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Probe position may change results in liver stiffness measurements in transient elastography
July 29, 2009A major clinical challenge is to find the best method to evaluate and to manage the increasing numbers of patients with chronic liver disease. Liver biopsy, due to its risks and limitations, is no longer considered mandatory as the first-line indicator of liver injury, and several markers have been developed as non-invasive alternatives.
The assessment of liver fibrosis by non-invasive techniques, such as biomarkers - FibroTest® (FT) - and liver stiffness measurement (LSM) by Fibroscan®, is now widely performed in countries where these techniques are available and approved. It is therefore essential to identify factors associated with a variability of the results of the techniques to reduce the risk of false positives or false negatives. There are no published procedures for the most accurate position of the probe in LSM.
A research article recently published on July 21,2009 in the World Journal of Gastroenterology addresses this issue. The research team led by Professor Thierry Poynard from the Hepatology Department of the Pitié-Salpêtrière Hospital in Paris, France, found that the applicability of Fibroscan examinations may increase when the probe is placed in a more anterior position. So far, recommendations for Fibroscan examinations derive from a spot vaguely defined as the "liver biopsy zone" which is in the axillary line in the 8th to 10th intercostal space. The article further investigates possible changes in fibrosis grades due to the different probe positions. The mean LSM was significantly lower (0.5 kPa) at the anterior position versus the reference position. This difference was also clinically significant. When using the anterior position instead of the reference position, 7% of patients changed status from advanced fibrosis to non-advanced fibrosis when a cutoff of 7.1 kPa was chosen. The difference of 0.5 kPa is particularly clinically relevant in the zone of 7 kPa to 9 kPa for the risk of a false negative/positive diagnosis of advanced fibrosis; it is less relevant for the diagnosis of cirrhosis as LSM cutoffs are usually recommended at a 12.5 kPa or 14 kPa cutoff with a range to 75 kPa.
Interestingly, the estimated fibrosis scores were compared with FibroTest® and not with liver biopsy in this study. The diagnostic value of LSM and FT has been validated in the most common chronic liver diseases and FT has shown as having at least a similar prognostic value to liver biopsy (which is also an imperfect gold-standard) in patients with chronic hepatitis C and B.
Non-invasive techniques will increasingly replace liver biopsy in chronic liver disease because they are easy-to-do and well accepted by patients. This study helps to improve the understanding of possible limitations of transient elastography. Further research will be needed to define advantages and pitfalls of this technique.
World Journal of Gastroenterology
Interestingly, the estimated fibrosis scores were compared with FibroTest® and not with liver biopsy in this study. The diagnostic value of LSM and FT has been validated in the most common chronic liver diseases and FT has shown as having at least a similar prognostic value to liver biopsy (which is also an imperfect gold-standard) in patients with chronic hepatitis C and B.
Non-invasive techniques will increasingly replace liver biopsy in chronic liver disease because they are easy-to-do and well accepted by patients. This study helps to improve the understanding of possible limitations of transient elastography. Further research will be needed to define advantages and pitfalls of this technique.
World Journal of Gastroenterology
Liver Biopsy Current Events and Liver Biopsy News RSSMount Sinai finds those with more difficult to treat forms of HCV are half as likely to get treated
A new study by Mount Sinai researchers has for the first time found that patients with more difficult to treat forms of hepatitis C are half as likely to initiate treatment for the disease, when compared to patients with hepatitis C that is easier to treat.
Is 31P MRS a useful tool for evaluating early acute hepatic radiation injury?
Acute hepatic radiation injury could lead to necrosis of hepatocytes, fatty degeneration and hepatic fibrosis. At the present, the gold standard test is liver biopsy.
FibroTest attributes to generate decision trees in hepatitis C
In recent years the use of non-invasive biomarkers to assess liver fibrosis has become widely accepted.
Do patients at risk for B-cell malignancy need antiviral treatment?
Some studies have shown that a relationship of hepatitis C (HCV) infection with type II mixed cryoglobulinemia exists. However the precise mechanism remains unclear.
Varicella zoster infection causes severe autoimmune hepatitis
Autoimmune hepatitis (AIH) is a chronic liver inflammation of unknown etiology that is characterized by the presence of circulatory autoantibodies and ongoing liver tissue damage.
A rigorous method for liver biopsy
Liver biopsy is still considered the gold standard for grading, staging and "stad-ging" the chronic liver disease. In addition, it remains a primary source for acquiring new knowledge on the liver pathology.
May hepatic granulomas be part of the histological spectrum of chronic hepatitis C?
While older large series of patients with hepatic granulomas have found sarcoidosis and tuberculosis to be the most common causes of hepatic granulomas, recent works have noted some patients with chronic hepatic C and hepatic granulomas and no other obvious associations.
Bariatric surgery may resolve liver disease
Obesity is a growing epidemic in the U.S. with a significant increase in prevalence from 15 percent to 32.9 percent from 1980 to 2004. Nonalcoholic fatty liver disease (NAFLD) is an emerging problem related to the obesity epidemic, becoming one of the most common causes of liver disease in the nation.
Mayo Clinic's new imaging technology accurately identifies a broad spectrum of liver disease
A new study shows that an imaging technology developed by Mayo Clinic researchers can identify liver fibrosis with high accuracy and help eliminate the need for liver biopsies. Liver fibrosis is a common condition that can lead to incurable cirrhosis if not treated in time.
How to differentiate macro-regenerative nodules from hepato-carcinoma?
BA, the congenital absence or destruction of intra- or extra-hepatic biliary system, affects about 5 - 10/100 000 live births. End stage liver cirrhosis developed in some BA patients later in life.
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