Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease

Authors

  • Vincent Wai-Sun Wong,

    1. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
    2. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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  • Julien Vergniol,

    1. Centre d'Investigation de la Fibrose Hépatique, Centre Hospitalier Universitaire (CHU) de Bordeaux, Hôpital Haut-Lévêque, France
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  • Grace Lai-Hung Wong,

    1. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
    2. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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  • Juliette Foucher,

    1. Centre d'Investigation de la Fibrose Hépatique, Centre Hospitalier Universitaire (CHU) de Bordeaux, Hôpital Haut-Lévêque, France
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  • Henry Lik-Yuen Chan,

    1. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
    2. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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  • Brigitte Le Bail,

    1. Institut National de la Santé et de la Recherche Médicale U889, Université Victor Segalen, Bordeaux, France
    2. Service d'Anatomie Pathologique, CHU de Bordeaux, Hôpital Pellegrin, France
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  • Paul Cheung-Lung Choi,

    1. Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
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  • Mathurin Kowo,

    1. Centre d'Investigation de la Fibrose Hépatique, Centre Hospitalier Universitaire (CHU) de Bordeaux, Hôpital Haut-Lévêque, France
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  • Anthony Wing-Hung Chan,

    1. Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
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  • Wassil Merrouche,

    1. Centre d'Investigation de la Fibrose Hépatique, Centre Hospitalier Universitaire (CHU) de Bordeaux, Hôpital Haut-Lévêque, France
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  • Joseph Jao-Yiu Sung,

    1. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
    2. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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  • Victor de Lédinghen

    Corresponding author
    1. Centre d'Investigation de la Fibrose Hépatique, Centre Hospitalier Universitaire (CHU) de Bordeaux, Hôpital Haut-Lévêque, France
    2. Institut National de la Santé et de la Recherche Médicale U889, Université Victor Segalen, Bordeaux, France
    • Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, 33604 Pessac Cedex, France===

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    • fax: (33)-557-656-445.


  • 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.

Abstract

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.)

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