Use Of Fibroscan Research Articles

Assessment of Liver Damage with Transient Hepatic Elastography (FIBROSCAN) in patients with chronic Graft-Versus-Host Disease

Introduction Chronic GVHD (cGVHD) is the most common non-relapse problem in long-term survivors after allogeneic stem cell transplantation (SCT). Liver is a commonly target-organ, being often refractory to immunosuppressive therapy. Hepatic cGVHD develops generally as an indolent cholestatic disease or as an autoimmune hepatitis. Both primary biliary cirrhosis and cGVHD show some analogies in the damage of bile ducts. Liver biopsy specimens show degeneration of the small bile ducts, portal fibrosis and are helpful to confirm the diagnosis and the prognosis of hepatic cGVHD. However, liver biopsy is not always feasible, because it may generate clinical complications such as bleeding and infections. Transient hepatic elastography (FibroScan) is a new, fast and non-invasive technique to measure liver stiffness. FibroScan has been validated to detect significant positive relationship between liver stiffness values and histological fibrosis in chronic liver diseases such as chronic hepatitis B and C, cirrhosis and, primary biliary cirrhosis. Being fibrosis a hallmark of cGVHD, we prospectively evaluated the usefulness of FibroScan as non-invasive tool to make diagnosis of liver cGVHD.Patients and methods Liver stiffness measurements were performed on 10 healthy subjects and on 18 patients undergoing allogeneic SCT (15 with related and 3 with unrelated donor) before transplantation, then every 3 months and at the diagnosis of cGVHD. Median age was 42 years (range, 22–62); 61% of patients were male. 72% received a reduced intensity conditioning and stem cells source was mainly peripheral blood (83%). Cyclosporine A and short course of methotrexate were used for GVHD prophylaxis. One patient was HCV RNA-positive. No patients had any sign of liver disease at transplantation. In transient elastography (TE), only procedures with at least ten successful acquisitions and a success rate of at least 60% were considered reliable. The median value of successful measurements was considered representative of the liver stiffness in a given patient, only if the interquartile range (IQR) of all validated measurements was less than 30% of the median value. Results were expressed in kilopascals (kPa). Wilcoxon test was used for statistical analysis of the data.Results Eight patients (44%) developed cGVHD at a median time of 5 months (range, 4–6). cGVHD was extensive in 6 patients (75%) with a median onset time of 6 months (range, 4–10). Liver was involved in 6 patients (75%). Liver stiffness values did not differ significantly in healthy subjects, patients before allo-SCT and patients after allo-SCT without cGVHD. Patients with hepatic cGVHD had higher stiffness values than healthy subjects (7,7 ± 4,6 vs 4,6 ± 1,5 kPa, p=0,03) and than patients without cGVHD (7,7 ± 4,6 vs 4,6 ± 1,9 kPa, p=0,03). Furthermore, liver stiffness values were higher in all patients with cGVHD than in healthy subjects (7 ± 3,9 vs 4,6 ± 1,5 kPa, p=0,04) and patients without cGVHD (7 ± 3,9 vs 4,6 ± 1,9 kPa, p=0,04). A trend to higher liver stiffness in patients with cGVHD was observed at 3rd month as well (6,4 ± 2,5 vs 4,6 ± 1,5 kPa, p=0,05).Discussion Our prospective study suggests that FibroScan could be a reliable non-invasive technique for the early diagnosis of hepatic cGVHD, which could replace liver biopsy in the future. In addition, TE could be an effective procedure to assess disease progression or response to therapy. However, it was not possible to demonstrate significantly different stiffness values in the setting of cGVHD between patients with and without liver involvement. The small number of patients included in the survey or a clinically silent involvement of liver in all cases of cGVHD may account for this observation. Further studies could support these preliminary results and answer to other interesting open questions.

Usefulness of FibroScan for Detection of Early Compensated Liver Cirrhosis in Chronic Hepatitis B

It is difficult to differentiate early compensated cirrhosis from chronic hepatitis solely by clinical features. The aim of this study was to assess the usefulness of liver stiffness measurement (LSM) for detection of early compensated liver cirrhosis in chronic hepatitis B (CHB). Ninety-one consecutive CHB patients who underwent liver biopsy (LB) and LSM were recruited. All patients did not fulfill the clinical criteria for cirrhosis. The cutoff of LSM for cirrhosis was 10.3 kPa. All patients were divided into either group A (cirrhosis) or group B (CHB) according to LB result. The median LSM values of groups A and B were 11.8 and 7.6 kPa, respectively (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of LSM in predicting cirrhosis were 0.59, 0.78, 0.68, and 0.72, respectively. The area under the receiver operating characteristics curve (AUROC) of LSM was 0.803, whereas the AUROCs of aspartate to alanine aminotransferase ratio (AAR) and aspartate aminotransferase to platelet ratio index (APRI) were 0.488 and 0.723, respectively. LSM showed an acceptable diagnostic accuracy for detecting early compensated cirrhosis in CHB.

