Journal of Gastroenterology

, Volume 42, Issue 5, pp 382–388 | Cite as

Diagnosis of hepatic steatosis and fibrosis by transient elastography in asymptomatic healthy individuals: a prospective study of living related potential liver donors

  • Kang Mo Kim
  • Won-Beom Choi
  • Seong Ho Park
  • Eunsil Yu
  • Sung Gyu Lee
  • Young-Suk Lim
  • Han Chu Lee
  • Young-Hwa Chung
  • Yung Sang Lee
  • Dong-Jin Suh
Liver, Pancreas, and Biliary Tract



This prospective study aimed to assess the ability of transient elastography to identify histologic parameters, including steatosis, in asymptomatic healthy individuals such as potential liver donors, and to compare these findings with results in liver disease patients.


Forty-seven patients with abnormal liver function and/or hepatitis symptoms and 80 living related potential liver donors were consecutively enrolled, and liver biopsy and a Fibroscan test were performed in each subject. Histologic parameters were evaluated according to METAVIR scale by a single pathologist.


In liver disease patients, stiffness was significantly correlated with fibrosis stage (Spearman correlation coefficient, 0.700; P < 0.001), and the optimal stiffness cutoff values for F ≥ 2, F ≥ 3, and F = 4 were 7.35, 8.85, and 15.1 kPa respectively. In potential liver donors, however, stiffness was not correlated with fibrosis (0.023; P = 0.851). In the latter group, the area under the receiver-operating characteristics curve was 0.70 (95% confidence interval, 0.58–0.81), and the optimal stiffness cutoff value was 4.00 for F ≥ 2, which was lower than that in liver disease patients. Steatosis was not correlated with stiffness (0.088; P = 0.463) in potential liver donors.


Transient elastography has limited value for detecting steatosis in asymptomatic healthy individuals, and the cutoff value for fibrosis should be reevaluated in these subjects.

