Liver Stiffness Measurement Values Research Articles

Clinical significance of preoperative liver stiffness measurements in primary HBV-positive hepatocellular carcinoma.

To analyze clinical significance of preoperative liver stiffness measurement (LSM) by FibroScan in postcurative resection hepatitis B virus (HBV) related hepatocellular carcinoma (HCC). A total of 263 patients underwent preoperative LSM and curative operation for primary HBV-positive HCC were enrolled. The correlation between preoperative LSM and survival was analyzed. All patients were stratified into two groups using the optimal cut-off value (13.2kPa) of LSM using the receiver-operating characteristic. Patients with an LSM≥13.2kPa had poorer overall survival (median, 61.3 vs 48.2months, hazard ratio: 0.15; p=0.009) and recurrence-free survival (median, 60.4 vs 47.0months; hazard ratio: 0.32; p=0.011) than patients with an LSM<13.2kPa and LSM also have been confirmed as independent predictor for survival for HCC. This could potentially guide patient stratification and individualized treatment. Preoperative LSM can be considered as an independent prognostic factor for HBV-positive HCC after curative resection.

Transient Elastography (FibroScan) Performs Better Than Non-Invasive Markers in Assessing Liver Fibrosis and Cirrhosis in Autoimmune Hepatitis Patients.

BackgroundAutoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that can lead to severe fibrosis and cirrhosis. Transient elastography (TE, FibroScan) can assess the fibrotic stages of chronic liver diseases by liver stiffness measurement (LSM). Studies on the diagnostic accuracy of FibroScan for the detection of fibrosis in AIH patients are still limited.Material/MethodsThis study enrolled 108 AIH patients who underwent liver biopsies. Using the METAVIR scoring system as the reference, Spearman’s rank correlation was performed to explore the relationship between the markers and stages of fibrosis. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic accuracy. The optimal LSM cut-off values for predicting the stages of fibrosis were calculated.ResultsLSM was superior to other non-invasive markers in differentiating the stages of fibrosis in AIH patients. AUROC value of LSM was 0.885 for stage F2, 0.897 for stage F3, and 0.878 for stage F4. The optimal LSM cut-off value was 6.27 kPa for stage F2, 8.18 kPa for F3, and 12.67 kPa for F4.ConclusionsFibroScan is a valuable non-invasive method for the evaluation of liver fibrosis of AIH patients.

Assessment of Liver Fibrosis by Transient Elastography Should Be Done After Hemodialysis in End Stage Renal Disease Patients with Liver Disease.

The patients with end stage renal disease (ESRD) are at greater risk of acquiring chronic hepatitis B or C and subsequently development of liver disease. The aim of the study was to assess liver fibrosis by transient elastography (TE) and look for factors associated with change in liver stiffness measurement (LSM) with one session of hemodialysis (HD). Consecutive ESRD patients on maintenance hemodialysis (MHD) with suspected liver disease were enrolled. They underwent LSM by TE before and after one session of HD. Bioelectric impedance analysis was done to evaluate the volume status at the time of TE. Sixty-eight patients with mean age of 40±14years were included. There was a significant reduction in LSM after HD (18.5 [95% CI 14.8-23.1] vs. 11.2 [95% CI 8.8-13.7]kPa, p<0.001), with a mean LSM reduction of 7.2 [95% CI 5.25-9.19]kPa. On stratification in two groups by net ultrafiltration during HD (> or <2.5 liters [L]), change in LSM was substantially higher in patients when total fluid removed was >2.5L (8.6 [95% CI 5.7-11.5] vs. 5.1 [95% CI 2.9-7.5], p=0.05). In 18 patients who underwent liver biopsy, LSM after HD performed better at detecting significant fibrosis, with area under receiver operating characteristics curve 0.71 [95% CI 0.46-0.97], versus 0.64 [95% CI 0.38-0.90], respectively. An LSM value of 12.2kPa after HD was 71% sensitive and 74% specific for detection of significant fibrosis (≥F2), while values less than 9kPa ruled out significant fibrosis with a sensitivity and specificity of 37 and 100%, respectively. LSM by TE decreases significantly after HD in patients with ESRD on long-term MHD. Hence, TE should be done after HD for accurate assessment of liver fibrosis.

