The diagnostic accuracy of fibroscan for cirrhosis is influenced by liver morphometry in HCV patients with an SVR
Abstract
Data di Pubblicazione:
2011
Abstract:
Background & Aim. Transient elastography (TE) is a validated
non-invasive method to evaluate hepatic fibrosis in patients with
chronic hepatitis C virus (HCV) infection. However it has never
been evaluated in patients with HCV-related cirrhosis and a
sustained virological response (SVR). The aim of this study was
to assess the accuracy of TE for the detection of liver fibrosis in
HCV cirrhotic patients achieving a SVR. Materials and Methods.
A liver biopsy (mean length: 24 mm) was performed in 38
patients with pre-treatment cirrhosis 61 months (range 46–104)
after the achievement of a SVR. Liver fibrosis and necroinflammatory
activity were assessed by METAVIR scoring system. The
area of fibrosis was assessed by morphometry (%). Liver stiffness
was measured by TE in parallel with the liver biopsy using
a cut-off >12 kPa for the prediction of cirrhosis (F4). ROC curve
analysis was used to assess TE diagnostic accuracy in predicting
F4. Results. Cirrhosis was still present in 15 (39%) patients,
whereas 23 (61%) showed a histological down-staging to F1
(5%), F2 (18%) and F3 (38%). TE was unreliable due to a success
rate < 60% and/or inter-quartile range > 30% in 10
(26%, 4 with F4 and 6 with F<4) patients. Median TE value did
not differ significantly between F4 and F<4 patients (12.4 kPa
vs 9.2 kPa, p=0.3, respectively). 5/11 (45%) cirrhotics had a
TE of less than 12 kPa and 1/17 (6%) non-cirrhotic patient had
a TE higher than 12 kPa. The diagnostic accuracy of TE for F4
was: 54% sensitivity, 94% specificity, 9 LR +, 0.48 LR −,
AUROC 0.77. Overall, the fibrosis amount assessed by morphometry
decreased in 34 (89%) patients, with the baseline
median collagen decreasing from 9.0% (2.9%-23.8%) to 2.4%
(0.6%-15.1%; p<0.0001) after treatment, the reduction being
significant also in patients still remaining F4 (p=0.006). A significant
positive correlation was observed between the area of
fibrosis and TE values (r 0.54; p = 0.01). Conclusions. In SVR
patients with HCV, TE has low accuracy for the detection of cirrhosis
as a consequence of liver fibrosis remodelling
non-invasive method to evaluate hepatic fibrosis in patients with
chronic hepatitis C virus (HCV) infection. However it has never
been evaluated in patients with HCV-related cirrhosis and a
sustained virological response (SVR). The aim of this study was
to assess the accuracy of TE for the detection of liver fibrosis in
HCV cirrhotic patients achieving a SVR. Materials and Methods.
A liver biopsy (mean length: 24 mm) was performed in 38
patients with pre-treatment cirrhosis 61 months (range 46–104)
after the achievement of a SVR. Liver fibrosis and necroinflammatory
activity were assessed by METAVIR scoring system. The
area of fibrosis was assessed by morphometry (%). Liver stiffness
was measured by TE in parallel with the liver biopsy using
a cut-off >12 kPa for the prediction of cirrhosis (F4). ROC curve
analysis was used to assess TE diagnostic accuracy in predicting
F4. Results. Cirrhosis was still present in 15 (39%) patients,
whereas 23 (61%) showed a histological down-staging to F1
(5%), F2 (18%) and F3 (38%). TE was unreliable due to a success
rate < 60% and/or inter-quartile range > 30% in 10
(26%, 4 with F4 and 6 with F<4) patients. Median TE value did
not differ significantly between F4 and F<4 patients (12.4 kPa
vs 9.2 kPa, p=0.3, respectively). 5/11 (45%) cirrhotics had a
TE of less than 12 kPa and 1/17 (6%) non-cirrhotic patient had
a TE higher than 12 kPa. The diagnostic accuracy of TE for F4
was: 54% sensitivity, 94% specificity, 9 LR +, 0.48 LR −,
AUROC 0.77. Overall, the fibrosis amount assessed by morphometry
decreased in 34 (89%) patients, with the baseline
median collagen decreasing from 9.0% (2.9%-23.8%) to 2.4%
(0.6%-15.1%; p<0.0001) after treatment, the reduction being
significant also in patients still remaining F4 (p=0.006). A significant
positive correlation was observed between the area of
fibrosis and TE values (r 0.54; p = 0.01). Conclusions. In SVR
patients with HCV, TE has low accuracy for the detection of cirrhosis
as a consequence of liver fibrosis remodelling
Tipologia CRIS:
1.5 Abstract in rivista
Elenco autori:
Prati, G. M.; D’Ambrosio, R.; Fraquelli, M.; Aghemo, A.; Rumi, M.; Ronchi, G.; Paradis, V.; Bedossa, P.; Colombo, M.
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