Steatohepatitis/Metabolic Liver Disease
Article first published online: 9 SEP 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 51, Issue 2, pages 454–462, February 2010
How to Cite
Wong, V. W.-S., Vergniol, J., Wong, G. L.-H., Foucher, J., Chan, H. L.-Y., Le Bail, B., Choi, P. C.-L., Kowo, M., Chan, A. W.-H., Merrouche, W., Sung, J. J.-Y. and de Lédinghen, V. (2010), Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology, 51: 454–462. doi: 10.1002/hep.23312
See Editorial on page 370.
Potential conflict of interest: Dr. Chan advises and is on the speakers' bureau of Novartis and Bristol-Myers Squibb. He also advises Pharmasset and Schering-Plough. Dr. Sung advises and is on the speakers' bureau of AstraZeneca, GlaxoSmithKline, and Roche.
- Issue published online: 25 JAN 2010
- Article first published online: 9 SEP 2009
- Accepted manuscript online: 9 SEP 2009 12:00AM EST
- Manuscript Accepted: 2 SEP 2009
- Manuscript Received: 18 JUL 2009
- Research fund of the Department of Medicine and Therapeutics, The Chinese University of Hong Kong
Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in affluent countries. Accurate noninvasive tests for liver injury are urgently needed. The aim of this study was to evaluate the accuracy of transient elastography for the diagnosis of fibrosis and cirrhosis in patients with NAFLD and to study factors associated with discordance between transient elastography and histology. Two hundred forty-six consecutive patients from two ethnic groups had successful liver stiffness measurement and satisfactory liver biopsy specimens. The area under the receiver-operating characteristics curve (AUROC) of transient elastography for F3 or higher and F4 disease was 0.93 and 0.95, respectively, and was significantly higher than that of the aspartate aminotransferase–to–alanine aminotransferase ratio, aspartate aminotransferase–to–platelet ratio index, FIB-4, BARD, and NAFLD fibrosis scores (AUROC ranged from 0.62 to 0.81, P < 0.05 for all comparisons). At a cutoff value of 7.9 kPa, the sensitivity, specificity, and positive and negative predictive values for F3 or greater disease were 91%, 75%, 52%, and 97%, respectively. Liver stiffness was not affected by hepatic steatosis, necroinflammation, or body mass index. Discordance of at least two stages between transient elastography and histology was observed in 33 (13.4%) patients. By multivariate analysis, liver biopsy length less than 20 mm and F0-2 disease were associated with discordance. Conclusion: Transient elastography is accurate in most NAFLD patients. Unsatisfactory liver biopsy specimens rather than transient elastography technique account for most cases of discordance. With high negative predictive value and modest positive predictive value, transient elastography is useful as a screening test to exclude advanced fibrosis. Liver biopsy may be considered in NAFLD patients with liver stiffness of at least 7.9 kPa. (HEPATOLOGY 2010;51:454–462.)