초음파영상을 이용한 간탄력도 검사의 유용성

Chronic diffuse hepatopathy is one of the important clinical tasks to reduce mortality and morbidity due to liver cirrhosis, liver failure, and liver cancer. The purpose of this study was to evaluate the criteria for predicting liver and chronic liver disease using Fibroscan based on ultrasound diagnosis. Serum and liver stiffness measurement(kPa) were analyzed in 280 patients and cut-off values of liver stiffness measurement for predicting fatty liver and chronic diffuse hepatopathy were determined using ROC curve analysis. Bilirubin and PT(prothrombin time) were not related to disease prediction(p=0.243, p=0.115). Serum glucose and triglyceride levels were significantly higher in the liver (p<0.05). The cut-off value for predicting chronic diffuse hepatopathy was determined as 10.3 kPa(AUC 0.98, sensitivity 94.94%, specificity 94.93%) in the order of control group, fatty liver and chronic diffuse hepatopathy. Therefore, it will be used as a primary tool for the diagnosis of chronic liver disease patients with quantitative evaluation.

CXCL9-11 polymorphisms are associated with liver fibrosis in patients with chronic hepatitis C: a cross-sectional study

Background and aimsCXCL9-11 polymorphisms are related to various infectious diseases, including hepatitis C virus (HCV) infection. In this study, we analyzed the association between CXCL9-11 polymorphisms and liver fibrosis in HCV-infected patients.MethodsWe performed a cross-sectional study in 389 patients who were genotyped for CXCL9-11 polymorphisms (CXCL9 rs10336, CXCL10 rs3921, and CXCL11 rs4619915) using the Sequenom’s MassARRAY platform. The primary outcome variable was the liver stiffness measurement (LSM). We established three cut-offs of LSM: LSM ≥ 7.1 kPa (F ≥ 2—significant fibrosis), LSM ≥ 9.5 kPa (F ≥ 3—advanced fibrosis), and LSM ≥ 12.5 kPa (F4—cirrhosis).ResultsRecessive, overdominant and codominant models of inheritance showed significant values, but the overdominant model was the best fitting our data. In this case, CXCL9 rs10336 AG, CXCL10 rs3921 CG and CXCL11 rs4619915 AG were mainly associated with lower values of LSM [(adjusted GMR (aGMR) = 0.85 (p = 0.005), aGMR = 0.84 (p = 0.003), and aGMR = 0.84 (p = 0.003), respectively]. Patients with CXCL9 rs10336 AG genotype had lower odds of significant fibrosis (LSM ≥ 7.1 kPa) [adjusted OR (aOR) = 0.59 (p = 0.016)], advanced fibrosis (LSM ≥ 9.5 kPa) [aOR = 0.54 (p = 0.010)], and cirrhosis (LSM ≥ 12.5 kPa) [aOR = 0.56 (p = 0.043)]. Patients with CXCL10 rs3921 CG or CXCL11 rs4619915 AG genotypes had lower odds of significant fibrosis (LSM ≥ 7.1 kPa) [adjusted OR (aOR) = 0.56 (p = 0.008)], advanced fibrosis (LSM ≥ 9.5 kPa) [aOR = 0.55 (p = 0.013)], and cirrhosis (LSM ≥ 12.5 kPa) [aOR = 0.57 (p = 0.051)]. Additionally, CXCL9-11 polymorphisms were related to lower liver stiffness under a codominant model of inheritance, being the heterozygous genotypes also protective against hepatic fibrosis. In the recessive inheritance model, the CXCL9 rs10336 AA, CXCL10 rs3921 CC and CXCL11 rs4619915 AA were associated with higher LSM values [(adjusted GMR (aGMR) = 1.19 (p = 0.030), aGMR = 1.21 (p = 0.023), and aGMR = 1.21 (p = 0.023), respectively]. Moreover, patients with CXCL9 rs10336 AA genotype had higher odds of significant fibrosis (LSM ≥ 7.1 kPa) [adjusted OR (aOR) = 1.83 (p = 0.044)] and advanced fibrosis (LSM ≥ 9.5 kPa) [aOR = 1.85 (p = 0.045)]. Furthermore, patients with CXCL10 rs3921 CC or CXCL11 rs4619915 AA genotypes had higher odds of advanced fibrosis (LSM ≥ 9.5 kPa) [aOR = 1.89 (p = 0.038)].ConclusionsCXCL9-11 polymorphisms were related to likelihood of having liver fibrosis in HCV-infected patients. Our data suggest that CXCL9-11 polymorphisms may play a significant role against the progression of CHC and could help prioritize antiviral therapy.