Key words

liver stiffness steatosis fibrosis liver donor liver biopsy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Friedman, SL 1993Seminars in medicine of the Beth Israel Hospital, Boston. The cellular basis of hepatic fibrosis. Mechanisms and treatment strategiesN Engl J Med328182835PubMedCrossRefGoogle Scholar
  2. 2.
    Ikeda, K, Saitoh, S, Suzuki, Y, Kobayashi, M, Tsubota, A, Koida, I,  et al. 1998Disease progression and hepatocellular carcinogenesis in patients with chronic viral hepatitis: a prospective observation of 2215 patientsJ Hepatol289308PubMedCrossRefGoogle Scholar
  3. 3.
    Benvegnu, L, Gios, M, Boccato, S, Alberti, A 2004Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complicationsGut537449PubMedCrossRefGoogle Scholar
  4. 4.
    Afdhal, NH, Nunes, D 2004Evaluation of liver fibrosis: a concise reviewAm J Gastroenterol99116074PubMedCrossRefGoogle Scholar
  5. 5.
    Castera, L, Vergniol, J, Foucher, J, Le Bail, B, Chanteloup, E, Haaser, M,  et al. 2005Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis CGastroenterology12834350PubMedCrossRefGoogle Scholar
  6. 6.
    Sandrin, L, Fourquet, B, Hasquenoph, JM, Yon, S, Fournier, C, Mal, F,  et al. 2003Transient elastography: a new noninvasive method for assessment of hepatic fibrosisUltrasound Med Biol29170513PubMedCrossRefGoogle Scholar
  7. 7.
    Ziol, M, Handra-Luca, A, Kettaneh, A, Christidis, C, Mal, F, Kazemi, F,  et al. 2005Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis CHepatology414854PubMedCrossRefGoogle Scholar
  8. 8.
    Saito, H, Tada, S, Nakamoto, N, Kitamura, K, Horikawa, H, Kurita, S,  et al. 2004Efficacy of non-invasive elastometry on staging of hepatic fibrosisHepatol Res2997103PubMedCrossRefGoogle Scholar
  9. 9.
    Colletta, C, Smirne, C, Fabris, C, Toniutto, P, Rapetti, R, Minisini, R,  et al. 2005Value of two noninvasive methods to detect progression of fibrosis among HCV carriers with normal aminotransferasesHepatology4283845PubMedCrossRefGoogle Scholar
  10. 10.
    Foucher, J, Chanteloup, E, Vergniol, J, Castera, L, Le Bail, B, Adhoute, X,  et al. 2006Diagnosis of cirrhosis by transient elastography (Fibroscan): a prospective studyGut554038PubMedCrossRefGoogle Scholar
  11. 11.
    Masaki, N, Imamura, M, Kikuchi, Y, Oka, S 2006Usefulness of elastometry in evaluating the extents of liver fibrosis in hemophiliacs coinfected with hepatitis C virus and human immunodeficiency virusHepatol Res351359PubMedCrossRefGoogle Scholar
  12. 12.
    Yeh, WC, Li, PC, Jeng, YM, Hsu, HC, Kuo, PL, Li, ML,  et al. 2002Elastic modulus measurements of human liver and correlation with pathologyUltrasound Med Biol2846774PubMedCrossRefGoogle Scholar
  13. 13.
    Chen, CL, Fan, ST, Lee, SG, Makuuchi, M, Tanaka, K 2003Living-donor liver transplantation: 12 years of experience in AsiaTransplantation75S611PubMedCrossRefGoogle Scholar
  14. 14.
    Imber, CJ, St Peter, SD, Handa, A, Friend, PJ 2002Hepatic steatosis and its relationship to transplantationLiver Transpl841523PubMedCrossRefGoogle Scholar
  15. 15.
    Adam, R, Reynes, M, Johann, M, Morino, M, Astarcioglu, I, Kafetzis, I,  et al. 1991The outcome of steatotic grafts in liver transplantationTransplant Proc23153840PubMedGoogle Scholar
  16. 16.
    Todo, S, Demetris, AJ, Makowka, L, Teperman, L, Podesta, L, Shaver, T,  et al. 1989Primary nonfunction of hepatic allografts with preexisting fatty infiltrationTransplantation479035PubMedCrossRefGoogle Scholar
  17. 17.
    Monsour, HP,Jr, Wood, RP, Ozaki, C, Katz, S, Clark, J, Dyer, C,  et al. 1994Utility of preoperative liver biopsy in live-related donor patients for liver transplantationTransplant Proc261389PubMedGoogle Scholar
  18. 18.
    Ryan, CK, Johnson, LA, Germin, BI, Marcos, A 2002One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantationLiver Transpl8111422PubMedCrossRefGoogle Scholar
  19. 19.
    Bravo, AA, Sheth, SG, Chopra, S 2001Liver biopsyN Engl J Med344495500PubMedCrossRefGoogle Scholar
  20. 20.
    Scott, WW,Jr, Sanders, RC, Siegelman, SS 1980Irregular fatty infiltration of the liver: diagnostic dilemmasAJR Am J Roentgenol1356771PubMedGoogle Scholar
  21. 21.
    Bedossa, P, Poynard, T 1996An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study GroupHepatology2428993PubMedCrossRefGoogle Scholar
  22. 22.
    Poynard, T, Ratziu, V, Bedossa, P 2000Appropriateness of liver biopsyCan J Gastroenterol145438PubMedGoogle Scholar
  23. 23.
    Regev, A, Berho, M, Jeffers, LJ, Milikowski, C, Molina, EG, Pyrsopoulos, NT,  et al. 2002Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infectionAm J Gastroenterol9726148PubMedCrossRefGoogle Scholar
  24. 24.
    Bedossa, P, Dargere, D, Paradis, V 2003Sampling variability of liver fibrosis in chronic hepatitis CHepatology38144957PubMedGoogle Scholar
  25. 25.
    Siddique, I, El-Naga, HA, Madda, JP, Memon, A, Hasan, F 2003Sampling variability on percutaneous liver biopsy in patients with chronic hepatitis C virus infectionScand J Gastroenterol3842732PubMedCrossRefGoogle Scholar
  26. 26.
    Siegelman, ES, Rosen, MA 2001Imaging of hepatic steatosisSemin Liver Dis217180PubMedCrossRefGoogle Scholar
  27. 27.
    Ricci, C, Longo, R, Gioulis, E, Bosco, M, Pollesello, P, Masutti, F,  et al. 1997Noninvasive in vivo quantitative assessment of fat content in human liverJ Hepatol2710813PubMedCrossRefGoogle Scholar
  28. 28.
    Longo, R, Pollesello, P, Ricci, C, Masutti, F, Kvam, BJ, Bercich, L,  et al. 1995Proton MR spectroscopy in quantitative in vivo determination of fat content in human liver steatosisJ Magn Reson Imaging52815PubMedCrossRefGoogle Scholar
  29. 29.
    Chen, YS, Cheng, YF, De Villa, VH, Wang, CC, Lin, CC, Huang, TL,  et al. 2003Evaluation of living liver donorsTransplantation75S169PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Kang Mo Kim
    • 1
  • Won-Beom Choi
    • 2
  • Seong Ho Park
    • 3
  • Eunsil Yu
    • 4
  • Sung Gyu Lee
    • 5
  • Young-Suk Lim
    • 1
  • Han Chu Lee
    • 1
  • Young-Hwa Chung
    • 1
  • Yung Sang Lee
    • 1
  • Dong-Jin Suh
    • 1
  1. 1.Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  2. 2.Department of Internal MedicineDongguk University International Hospital, University of Dongguk College of MedicineGoyangKorea
  3. 3.Department of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  4. 4.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  5. 5.Department of Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

Personalised recommendations