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Noninvasive screening for liver fibrosis and portal hypertension by transient elastography—a large single center experience

Transiente Elastographie: eine neue nichtinvasive Screeningmethode für Leberfibrose und portale Hypertension

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Summary

Background

Transient elastography (TE) is a noninvasive tool to assess hepatic fibrosis by measuring liver stiffness (LS). Recent studies suggest that TE may be used to screen for liver cirrhosis and clinically significant portal hypertension (³ 10 mmHg; CSPH), whereas data on the clinical applicability of TE are limited.

Methods

Among 695 patients undergoing measurement of LS, data on liver biopsies and on hepatic venous pressure gradient (HVPG) were available in 290 and 502 patients, respectively. Analysis of the area under the receiver operating curve (AUC) was used to assess the positive (PPV) and negative predictive (NPV) values of LS cut-offs for staging of hepatic fibrosis and for diagnosis of CSPH.

Results

LS was significantly associated with fibrosis stage (R = 0.872;p  < 0.0001). AUC for diagnosis of fibrosis F2 (> 7.2 kPa) was 0.690, 0.737 for F3 (> 9.6 kPa), and 0.904 for F4 (> 12.1 kPa), respectively. At a LS cut-off of 12.1 kPa the PPV and NPV for diagnosis of cirrhosis were 87 and 91 %, respectively. A significant correlation of LS and HVPG was noted (R = 0.794;p < 0.0001), being stronger in patients with viral disease (R = 0.838;p < 0.0001) than in patients with alcoholic disease (R = 0.756;p < 0.0001). The LS cut-off at 18 kPa can identify CSPH with a PPV and NPV of 86 and 80 %, respectively.

Conclusions

This large single center study confirms the clinical utility of TE as valuable noninvasive screening tool for liver fibrosis with excellent accuracy to rule out F4 cirrhosis. However, the moderate PPV and NPV limit the diagnostic use of TE for discriminating patients with and without CSPH.

Zusammenfassung

Grundlagen

Die transiente Elastographie (TE) ist eine ultraschallbasierte nicht-invasive Methode, um die Lebersteifigkeit (LS) zu messen. Rezente Studien suggerieren, dass die TE als Screeningtool für das Vorliegen einer Leberzirrhose und einer signifikanten portalen Hypertension (³ 10 mmHg; CSPH) verwendet werden kann. Die Evidenz durch die aktuelle Datenlage ist jedoch gering.

Methodik

Bei 695 Patienten wurde die LS durch eine TE gemessen. Zusätzlich wurden bei 290 Patienten eine Leberbiopsie und bei 502 Patienten eine Pfortaderdruckmessung (HVPG) durchgeführt. Die positiv (PPV) und negativ prädiktiven (PPV) Werte sowie die „area under the curve“ (AUC) für die nichtinvasive Diagnostik von histologischen Leberfibrosestadien (F1–F4) sowie einer CSPH wurden in Bezug auf verschiedene LS Grenzwerte berechnet.

Ergebnisse

Die Höhe der LS war signifikant mit den histologischen Fibrosestadien assoziiert (R = 0.872;p < 0.0001). Die AUCs lagen für die Diagnose eines Fibrosestadium F2 mit einem TE Grenzwert von > 7.2 kPa bei 0.690, für ein F3 Stadium mit einem TE Grenzwert von > 9.6 kPa bei 0.737, und für ein F4 Stadium (= Zirrhosestadium) mit einem TE Grenzwert von > 12.1 kPa bei 0.904. Mittels einem LS Grenzwert von > 12.1 kPa für die Diagnose einer Leberzirrhose (F4) betrugen der PPV 87 % und der NPV 91 %.

Es gab eine signifikante Korrelation zwischen LS und Pfortaderdruck (HVPG): (R = 0.794;p < 0.0001), die bei Patienten mit einer chronischen Virushepatitis (R = 0.838;p < 0.0001) stärker ausgeprägt war als bei Patienten mit alkoholischer Lebererkrankung (R = 0.756;p < 0.0001). Für die Diagnose einer signifikanten portalen Hypertension (CSPH) mittels LS Grenzwert bei > 18 kPa lagen der PPV bei 86 % bzw. der NPV bei 80 %.

Schlussfolgerungen

Diese Analyse an einem großen Kollektiv von Patienten mit chronischer Lebererkrankung bestätigte die klinische Wertigkeit einer TE als wertvolle nichtinvasive Screeningmethode auf das Vorliegen einer Leberzirrhose. Die klinische Aussagekraft einer TE in Bezug eine nichtinvasive Diagnostik für das Vorliegen einer portalen Hypertension ist jedoch limitiert.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Waehringer Guertel 18–20, Vienna, Austria

    Thomas Reiberger MD, Arnulf Ferlitsch, Berit Anna Payer, Matthias Pinter, Philipp Schwabl, Michael Trauner &  Markus Peck-Radosavljevic MD

  2. Department of Pathology, Medical University Vienna, Waehringer Guertel 18–20, Vienna, Austria

    Judith Stift

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  1. Thomas Reiberger MD
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Correspondence to Markus Peck-Radosavljevic MD.

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Reiberger, T., Ferlitsch, A., Payer, B. et al. Noninvasive screening for liver fibrosis and portal hypertension by transient elastography—a large single center experience. Wien Klin Wochenschr 124, 395–402 (2012). https://doi.org/10.1007/s00508-012-0190-5

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