Serial combination of non-invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with NAFLD.

The accuracy of available non-invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is still limited. To assess the diagnostic performance of paired or serial combination of non-invasive tools in NAFLD patients. We analysed data from 741 patients with a histological diagnosis of NAFLD. The GGT/PLT, APRI, AST/ALT, BARD, FIB-4, and NAFLD Fibrosis Score (NFS) scores were calculated according to published algorithms. Liver stiffness measurement (LSM) was performed by FibroScan. LSM, NFS and FIB-4 were the best non-invasive tools for staging F3-F4 fibrosis (AUC 0.863, 0.774, and 0.792, respectively), with LSM having the highest sensitivity (90%), and the highest NPV (94%), and NFS and FIB-4 the highest specificity (97% and 93%, respectively), and the highest PPV (73% and 79%, respectively). The paired combination of LSM or NFS with FIB-4 strongly reduced the likelihood of wrongly classified patients (ranging from 2.7% to 2.6%), at the price of a high uncertainty area (ranging from 54.1% to 58.2%), and of a low overall accuracy (ranging from 43% to 39.1%). The serial combination with the second test used in patients in the grey area of the first test and in those with high LSM values (>9.6 KPa) or low NFS or FIB-4 values (<-1.455 and <1.30, respectively) overall increased the diagnostic performance generating an accuracy ranging from 69.8% to 70.1%, an uncertainty area ranging from 18.9% to 20.4% and a rate of wrong classification ranging from 9.2% to 11.3%. The serial combination of LSM with FIB-4/NFS has a good diagnostic accuracy for the non-invasive diagnosis of severe fibrosis in NAFLD.

Serum S100 calcium binding protein A4 improves the diagnostic accuracy of transient elastography for assessing liver fibrosis in hepatitis B

The diagnostic performance of Fibroscan might be improved when combined with other serum fibrosis related markers. Previous study has demonstrated that S100A4 expression is associated with liver fibrosis in humans with hepatitis. This study aimed to clarify diagnostic accuracy of serum S100A4 levels for significant liver fibrosis in patients with chronic hepatitis B (CHB), and develop a combined algorithm of liver stiffness measurement (LSM) and S100A4 to predict significant liver fibrosis in CHB. One hundred and seventy-five CHB patients who had performed liver biopsy were consecutively included. We evaluated serum S100A4 levels, LSM values and other clinically-approved fibrosis scores. Serum S100A4 level was higher in CHB patients with significant fibrosis, compared to those without [199.58 (33.31-1971.96) vs. 107.15 (2.10-1038.94), P<0.001]. Using receiver-operating characteristic (ROC) analyses, the area under the curves (AUC), sensitivity, specificity and accuracy of S100A4 were found to be 0.749, 62.7%, 75.9% and 0.70 for significant fibrosis (≥Stage 2), respectively. Although not superior to LSM, these results were better than the fibrosis index based on the 4 factor (FIB-4) and the aspartate aminotransferase-to-platelet ratio index (APRI) for significant fibrosis detection. An algorithm consisting of S100A4 and LSM was derived. The AUC, sensitivity, specificity and accuracy of model based on serum S100A4 level and LSM were 0.866, 86.6%, 77.8% and 0.79 for significant fibrosis detection, superior to those based on LSM alone (0.834, 76.1%, 80.7% and 0.76, P=0.041). Serum S100A4 level was identified as a fibrosis marker of liver fibrosis in patients with CHB. Combining serum S100A4 with LSM improved the accuracy of transient elastography for hepatitis B significant fibrosis detection.

