Overestimation Of Fibrosis Research Articles

The role of elastography in alcoholic liver disease: fibrosis staging and confounding factors, a review of the current literature.

Alcohol-related liver disease (ALD) was estimated to have a prevalence of 2% among the USA population. Since severe fibrosis in compensated patients is the main predictor of long-term survival, it is of utmost importance to early detect patients with severe fibrosis before decompensation occurs. Liver elastography has been used to stage liver fibrosis. However, there is a widespread lack in guidelines for the correct use of liver stiffness (LS) in ALD. A structured search was carried out on MEDLINE/PubMed database. From the original 225 research articles identified, only 12 studies met the inclusion criteria, with 10 studies being eventually included. According to reported data, patients with aspartate aminotransferase (AST)>100 IU/L and 50 IU/L showed significantly higher values of LS if compared to patients with the same fibrosis stage. Also, excessive alcohol consumption greatly influences elastography, leading to false fibrosis staging. When LS values >5-6 kPa are detected, several aspects should be taken into account. First of all, the patient should be asked about the current alcohol consumption (i.e. active vs. abstinence, determination of abstinence period, and quantification of alcohol intake), and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. Secondly, clinicians should check liver transaminases level, and if AST are above 100 IU/L, they should be aware of a possible overestimation of fibrosis. However, whether transaminases-adapted cut-off values should be used for ad-hoc decisions in patients with no time or option to withdraw from alcohol consumption is still a matter of debate. We hope that our review article may serve as a reference point in the prospect of futures guidelines.

The role of elastography in alcoholic liver disease: fibrosis staging and confounding factors. A review of the current literature

Introduction Alcohol-related liver disease (ALD) was estimated to have a prevalence of 2% among the United States population. Since severe fibrosis in compensated patients is the main predictor of long-term survival, it is of utmost importance to early detect patients with severe fibrosis before decompensation occurs. Liver elastography has been used to stage liver fibrosis. However, there is a widespread lack in guidelines for the correct use of liver stiffness (LS) in ALD. Evidence acquisition A structured search was carried out on MEDLINE/PubMed database. From the original 225 research articles identified, only 12 studies met the inclusion criteria, with 10 studies being eventually included. Evidence synthesis According to reported data, patients with aspartate aminotransferase (AST) > 100 IU/L and 50 IU/L showed significantly higher values of LS if compared to patients with the same fibrosis stage. Also, excessive alcohol consumption greatly influences elastography, leading to false fibrosis staging. When LS values > 5-6 kPa are detected, several aspects should be taken into account. First of all, the patient should be asked about the current alcohol consumption (i.e., active vs. abstinence, determination of abstinence period, and quantification of alcohol intake), and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. Secondly, clinicians should check liver transaminases level, and if AST are above 100 IU/L, they should be aware of a possible overestimation of fibrosis. However, whether transaminases-adapted cut-off values should be used for ad hoc decisions in patients with no time or option to withdraw from alcohol consumption is still a matter of debate. Conclusions We hope that our review article may serve as a reference point in the prospect of futures guidelines.

PTU-079 Effect of Inflammation on Liver Stiffness in Active Autoimmune Liver Disease: A Simultaneous Biopsy-Controlled Study Using Acoustic Radiation Force Impulse (ARFI) Elastography

Introduction ARFI elastography (virtual touch quantification,VTq ™) is a well validated technique for non-invasive assessment of liver fibrosis in viral hepatitis. The interpretation of shear velocity readings in active autoimmune liver disease (AILD) may be affected by a number of factors. However, few studies have specifically examined the effect of inflammation on liver stiffness (LS) in this group. We report the results of a preliminary study in which LS and histology have been sampled simultaneously from the same region of liver tissue in a large cohort with active AILD. Methods Our local database of 101 patients with AILD (63 autoimmune hepatitis AICH +/- overlap, 38 cholestatic-PBC or PSC) was investigated. LS estimation by ARFI was performed using a standard validated protocol by a single operator. Biopsies were performed from the same region of liver using an 18 G Biopince™ needle, immediately after LS measurement. Clinical, biochemical, ultrasonic and histopathological data were collated retrospectively. ARFI/histological variance (AHV) was defined as a difference of more than 1 Metavir or 2 Ishak stages from that predicted by ARFI, according to standard calibration. 1 Results Sixty one ARFI + liver biopsies performed at the same session were identified out of a total of 164 ARFI and 114 liver biopsies. Patients included group 1: 37 active AICH (diagnosis/flare on therapy); group 2: 7 AICH remission; and group 3: 17 cholestatic liver disease. Co-pathology was seen in 8. Standard ARFI quality measures were validated in 93%. Mean ARFI shear velocities were significantly higher in group 1 compared with 2 and 3–2.41, 1.29 and 1.64 m/sec, respectively (p = 0.001). AHV occurred in 44.1, 28.6 and 29.4%, AHV prevalence was 41% overall, with 100% in group 1 and 88% overall reflecting overestimation of fibrosis. Across all groups, Ishak necro-inflammatory grade was strongly correlated with both ARFI shear velocity (r = 0.58,p Conclusion These data show that variance between ARFI shear velocity and histology is common in active AILD, usually overestimating predicted fibrosis stage. Strong positive correlations were seen between histological inflammatory grade with both shear velocity and AHV, suggesting that inflammation is implicated in the observed increase in LS in this group. Confirmation of this association in further studies would suggest a potential role for ARFI elastography in monitoring resolution of inflammation during treatment of AILD. Reference 1 D. Sherman, et al . J Hepatol 2014; 60 (Suppl 1):S413. Disclosure of Interest None Declared

