis increases LSM. The same LSM cut-offs can be used without further adjustment for steatosis when M and XL probes are used according to the appropriate BMI.

  • liver cirrhosis
  • liver biopsy
  • fatty liver
  • nonalcoholic steatohepatitis
  • hepatic fibrosis

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  • Contributors VW-SW, WKC and VdL designed the study. VW-SW, MI, GL-HW, SS, AW-HC, WM, SS-TS, JF, BLB and VdL collected patient data. AW-HC and BLB performed histological assessment. HL-YC and VdL provided administrative support. VW-SW and VdL performed statistical analysis and drafted the manuscript. All authors approved the final version of the manuscript.

  • Funding This project was partially supported by a grant from the Research Grant Council of the Hong Kong SAR Government (Project Ref 14108916).

  • Competing interests VW-SW, GL-HW, HL-YC and VdL have served as speakers for Echosens.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by the institutional review boards of Bordeaux University Hospital, France and Prince of Wales Hospital, Hong Kong.

  • Provenance and peer review Not commissioned; externally peer reviewed.