Potential impact of screening for fatty liver disease by transient elastography with liver stiffness and controlled attenuation parameter measurements: a pilot study.

Background The prevalence of chronic liver diseases is high in developed countries, and the leading causes are amenable to prevention. The German Lebertag is to increase awareness of the burden of chronic liver diseases in the general public. We performed a pilot study using transient elastography with liver stiffness measurement (LSM) and the controlled attenuation parameter (CAP) as a screening tool for previously unrecognized liver diseases. Patients and methods LSM and CAP was performed in 60individuals,and participants filled in a questionnaire reporting basic characteristics and past medical history. Results Median LSM and CAP values were within the normal range. Participants with self-reported diabetes mellitus had significantly elevated LSM (p = 0.02) and CAP values (p = 0.002). Participants with a BMI > 30 kg/m2 or dyslipidemia had significantly elevated CAP values (p = 0.007 and p = 0.01, respectively) with normal LSM values. Overall, 35 % of participants had elevated CAP values, indicating a high prevalence ofhepatic steatosis. Discussion In a German pilot study, diabetes mellitus was a key risk factor for increased LSM and CAP values. Prevalence of steatosis was high and comparable to other Western countries. Transient elastography is a valuable tool to identify patients with increased risk for metabolic liver diseases. In people without risk factors, LSM and CAP values were within the normal range, indicating that screening for chronic liver injury was not warranted.

Childhood factors in the development of health anxiety: A systematic review

Host genetic background has been associated with liver fibrosis progression.To analyze the association between the patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 polymorphism and liver fibrosis progression in hepatitis C virus (HCV)-infected patients.In this retrospective cohort study, 187 patients with chronic HCV infection were included, who had at least two liver stiffness measurements (LSM) by transient elastography during the follow-up. Results were expressed in kilopascals (kPa). The analysis of genetic association was carried out according to additive model by using Generalized Linear Models.No patients had advanced fibrosis/cirrhosis at baseline. During a median follow-up time of 47.9 months, 15 patients developed advanced fibrosis and 17 cirrhosis. In multivariate analysis adjusted by the main clinical and epidemiological covariates, the rs738409 G allele was related to higher increase of LSM values during the follow-up (adjusted arithmetic mean ratio (aAMR) = 1.16 (95%CI = 1.04; 1.29); p = .006) and higher odds of having progression to advanced fibrosis [aOR = 2.03 (95%CI = 1.01; 4.06); p = .045], and progression to cirrhosis [aOR = 3.03 (95%CI = 1.26; 7.30); p = .014].PNPLA3 rs738409 polymorphism appears to be related to the increased progression of liver fibrosis in HCV infected patients.

Chronic hepatitis B patients with high liver fibrosis levels should receive antiviral treatment.

The present study aimed to evaluate improvements in liver stiffness (LS) measured by transient elastography (TE) and associated factors in Chinese patients with chronic hepatitis B (CHB) treated with entecavir (ETV). A total of 190 consecutive CHB patients who received entecavir therapy and two LS measurements (LSMs) were enrolled in this retrospective study (average age, 47 years; 137 males [72.1%]), including 111 patients without liver cirrhosis (group 0) and 79 patients with liver cirrhosis (group 1). Each patient received LSM twice with an interval of six months. Normalized aspartate aminotransferase (AST) levels were accompanied by a significant reduction in LSM values (P<0.001) in each group. Multivariate analysis revealed that a higher initial LS value in groups 0 and 1, and a higher prothrombin time activity in group 1 was associated with a greater decline of the LS value. Higher initial quantitative hepatitis B surface antigen (qHBsAg) levels were correlated with a greater decline of the qHBsAg value in the two groups. In conclusion, LS values in CHB patients significantly improved after 24 weeks of entecavir therapy. The results suggested that higher LSM values at baseline contributed to a greater regression of LSM, and higher initial qHBsAg values could lead to greater qHBsAg reduction during ETV therapy. Extrapolating our results, we might be able to consider CHB patients who have higher initial LSM values or have higher levels of qHBsAg values when enrolled would have more benefit during ETV treatment.

