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Journal of Gastroenterology

, 43:720 | Cite as

Transient elastography for measurement of liver stiffness measurement can detect early significant hepatic fibrosis in Japanese patients with viral and nonviral liver diseases

  • Noriyuki Obara
  • Yoshiyuki Ueno
  • Koji Fukushima
  • Yu Nakagome
  • Eiji Kakazu
  • Osamu Kimura
  • Yuta Wakui
  • Osamu Kido
  • Masashi Ninomiya
  • Takayuki Kogure
  • Jun Inoue
  • Yasuteru Kondo
  • Masaaki Shiina
  • Takao Iwasaki
  • Takeshi Yamamoto
  • Tooru Shimosegawa
Liver, Pancreas, and Biliary Tract

Abstract

Background

Many studies have reported the efficiency of transient elastography, a noninvasive, reproducible, and reliable method for predicting liver fibrosis, in patients with chronic hepatitis C (CHC) and B (CHB), but there are few reports about nonviral chronic liver disease (CLD) such as primary biliary cirrhosis (PBC), nonalcoholic steatohepatitis (NAFLD), and autoimmune hepatitis (AIH). We therefore compared the efficiency of transient elastography between CHC and nonviral CLD.

Methods

We assessed the accuracy of liver stiffness measurement (LSM) using Fibroscan, and compared these values with those of hyaluronic acid, type 4 collagen, platelet count, prothrombin index, and AST/platelet ratio index (APRI) as indices for the diagnosis of liver fibrosis in 114 patients with a variety of chronic liver diseases: CHC (n = 51), CHB (n = 11), NAFLD (n = 17), PBC (n = 20), and AIH (n = 15). The histology was assessed according to the METAVIR score by two pathologists.

Results

The number of fibrosis stage (F0/1/2/3/4) with CHC was 9/15/12/6/10, and that with nonviral CLD was 10/21/11/4/6, respectively. The ability, assessed by area under receiver operating characteristic (AUROC) curve, to predict liver fibrosis F ≥ 2 for LSM, HA, type 4 collagen, platelet count, prothrombin index, and APRI, was 0.92, 0.81, 0.87, 0.85, 0.85, and 0.92 in CHC patients, respectively; and 0.88, 0.72, 0.81, 0.67, 0.81, and 0.77 in nonviral CLD patients, respectively.

Conclusions

In patients with nonviral CLD, LSM was most helpful in predicting significant fibrosis (F ≥ 2). Transient elastography is a reliable method for predicting significant liver fibrosis, not only in CHC patients but also in nonviral CLD patients.

