Accuracy and reproducibility of transient elastography for the diagnosis of fibrosis in pediatric nonalcoholic steatohepatitis

Authors

  • Valerio Nobili,

    Corresponding author
    1. Liver Unit, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
    • Liver Unit, Research Institute, Bambino Gesù Children's Hospital, Piazza S. Onofrio, 4, 00165 Rome, Italy
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    • fax: 39-0668592192.

  • Francesco Vizzutti,

    1. Department of Internal Medicine, Higher Education and Transfer DENOThe, University of Florence/Azienda Ospedaliero Universitaria Careggi Firenze (AOUC), Florence, Italy
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  • Umberto Arena,

    1. Department of Internal Medicine, Higher Education and Transfer DENOThe, University of Florence/Azienda Ospedaliero Universitaria Careggi Firenze (AOUC), Florence, Italy
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  • Juan G. Abraldes,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, IMDiM, Hospital Clínic, Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas (Ciberehd), University of Barcelona, Barcelona, Spain
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  • Fabio Marra,

    1. Department of Internal Medicine, Higher Education and Transfer DENOThe, University of Florence/Azienda Ospedaliero Universitaria Careggi Firenze (AOUC), Florence, Italy
    2. Center for Research, Higher Education and Transfer DENOThe, University of Florence/Azienda Ospedaliero Universitaria Careggi Firenze (AOUC), Florence, Italy
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  • Andrea Pietrobattista,

    1. Liver Unit, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
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  • Rodolfo Fruhwirth,

    1. Radiology Department “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
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  • Matilde Marcellini,

    1. Liver Unit, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
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  • Massimo Pinzani

    1. Department of Internal Medicine, Higher Education and Transfer DENOThe, University of Florence/Azienda Ospedaliero Universitaria Careggi Firenze (AOUC), Florence, Italy
    2. Center for Research, Higher Education and Transfer DENOThe, University of Florence/Azienda Ospedaliero Universitaria Careggi Firenze (AOUC), Florence, Italy
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  • Potential conflict of interest: Nothing to report.

Abstract

Transient elastography (TE) has received increasing attention as a means to evaluate disease progression in chronic liver disease patients. In this study, we assessed the value of TE for the prediction of fibrosis stage in a cohort of pediatric patients with nonalcoholic steatohepatitis. Furthermore, TE interobserver agreement was evaluated. TE was performed in 52 consecutive biopsy-proven nonalcoholic steatohepatitis patients (32 males, 20 females, age 13.6 ± 2.44 years). The area under the receiver operating characteristic curves for the prediction of “any” (≥1), significant (≥2), or advanced fibrosis (≥3) were 0.977, 0.992, and 1, respectively. Calculation of multilevel likelihood ratios showed that TE values <5, <7, and <9 kPa, suggest the presence of “any” fibrosis, significant fibrosis, and advanced fibrosis, respectively. TE values between 5 and 7 kPa predict a fibrosis stage of 1, but with some degree of uncertainty. TE values between 7 and 9 kPa predict fibrosis stages 1 or 2, but cannot discriminate between these two stages. TE values of at least 9 kPa are associated with the presence of advanced fibrosis. The intraclass correlation coefficient for absolute agreement was 0.961. Conclusion: TE is an accurate and reproducible methodology to identify pediatric subjects without fibrosis or significant fibrosis, or with advanced fibrosis. In patients in which likelihood ratios are not optimal to provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. (HEPATOLOGY 2008.)

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