Non-invasive diagnosis of portal hypertension in cirrhosis using ultrasound based elastography.

Liver stiffness measurement (LSM) by ultrasound-based elastography may be used to non-invasively discriminate betweenthe stages of liver fibrosis, rule out cirrhosis and follow its evolution, including the prediction of the presence ofoesophageal varices. The same is possible in order to diagnose clinically significant portal hypertension, referring primarilyto transient elastography and LSM values ≥20-25 kPa. The same approach may be used to reliably rule out the presence ofoesophageal varices (LSM <20 kPa + platelets >150x109/L). These recommendations refer primarily to patients with viral aetiologyof chronic liver disease (hepatitis C), while additional studies are required for other aetiologies. While spleen stiffnessmeasurement (SSM) also poses a logical choice in this indication, controversial results have nevertheless been published on this issue. It should be emphasized, however, that more recent data indicate that this parameter should be included in the diagnosticalgorithm for portal hypertension, if not as the sole then as a part of a sequential algorithm, combined with LSM. Untilnow, transient elastography has been most extensively studied and founded on scientific evidence, although the results of otherultrasound-based elastography techniques demonstrate the same trend for the non-invasive assessment of portal hypertension.

Noncirrhotic Portal Fibrosis in Pediatric Population

Noncirrhotic portal fibrosis (NCPF) has been classically described as a disease of young to middle age with limited literature regarding its occurrence, onset, or clinical presentation in children. We hereby present a series of 19 patients diagnosed and managed as NCPF in pediatric age group. A retrospective review of all the patients presenting to the pediatric hepatology department (age <18 years) and diagnosed as NCPF was done and data were evaluated. A total of 19 patients were diagnosed as NCPF with median age at onset of symptoms and diagnosis as 10 years and 13.8 years respectively. Majority presented with left upper quadrant discomfort or mass. Laboratory parameters showed hypersplenism in majority with preserved liver synthetic functions. Median values for hepatic venous pressure gradient and liver stiffness measurement were 13.5 mmHg and 10.6 kPa, respectively. Classical hepatic histopathological features seen were maintained lobular architecture, atretic portal tracts, approximation of portal-portal and portal-central areas, and aberrant peripheral portal channels. During follow-up, majority of the patients did not show disease progression. NCPF is not an uncommon entity in pediatric population with age of onset in early second decade. Hepatic histopathology must be used to exclude cirrhosis and to confirm the diagnosis. Hepatic venous pressure gradient and liver stiffness measurement values, in some cases, may overlap with those in patients with cirrhosis and may not be diagnostic in isolation. Any patient presenting with evidence of portal hypertension with preserved hepatic functions, irrespective of the age, should be evaluated for possible NCPF.

Transient elastography as a screening tool for liver fibrosis in a large hemodialysis population

Metabolic syndrome, an etiological factor in non-alcoholic fatty liver disease (NAFLD), is often present in hemodialysis patients. Little is known about the prevalence of, and factors associated with, liver fibrosis in hemodialysis populations. We used transient elastography (TE) to investigate these phenomena. 659 patients treated with chronic hemodialysis were enrolled. We excluded those with excess alcohol intake, liver stiffness measurement (LSM) failure, or unreliable LSM values. LSM ≥8.0 kPa was used as a cutoff suggesting clinically relevant fibrosis. Controlled attenuation parameter (CAP) ≥ 232.5 dB/m was used as a cutoff suggesting steatosis. 333 patients (50.5%) had steatosis, 159 (24.1%) had hepatitis B or C, and 149 (22.6%) had LSM ≥8.0 kPa. In multivariable analyses, male gender (OR: 2.16; 95% CI: 1.29–3.63; P = 0.004), overweight body habitus (OR:2.31; 95% CI: 1.35–3.94; P = 0.002), high AST level (OR:1.08; 95% CI: 1.04–1.12; P < 0.001), low albumin level (OR: 0.25; 95% CI: 0.12–0.53; P < 0.001), low creatinine level (OR: 0.89; 95% CI: 0.79–1.00; P = 0.05) and low platelet count (OR: 0.99; 95% CI: 0.99–1.00; P < 0.001) were associated with LSM ≥8.0 kPa. We thus conclude that hemodialysis patients have a high prevalence of NAFLD and clinically relevant fibrosis. NAFLD may be an important determinant of clinically relevant fibrosis in hemodialysis populations.