Key words

transient elastography fibrosis chronic liver disease NAFLD 

References

  1. 1.
    Benvegnu L, Gios M, Boccato S, Alberti A. Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut 2004;53:744–749.PubMedCrossRefGoogle Scholar
  2. 2.
    Degos F, Christidis C, Ganne-Carrie N, Farmachidi JP, Degott C, Guettier C, et al. Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death. Gut 2000;47:131–136.PubMedCrossRefGoogle Scholar
  3. 3.
    Fattovich G. Natural history of hepatitis B. J Hepatol 2003;39(suppl 1):S50–S58.PubMedCrossRefGoogle Scholar
  4. 4.
    Fattovich G, Giustina G, Degos F, Tremolada F, Diodati G, Almasio P, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology 1997;112:463–472.PubMedCrossRefGoogle Scholar
  5. 5.
    Serfaty L, Aumaitre H, Chazouilleres O, Bonnand AM, Rosmorduc O, Poupon RE, et al. Determinants of outcome of compensated hepatitis C virus-related cirrhosis. Hepatology 1998;27:1435–1440.PubMedCrossRefGoogle Scholar
  6. 6.
    Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495–500.PubMedCrossRefGoogle Scholar
  7. 7.
    Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology 2000;32:477–481.PubMedCrossRefGoogle Scholar
  8. 8.
    Bedossa P, Dargere D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38:1449–1457.PubMedGoogle Scholar
  9. 9.
    Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005;128:343–350.PubMedCrossRefGoogle Scholar
  10. 10.
    Corpechot C, El Naggar A, Poujol-Robert A, Ziol M, Wendum D, Chazouilleres O, et al. Assessment of biliary fibrosis by transient elastography in patients with PBC and PSC. Hepatology 2006;43:1118–1124.PubMedCrossRefGoogle Scholar
  11. 11.
    Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006;55:403–408.PubMedCrossRefGoogle Scholar
  12. 12.
    Fraquelli M, Rigamonti C, Casazza G, Conte D, Donato MF, Ronchi G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007;56:968–973.PubMedCrossRefGoogle Scholar
  13. 13.
    Ganne-Carrie N, Ziol M, de Ledinghen V, Douvin C, Marcellin P, Castera L, et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatology 2006;44:1511–1517.PubMedCrossRefGoogle Scholar
  14. 14.
    Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003;29:1705–1713.PubMedCrossRefGoogle Scholar
  15. 15.
    Yoneda M, Yoneda M, Fujita K, Inamori M, Tamano M, Hiriishi H, et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut 2007;56:1330–1331.PubMedCrossRefGoogle Scholar
  16. 16.
    Ogawa E, Furusyo N, Toyoda K, Takeoka H, Otaguro S, Hamada M, et al. Transient elastography for patients with chronic hepatitis B and C virus infection: non-invasive, quantitative assessment of liver fibrosis. Hepatol Res 2007;37:1002–1010.PubMedCrossRefGoogle Scholar
  17. 17.
    Guechot J, Laudat A, Loria A, Serfaty L, Poupon R, Giboudeau J. Diagnostic accuracy of hyaluronan and type III procollagen amino-terminal peptide serum assays as markers of liver fibrosis in chronic viral hepatitis C evaluated by ROC curve analysis. Clin Chem 1996;42:558–563.PubMedGoogle Scholar
  18. 18.
    Pereira TN, Lewindon PJ, Smith JL, Murphy TL, Lincoln DJ, Shepherd RW, et al. Serum markers of hepatic fibrogenesis in cystic fibrosis liver disease. J Hepatol 2004;41:576–583.PubMedCrossRefGoogle Scholar
  19. 19.
    Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518–526.PubMedCrossRefGoogle Scholar
  20. 20.
    Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999;31:929–938.PubMedCrossRefGoogle Scholar
  21. 21.
    Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996;24:289–293.PubMedCrossRefGoogle Scholar
  22. 22.
    Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45:846–854.PubMedCrossRefGoogle Scholar
  23. 23.
    Forns X, Ampurdanes S, Llovet JM, Aponte J, Quinto L, Martinez-Bauer E, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2002;36:986–992.PubMedGoogle Scholar
  24. 24.
    Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001;357:1069–1075.PubMedCrossRefGoogle Scholar
  25. 25.
    Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221–1231.PubMedCrossRefGoogle Scholar
  26. 26.
    Corpechot C, Poujol-Robert A, Wendum D, Galotte M, Chretien Y, Poupon RE, et al. Biochemical markers of liver fibrosis and lymphocytic piecemeal necrosis in UDCA-treated patients with primary biliary cirrhosis. Liver Int 2004;24:187–193.PubMedCrossRefGoogle Scholar
  27. 27.
    Papamichalis PA, Zachou K, Koukoulis GK, Veloni A, Karacosta EG, Kypri L, et al. The revised international autoimmune hepatitis score in chronic liver diseases including autoimmune hepatitis/overlap syndromes and autoimmune hepatitis with concurrent other liver disorders. J Autoimmune Dis 2007;4:3.PubMedCrossRefGoogle Scholar
  28. 28.
    Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology 2005;42:44–52.PubMedCrossRefGoogle Scholar
  29. 29.
    Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004;40:1387–1395.PubMedCrossRefGoogle Scholar
  30. 30.
    Dam-Larsen S, Franzmann M, Andersen IB, Christoffersen P, Jensen LB, Sorensen TI, et al. Long term prognosis of fatty liver: risk of chronic liver disease and death. Gut 2004;53:750–755.PubMedCrossRefGoogle Scholar
  31. 31.
    Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 1995;22:1714–1719.PubMedCrossRefGoogle Scholar
  32. 32.
    Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology 2005;129:113–121.PubMedCrossRefGoogle Scholar
  33. 33.
    Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 2002;123:134–140.PubMedCrossRefGoogle Scholar
  34. 34.
    Sanyal AJ, Banas C, Sargeant C, Luketic VA, Sterling RK, Stravitz RT, et al. Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology 2006;43:682–689.PubMedCrossRefGoogle Scholar
  35. 35.
    Pinzani M, Vizzutti F, Arena U, Marra F. Technology insight: noninvasive assessment of liver fibrosis by biochemical scores and elastography. Nat Clin Pract Gastroenterol Hepatol 2008;5:95–106.PubMedCrossRefGoogle Scholar
  36. 36.
    Foucher J, Castera L, Bernard PH, Adhoute X, Laharie D, Bertet J, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol 2006;18:411–412.PubMedCrossRefGoogle Scholar
  37. 37.
    Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999;94:2467–2474.PubMedCrossRefGoogle Scholar
  38. 38.
    Brunt EM, Neuschwander-Tetri BA, Oliver D, Wehmeier KR, Bacon BR. Nonalcoholic steatohepatitis: histologic features and clinical correlations with 30 blinded biopsy specimens. Hum Pathol 2004;35:1070–10782.PubMedCrossRefGoogle Scholar
  39. 39.
    Murata Y, Abe M, Furukawa S, Kumagi T, Matsui H, Matsuura K, et al. Clinical features of symptomatic primary biliary cirrhosis initially complicated with esophageal varices. J Gastroenterol 2006;41:1220–1226.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Noriyuki Obara
    • 1
  • Yoshiyuki Ueno
    • 1
  • Koji Fukushima
    • 1
  • Yu Nakagome
    • 1
  • Eiji Kakazu
    • 1
  • Osamu Kimura
    • 1
  • Yuta Wakui
    • 1
  • Osamu Kido
    • 1
  • Masashi Ninomiya
    • 1
  • Takayuki Kogure
    • 1
  • Jun Inoue
    • 1
  • Yasuteru Kondo
    • 1
  • Masaaki Shiina
    • 1
  • Takao Iwasaki
    • 1
  • Takeshi Yamamoto
    • 2
  • Tooru Shimosegawa
    • 1
  1. 1.Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Department of GastroenterologyTohoku Koseinenkin HospitalMiyagino, SendaiJapan

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