Evaluation of Transient Elastography, Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients

BackgroundLiver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients.Patients and Methods41 patients (median BMI 47 kg/m2) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).ResultsValid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6–75 and 6.7/2.9–21.3 kPa) and ARFI (2.1/0.7–3.7 and 2.0/0.7–3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients.ConclusionIn bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.

Liver Hemangioma Might Lead to overestimation of Liver Fibrosis by Fibroscan; A Missed Issue in Two Cases

The assessment of liver fibrosis is an important way for prediction of liver disease progression and patient's prognosis. Liver stiffness measurement (LSM) is strongly associated with stage of liver diseases. overestimation of liver fibrosis in heart failure has been reported. We would like to introduce a new leading cause of liver fibrosis overestimation by presentation of two cases. one case with right lobe hemangioma has an overestimation of liver fibrosis. The result completely changed when Fibroscan was performed in patient's left lobe. Interestingly, another case with left lobe hemangioma had overestimation of fibrosis in her left lobe but, right lob Fibroscan was normal. We found that liver hemangioma may leads to overestimation of liver stiffness and the correct inspection of liver echogenicity before any interpretation of high liver stiffness is recommended. We suggest that patient with higher level of Fibroscan score repeat it in other sides of the liver. Also, they should be evaluated by sonography for ruling out of possible confounders such as hepatic hemangioma.

392 LONGITUDINAL ASSESSMENT OF LIVER FIBROSIS USING TRANSIENT ELASTOGRAPHY AND FOUR BIOMARKERS IN HCV PATIENTS WITH F3–F4 FIBROSIS: RELATIONSHIP WITH ANTIVIRAL TREATMENT RESPONSE AND CLINICAL OUTCOME

accelerated in HCV patients with significant steatosis and/or insulin resistance (IR). There is little data regarding the impact of these factors on the accuracy of TE. Aim: To evaluate the influence of metabolic variables on the performance of TE for predicting fibrosis in HBV/HCV subjects. Methods: This study enrolled treatment-naive subjects with positive HBsAg or detectable HCVRNA ≥6 months, submitted to liver biopsy (LB) and TE on the same day. METAVIR score was used for histological analysis. Steatosis ≥30% was considered significant. TE cut-offs: 7.2 (F ≥ 2) and 8.1 (F ≥ 3) kPa for HBV; 7.1 (F ≥ 2) and 9.5 (F ≥ 3) kPa for HCV. IR was defined by HOMA-IR ≥3 and obesity by a BMI ≥30kg/m. Results: After excluding 48 cases (7.8%) with unreliable/unsuccessful TE measurement, 565 patients were analyzed (HBV = 202; HCV = 363). Mean age was 46.1±11.2 years, 67% male. Obesity and diabetes were identified in 6% and 5%, respectively. Significant steatosis was observed in 118 cases (21%) and 141 (25%) had IR. METAVIR F ≥2 was seen in 42% and 54% in HBV and HCV groups, respectively (P = 0.005). Higher TE values were observed in diabetics (P < 0.001), subjects with significant steatosis (P < 0.001), and in those with IR (P < 0.001). Obesity had no influence on TE values (P = 0.607). There was no correlation between TE and BMI (r = 0.108; P = 0.11) and positive but weak correlations were found between TE and HOMA-IR (r = 0.213; P = 0.001) and glucose (r = 0.217; P < 0.001). Discordant results between LB and TE were observed in 117/565 cases (21%). Discordant cases were comparable to concordant ones regarding age, etiology, gender, ALT, AST, GGT, A2/3 METAVIR grade, and all metabolic factors. TE overestimation of fibrosis was identified in 33/565 cases (6%). Among these, none had diabetes or obesity and no association was found between overestimation and metabolic factors. Conclusions: Higher TE values are observed in chronic viral hepatitis patients with metabolic disorders (IR, diabetes, significant steatosis). However, this seems not to exert a significant negative impact on the diagnostic performance of TE for predicting liver fibrosis.