Assessing Liver Stiffness by 2D-Shear Wave Elastography in a Healthy Cohort

To assess the normal range and agreement of liver stiffness measurements in healthy subjects, using 2D-Shear Wave Elastography from General Electric (2D-SWE-GE) compared with Transient Elastography (TE). We included 80 healthy subjects without known liver disease, in whom liver stiffness (LS) was evaluated in the same session using two elastographic methods, TE and 2D-SWE-GE. Reliable liver stiffness measurements (LSM) were defined for TE as the median value of ten measurements with a success rate (SR) of ≥60% and an interquartile range (IQR) <30%, and for 2D-SWE-GE as the median value of 10 measurements acquired in a homogenous area and IQR <30%. Reliable LSM were obtained in 79 subjects (98.7%) by means of 2D-SWE-GE and in 80 subjects (100%) by means of TE (p=0.9). The mean LSM value in our cohort of healthy subjects obtained by means of 2D-SWE-GE was 5.1±1.3 kPa, which was significantly higher than the LSM values assessed by TE (4.3±0.9 kPa, p< 0.0001). In 2D-SWE-GE mean LSM values were significantly higher for men than for women, 5.9±1.2 kPa vs. 4.7±1.2 kPa (p=0.0005). 2D-SWE has a very good feasibility (98.7%) in healthy subjects. The mean LSM value determined by 2D-SWE-GEin healthy subjects is 5.1±1.3 kPa. LSM values obtained by means of 2D-SWE-GE are higher than those obtained by TE in healthy subjects.

A Large Scale Validation of Two-Dimensional Shear Wave Elastography in the Diagnosis of Liver Fibrosis Progression in Patients with Chronic Hepatitis B

Two-dimensional shear wave elastography (2D-SWE) is a noninvasive approach for staging chronic liver diseases. Our previous published study had established the cut-off value of 2D-SWE in the diagnosis of significant fibrosis (7.2 kPa), severe fibrosis (9.2 kPa), and cirrhosis (10.4 kPa) based on 304 patients with chronic hepatitis B (CHB). The aim of this study is to validate the value of 2D-SWE in assessing liver fibrosis progression and to compare its diagnostic accuracy with serological fibrosis indices involving aminotransferase/platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4), King’s score and Forns index. From July 2015 to January 2017, 639 subjects who underwent partial hepatectomy were enrolled in the study and they were divided into S0–S4 groups by using resected liver specimen. There were 535 males and 104 females with an average age 54.1±10.7 yrs (19-82 yrs). All patients were examined with 2D-SWE (Aixplorer ultrasound system) and serological testing preoperatively to obtain liver stiffness measurements (LSMs) and values of serum fibrosis models. Performance of noninvasive methods was analyzed for validation with areas under the receiver operating characteristic curve (AUCs). Intraobserver agreement of intraclass correlation coefficient was 0.943 for the five measurements of liver stiffness. Mean values of LSMs were 5.52±1.15 kPa (n=33), 6.51±1.09 kPa (n=74), 7.95±0.81 kPa (n=107), 9.41±1.32 kPa (n=135), and 14.55±3.50 kPa (n=290) for the fibrosis S0, S1, S2, S3, and S4 groups, respectively. When the optimal cutoff values of 2D-SWE were applied for S2-4 fibrosis stages, AUCs in predicting significant fibrosis, severe fibrosis and cirrhosis were 0.970, 0.971 and 0.979, respectively. All noninvasive approaches were statistically significantly related to hepatic fibrosis stage (P<0.05). When compared with four serological fibrosis indices, 2D-SWE showed significantly higher AUCs than four serum fibrosis indices in predicting significant fibrosis, severe fibrosis and cirrhosis (P < 0.05 for all). The large scale validation shows that 2D-SWE is an effective approach in predicting significant fibrosis, severe fibrosis, and cirrhosis in CHB patients with notably higher diagnostic accuracy than serum fibrosis models.

