Original Article—Liver, Pancreas, and Biliary Tract

Journal of Gastroenterology

, Volume 46, Issue 3, pp 350-358

Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C

  • Hiroyasu MorikawaAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Katsuhiko FukudaAffiliated withDepartment of Gastroenterology, PL Hospital
  • , Sawako KobayashiAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Hideki FujiiAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Shuji IwaiAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Masaru EnomotoAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Akihiro TamoriAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Hiroki SakaguchiAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Norifumi KawadaAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University Email author 

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Abstract

Background

Although histopathological examination by “invasive” liver biopsy remains the gold standard for evaluating disease progression in chronic liver disease, noninvasive tools have appeared and have led to great progress in diagnosing the stage of hepatic fibrosis. The aim of this study was to assess the value of real-time tissue elastography, using an instrument made in Japan, for the visible measurement of liver elasticity; in particular, comparing the results with those of transient elastography (Fibroscan).

Methods

Real-time tissue elastography (RTE), transient elastography (Fibroscan), liver biopsy, and routine laboratory analyses were performed in 101 patients with chronic hepatitis C. The values for tissue elasticity obtained using novel software (Elasto_ver 1.5.1) connected to RTE were transferred to four image features, Mean, Standard Deviation (SD), Area, and Complexity. Their association with the stage of fibrosis at biopsy and with liver stiffness (kPa) obtained by Fibroscan was analyzed.

Results

Colored images obtained by RTE were classified into diffuse soft, intermediate, and patchy hard patterns and the calculated elasticity differed significantly between patients according to and correlated with the stages of fibrosis (p < 0.0001). Mean, SD, Area, and Complexity showed significant differences between the stages of fibrosis (Tukey–Kramer test, p < 0.05). In discriminating patients with cirrhosis, the areas under the receiver operating characteristic curves (AUC) were 0.91 for Mean, 0.84 for SD, 0.91 for Area, 0.93 for Complexity, and 0.95 for Fibroscan.

Conclusions

RTE is a noninvasive instrument for the colored visualization of liver elasticity in patients with chronic liver disease.

Keywords

Liver fibrosis Transient elastography Ultrasound Liver biopsy