Transient elastography: Applications and limitations

Transient elastgraphy with use of FibroScan is one of most accurate methods for assessment of liver fibrosis. FibroScan can be readily used with an operator with a short training. In many different studies, liver stiffness measured by transient elastgraphy correlates well with fibrosis stages, and cutoff values of liver stiffness for fibrosis staging are similar even among different diseases. However there is wide variation of stiffness values in the same fibrosis stage, and some overlap between the adjacent stages. In addition, inflammatory activity and size of nodule of cirrhosis affect the liver stiffness values. The reproducibility may be reduced by age, obesity, steatosis, narrow intercostal space and lower degrees of hepatic fibrosis in patients. Thus the estimation of fibrosis stages from liver stiffness should be cautiously done. To improve the accuracy of liver fibrosis staging, the combination of transient elastography with other noninvasive methods such as FibroTest should be required.

Liver Stiffness Measurement in Children Using FibroScan: Feasibility Study and Comparison With Fibrotest, Aspartate Transaminase to Platelets Ratio Index, and Liver Biopsy

Transient elastography (FibroScan) is a novel, noninvasive, rapid bedside method to assess liver fibrosis by measuring liver stiffness in adult patients. The usefulness of FibroScan in children with chronic liver diseases is unknown. The aim of this prospective study was to evaluate the feasibility of liver stiffness measurement and to compare FibroScan, Fibrotest, and aspartate transaminase to platelets ratio index (APRI) with liver biopsy for the diagnosis of cirrhosis in children with chronic liver diseases. Between February 2004 and October 2005, 116 consecutive children with chronic liver diseases were prospectively included. All except 1 child (58 boys, mean age 10.7 years) could have noninvasive tests for fibrosis: FibroScan, Fibrotest, and APRI, and, when necessary, a liver biopsy (n = 33). FibroScan, Fibrotest, and APRI were correlated with clinical or biological parameters of chronic liver diseases, but the FibroScan marker correlated most with all parameters. By histology, the METAVIR fibrosis category score was F1 in 7 cases, F2 in 8 cases, F3 in 6 cases, and F4 in 12 cases. FibroScan, Fibrotest, and APRI were significantly correlated with the METAVIR fibrosis score. For the diagnosis of cirrhosis, the area under the receiver operating characteristic curve was 0.88, 0.73, and 0.73 for FibroScan, Fibrotest, and APRI, respectively. These results indicate that liver stiffness measurement is feasible in children and is related to liver fibrosis. A specific probe dedicated to children and slender patients has thus been developed and is currently under evaluation. The FibroScan equipped with this specific probe could become a useful tool for the management of chronic liver diseases in children.

Features associated with success rate and performance of fibroscan measurements for the diagnosis of cirrhosis in HCV patients: A prospective study of 935 patients

FibroScan, a non-invasive procedure for the diagnosis of cirrhosis, benefits only patients for which at least 10 valid shots are acquired. We investigated features associated with success rate of shots, and performance of FibroScan for the diagnosis of cirrhosis. Liver biopsy and stiffness measurement were performed in HCV patients. AUROCs and mixed logistic models evaluated the influence of patient and operator features on the success of shots and the performance for the diagnosis of cirrhosis. Nine hundred and thirty five (935) patients were included. Success rate of shots decreased with age, and was lower in obese than in other patients. After adjusting for age and obesity, an operator with at least 50 prior FibroScan exams had a higher success rate in shots. FibroScan performance for the diagnosis of cirrhosis was not influenced by the number of valid shots taken into account and by operator skills. After a rapid training, FibroScan provides a reasonable performance for the diagnosis of cirrhosis that is not influenced substantially by any other feature. More patients will benefit from this procedure with no significant loss in performance if only 5 valid shots are requested. These results should emphasize the use of FibroScan even in non-specialized units.

Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C

Transient elastography (FibroScan; Echosens, Paris, France) is a novel, noninvasive, and rapid bedside method to assess liver fibrosis by measuring liver stiffness. We prospectively assessed the performance of FibroScan in patients with chronic hepatitis C, in comparison with and combined with currently available biochemical markers (Fibrotest; Biopredictive; and the aspartate transaminase to platelets ratio index [APRI]); a liver biopsy examination performed the same day served as the reference. We studied 183 consecutive patients with chronic hepatitis C (METAVIR fibrosis stage F1, n = 47; F2, n = 53; F3, n = 37; F4, n = 46). FibroScan values ranged from 2.4 to 75.4 kilopascals (median, 7.4 kilopascals). Cut-off values were 7.1 kPa for F > or = 2, 9.5 kPa for F > or = 3, and 12.5 kPa for F = 4. The areas under the receiver operating characteristic (ROC) curve of FibroScan, FibroTest, and APRI values were of the same order (.83, .85, and .78, respectively, for F > or = 2; .90, .90, and .84, respectively, for F > or = 3; and .95, .87, and .83, respectively, for F = 4). The best performance was obtained by combining the FibroScan and FibroTest, with areas under the ROC curve of .88 for F > or = 2, .95 for F > or = 3, and .95 for F = 4. When the FibroScan and FibroTest results agreed, liver biopsy examination confirmed them in 84% of cases for F > or = 2, in 95% for F > or = 3, and in 94% for F = 4. FibroScan is a simple and effective method for assessing liver fibrosis, with similar performance to FibroTest and APRI. The combined use of FibroScan and FibroTest to evaluate liver fibrosis could avoid a biopsy procedure in most patients with chronic hepatitis C.