Risk Assessment of Hepatocellular Carcinoma in General Population by Liver Stiffness in Combination with Controlled Attenuation Parameter using Transient Elastography: A Cross Sectional Study

Hepatocellular carcinoma (HCC) in patients without hepatitis B (HBV) and -C virus (HCV) infection are increasing in Japan. Method for detecting high-risk liver diseases of HCC in general population has still not been established. Liver stiffness measurement (LSM) and Controlled Attenuation Parameter (CAP) using transient elastography (TE; FibroScan System) are useful for detecting liver fibrosis and steatosis. The aim of this study is to clarify TE for risk assessment of HCC in general population. This cross-sectional study was performed for residents aged ≥ 40 years in an intermountain town in Japan with a population of 3,493. Blood laboratory testing included tumor markers, abdominal ultrasound (AUS), and TE was performed. Among 175 subjects (64 men, 111 women), TE was evaluated and three patients with HCC were detected by AUS. For detecting HCC, the cut-off value of LSM was 5.3 kPa sensitivity 100%, specificity 75%, AUROC 0.88). The combination of LSM and CAP (LSM > 5.3 kPa with any CAP and CAP > 248 dB/m with any LSM) could detect the high-risk liver diseases of HCC (HCC, nonalcoholic fatty liver/steatohepatitis, HBV or HCV related chronic viral hepatitis with alanine transaminase (ALT) > 30 IU/L for men or > 19 IU/L for women or cirrhosis of any cause) with high sensitivity (sensitivity 90%, specificity 55%, positive predictive value 10%, negative predictive value 99%, P = 0.006). The combination of LSM and CAP can be useful in detecting high-risk liver diseases of HCC out of general population.

Serial Liver Stiffness Measurements and Monitoring of Liver-Transplanted Patients in a Real-Life Clinical Practice.

BackgroundLiver transplanted patients need close surveillance for early signs of graft disease.ObjectivesTransient elastography can safely be repeated over time, offering serial liver stiffness measurement values. Serial stiffness measurements were compared to single baseline stiffness measurements in predicting the appearance of liver-related clinical events and guiding subsequent clinical decisions.MethodsOne hundred and sixty liver transplanted patients were observed for three years in our real-life practice.ResultsLiver stiffness measurements were stable in 75% of patients, decreased in 4% of patients, and increased in 21% of patients. The pattern of increased stiffness measurements was associated with both HCV-RNA positive status and the presence of an active biliary complication of liver transplantation and was more predictive of a clinically significant event resulting from any disease of the transplanted liver when compared to a stable pattern or to a single liver stiffness measurement. The procedures that were consequently performed were often diagnostic for unexpected situations, both in HCV-RNA positive and HCV-RNA negative patients.ConclusionsThe pattern of longitudinally increased liver stiffness measurements efficiently supported clinical decisions for individualized management strategies. Repeated transient elastography in real-life clinical practice appears to have a practical role in monitoring liver transplanted patients.

Assessment of transient elastography in Japanese patients with non-alcoholic fatty liver disease.

Transient elastography (TE) is a non-invasive method for predicting liver fibrosis. However, there are limited data regarding the performance of TE in Japanese patients with non-alcoholic fatty liver disease (NAFLD). We aimed to evaluate the association between liver stiffness measurement (LSM) by TE and liver fibrosis stage, and define a cut-off value for predicting liver fibrosis. A total of 171 Japanese patients with biopsy-proven NAFLD underwent LSM using TE with FibroScan. The area under the receiver operating characteristic curve of LSM and other non-invasive markers of liver fibrosis were compared to determine the most accurate method of predicting liver fibrosis. Liver stiffness measurement significantly correlated with fibrosis stage (P <0.001). The areas under the receiver operating characteristic curve of LSM for fibrosis stage ≥1 and ≥3 was 0.85 and 0.91, respectively and were higher than those of the aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index, fibrosis-4 index, and NAFLD fibrosis score. The best cut-off values of LSM fibrosis stage ≥1 and ≥3 were 7.2kPa (sensitivity 78.5%, specificity 78.3%) and 10.0kPa (sensitivity 89.5%, specificity 87.6%), respectively. The combination of LSM (≥10kPa) and type IV collagen 7 s (≥6.0ng/mL) had a specificity of 97.6% for advanced fibrosis. The LSM in patients with high alanine aminotransferase levels or high body mass index was associated with false positive results regarding advanced fibrosis. In NAFLD patients, TE has excellent utility for the assessment of liver fibrosis, particularly for advanced stage cases. The cut-off value of LSM by TE for predicting liver fibrosis stage ≥3 is 10.0kPa in Japanese NAFLD patients.

