Factors That Could Impact on Liver Fibrosis Staging by Transient Elastography

Overview

Journal Int J Hepatol

Publisher Wiley

Specialty Gastroenterology

Date 2016 Jan 16

PMID 26770833

Citations 23

Authors

Hugo Perazzo

Valdilea G Veloso

Beatriz Grinsztejn

Chris Hyde

Rodolfo Castro

Affiliations

Soon will be listed here.

Abstract

Transient elastography (TE) based on liver stiffness measurement (LSM) is one of the most validated noninvasive methods for liver fibrosis staging in patients with chronic liver diseases. This method is painless, has no potential complications, is rapid (<10 min), and can be performed at the patient's bedside. However, several points should be considered when interpreting TE results. This review aims to discuss the critical points that might influence liver stiffness and TE results. Spectrum bias and the impact of the prevalence of fibrosis stages should be taken into account when interpreting the studies that validated this method using liver biopsy as a gold-standard. LSM might be influenced by nonfasting status, flare of transaminases, heart failure, extrahepatic cholestasis, presence of steatosis, aetiology of liver disease, type and position of probe, and operator's experience. In addition, interobserver variability can impact on the management of patients with chronic liver diseases. TE should be performed by an experienced operator (>100 exams), in a 3-hour fasting status, and its results should be handled by specialist clinicians that are aware of the limitations of this method.

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References

Poynard T, Ngo Y, Munteanu M, Thabut D, Ratziu V . Noninvasive Markers of Hepatic Fibrosis in Chronic Hepatitis B. Curr Hepat Rep. 2011; 10(2):87-97. PMC: 3085108. DOI: 10.1007/s11901-011-0096-0. View

Perazzo H, Fernandes F, Castro Filho E, Perez R . Points to be considered when using transient elastography for diagnosis of portal hypertension according to the Baveno's VI consensus. J Hepatol. 2015; 63(4):1048-9. DOI: 10.1016/j.jhep.2015.06.036. View

Arena U, Vizzutti F, Corti G, Ambu S, Stasi C, Bresci S . Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2007; 47(2):380-4. DOI: 10.1002/hep.22007. View

Poynard T, Lenaour G, Vaillant J, Capron F, Munteanu M, Eyraud D . Liver biopsy analysis has a low level of performance for diagnosis of intermediate stages of fibrosis. Clin Gastroenterol Hepatol. 2012; 10(6):657-63.e7. DOI: 10.1016/j.cgh.2012.01.023. View

Colli A, Pozzoni P, Berzuini A, Gerosa A, Canovi C, Molteni E . Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology. 2010; 257(3):872-8. DOI: 10.1148/radiol.10100013. View

Poynard T, Halfon P, Castera L, Munteanu M, Imbert-Bismut F, Ratziu V . Standardization of ROC curve areas for diagnostic evaluation of liver fibrosis markers based on prevalences of fibrosis stages. Clin Chem. 2007; 53(9):1615-22. DOI: 10.1373/clinchem.2007.085795. View

Boursier J, Konate A, Guilluy M, Gorea G, Sawadogo A, Quemener E . Learning curve and interobserver reproducibility evaluation of liver stiffness measurement by transient elastography. Eur J Gastroenterol Hepatol. 2008; 20(7):693-701. DOI: 10.1097/MEG.0b013e3282f51992. View

Perazzo H, Fernandes F, Gomes A, Terra C, Perez R, Figueiredo F . Interobserver variability in transient elastography analysis of patients with chronic hepatitis C. Liver Int. 2014; 35(5):1533-9. DOI: 10.1111/liv.12551. View

Millonig G, Reimann F, Friedrich S, Fonouni H, Mehrabi A, Buchler M . Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008; 48(5):1718-23. DOI: 10.1002/hep.22577. View

10.

Lambert J, Halfon P, Penaranda G, Bedossa P, Cacoub P, Carrat F . How to measure the diagnostic accuracy of noninvasive liver fibrosis indices: the area under the ROC curve revisited. Clin Chem. 2008; 54(8):1372-8. DOI: 10.1373/clinchem.2007.097923. View

11.

Poynard T, Ingiliz P, Elkrief L, Munteanu M, Lebray P, Morra R . Concordance in a world without a gold standard: a new non-invasive methodology for improving accuracy of fibrosis markers. PLoS One. 2008; 3(12):e3857. PMC: 2586659. DOI: 10.1371/journal.pone.0003857. View

12.

Hopper I, Kemp W, Porapakkham P, Sata Y, Condon E, Skiba M . Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography. Eur J Heart Fail. 2012; 14(6):621-7. DOI: 10.1093/eurjhf/hfs044. View

13.

Snowdon V, Guha N, Fallowfield J . Noninvasive evaluation of portal hypertension: emerging tools and techniques. Int J Hepatol. 2012; 2012:691089. PMC: 3376538. DOI: 10.1155/2012/691089. View

14.

Fung J, Lai C, Chan S, But D, Seto W, Cheng C . Correlation of liver stiffness and histological features in healthy persons and in patients with occult hepatitis B, chronic active hepatitis B, or hepatitis B cirrhosis. Am J Gastroenterol. 2009; 105(5):1116-22. DOI: 10.1038/ajg.2009.665. View

15.

Singh S, Fujii L, Murad M, Wang Z, Asrani S, Ehman R . Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013; 11(12):1573-84.e1-2. PMC: 3900882. DOI: 10.1016/j.cgh.2013.07.034. View

16.

Fraquelli M, Rigamonti C, Casazza G, Conte D, Donato M, Ronchi G . Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut. 2007; 56(7):968-73. PMC: 1994385. DOI: 10.1136/gut.2006.111302. View

17.

Obuchowski N . An ROC-type measure of diagnostic accuracy when the gold standard is continuous-scale. Stat Med. 2005; 25(3):481-93. DOI: 10.1002/sim.2228. View

18.

European Association For The Study Of The Liver . Corrigendum to 'EASL recommendations on treatment of hepatitis C: Final update of the series [J Hepatol 73 (2020) 1170-1218]. J Hepatol. 2022; 78(2):452. DOI: 10.1016/j.jhep.2022.10.006. View

19.

de Ledinghen V, Vergniol J . Transient elastography (FibroScan). Gastroenterol Clin Biol. 2008; 32(6 Suppl 1):58-67. DOI: 10.1016/S0399-8320(08)73994-0. View

20.

Macaluso F, Maida M, Camma C, Cabibbo G, Cabibi D, Alduino R . Steatosis affects the performance of liver stiffness measurement for fibrosis assessment in patients with genotype 1 chronic hepatitis C. J Hepatol. 2014; 61(3):523-9. DOI: 10.1016/j.jhep.2014.04.045. View