What Did We Learn from the First 3,459 Cases of Liver Stiffness Measurement by Transient Elastography (FibroScan®)?

Zusammenfassung

Ziel: Die chronische virale Hepatitis kann man durch invasive oder nicht invasive Methoden einschätzen. Das Ziel dieser Arbeit war die Evaluation der Indikationen und Ergebnisse der transienten elastografischen (TE) Untersuchung der Leber von Patienten mit chronischer Hepatitis und Zirrhose. Material und Methoden: Im Rahmen der Evaluation wurden alle Lebersteifheitsmessungen (LSM) (FibroScan®) bewertet, die über einen Zeitraum von 2 Jahren durchgeführt wurden (2007 – 2009). Ergebnisse: 3459 TE-Bewertungen wurden hauptsächlich für die Einschätzung von Hepatitis C, HBV-Infektion (chronische Hepatitis und inaktive HBV-Träger), bivirale Hepatitis (B + C oder B + D), Zirrhose sowie an 176 normalen Probanden (um die normalen LSM-Werte zu ermitteln) durchgeführt. Von den 3459 Bewertungen konnten wir in 183 Fällen (5,3 %) keine gültige LSM erhalten, 93,9 % dieser Fälle wegen Übergewichtigkeit (BMI > 25 kg/m²). In 527 Fällen (16 %) war die Erfolgsrate ER (Erfolgsrate: Anzahl der gültigen Messungen/Gesamtzahl der Messungen) < 60 %. Die TE-Reproduzierbarkeit der Ergebnisse wurde in 287 Fällen analysiert. Die Reproduzierbarkeit der Ergebnisse einzelner Untersucher waren die ICC-Werte 0,985, 0,949 bzw. 0,874 und die gesamten ICC-Werte 0,982. Es wurden 596 Fälle von Zirrhose bewertet. Ein Höchstwert von 23,3 kPa wurde ermittelt, um die Anwesenheit von Ösophagusvarizen mindestens 2. Grades vorherzusagen. Schlussfolgerung: LSM mittels TE ist eine vielversprechende, nicht invasive Bewertungsmethode, die man in zahlreichen klinischen Situationen anwenden kann. In manchen klinischen Situationen ist diese Methode gut (Verdacht auf LC, Vorhersage signifikanter Fibrose), in anderen weniger etabliert (HBV chronische Hepatitis, Schwere des portalen Bluthochdrucks).

Abstract

Purpose: Chronic viral hepatopathies can be evaluated through invasive or noninvasive methods. The aim of this paper was to assess the indications and results of transient elastographic (TE) evaluation of the liver in patients with chronic viral hepatitis and cirrhosis. Materials and Methods: We retrospectively assessed all the liver stiffness measurements (LSM) (FibroScan®) performed over a two-year period (2007 – 2009). Results: 3,459 TE evaluations were made mainly for the assessment of: HCV hepatitis, HBV infection (chronic hepatitis and inactive HBV carriers), biviral hepatitis (B + C or B + D), cirrhosis and in 176 normal subjects (to establish the normal values of LSM). From the 3,459 FS evaluations, we could not obtain valid LSM in 183 cases (5.3 %). 93.9 % of the patients in the failure group were overweight (BMI > 25 kg/m²). In 527 cases (16 %) the SR (success rate = number of valid measurements/total number of measurements) was < 60 %. TE reproducibility was analyzed in 287 cases. The ICCs for the three operators were 0.985, 0.949, and 0.874 respectively, and the overall ICC was 0.982. 596 cases of cirrhosis were evaluated. A cut-off value of 23.3kPa was found to predict the presence of at least grade 2 esophageal varices. Conclusion: LSM by means of TE is a promising noninvasive evaluation method, which can be used in numerous clinical situations, some in which its value is well established (suspicion of LC, predicting significant fibrosis) and some in which its value is less known (HBV chronic hepatitis, inactive HBV carriers or severity of portal hypertension).

Key words

transient elastography - noninvasive evaluation - liver fibrosis

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