Increased liver stiffness measurement values using transient elastography in Egyptian patients with acute viral hepatitis

Transient Elastography (TE) is one of the non-invasive and reproducible tools for assessment of liver fibrosis/ cirrhosis. However, it remains to be determined if ALT flare interferes with fibrosis assessment. 1.1.Aim: To determine the effect of increased serum ALT and AST on liver stiffness measurement in patients with acute viral hepatitis. 1.2.Methods: Thirty consecutive patients with acute hepatitis of viral etiology with elevated liver enzymes (>10 folds of ULN) were prospectively included. Blood samples were collected and TE was done initially and after resolution of hepatitis and after normalization of liver enzymes. Patients with high BMI which could affect TE (> 40 kg/m2) and patients with ascites or liver cirrhosis were excluded. For determination of the etiology of hepatitis, history taking, a detailed physical examination and laboratory tests were performed in all patients. 1.3.Results: The mean age of patients was 32.87 ± 10.2 years old and males represented 46.7% (n=14). In all patients, the degree of liver stiffness at the time of the peak increase in aminotransferases exceeded the cutoff values proposed for the prediction of significant fibrosis or cirrhosis. The mean value of LSM at the time of inclusion in the study was 13.91±6.7 kPa and the mean value of LSM after resolution of hepatitis was 7.7±3.08 kPa. A progressive significant reduction in liver stiffness values was observed (P 0.05). Reduction of mean value of LSM to 6.21 ± 1.14 kPa was observed in 10 patients after 1 year of ALT normalization. 1.4.Conclusion: TE has not demonstrated reliable diagnostic accuracy in patients with acute viral hepatitis.

Accuracy of elastography point quantification and steatosis influence on assessing liver fibrosis in patients with chronic hepatitis C.

Elastography point quantification is a novel non-invasive method for the assessment of liver fibrosis by measuring liver stiffness. The aim of this study was to evaluate the accuracy of elastography point quantification for the diagnosis of liver fibrosis and to assess impact of steatosis on liver stiffness measurement, in a cohort of patients with chronic hepatitis C. In this single-centre cross-sectional study, 211 consecutive patients with chronic hepatitis C, scheduled for liver biopsy, were examined with the elastography point quantification technology. On the same day, all patients underwent clinical examination, laboratory tests and abdominal ultrasound. The best cut-offs of liver stiffness measurement were 6.16kPa for the diagnosis of significant fibrosis (≥S3) and 6.79kPa for advanced fibrosis (≥S4). Areas under the receiver operating characteristic curve were 0.831 (CI: 0.773-0.880) for significant fibrosis, and 0.954 (CI: 0.916-0.978) for advanced fibrosis. Among patients within the same fibrosis stages (S0-S2 and S3-S6; S0-S3 and S4-S6), mean liver stiffness measurement values were similar in patients with steatosis (≥10% at liver biopsy or detected by ultrasound) compared to those without. Discordance between elastography point quantification and histology were affected by the presence of BMI>30kg/m2 (P=.047, CI: 0.136-0.988 and P=.020, CI: 0.083-0.812 respectively). In patients with chronic hepatitis C, elastography point quantification is an accurate non-invasive method for the diagnosis of significant and advanced fibrosis. The presence of obesity is a risk factor for misclassification of significant and advanced liver fibrosis.