Nicht invasive Beurteilung des Leberfibrosestadiums mit der transienten Elastografie (FibroScan): Aktueller Stand und Perspektiven

Zusammenfassung

Die Kenntnis des Leberfibrosestadiums ist für die Einschätzung von Prognose und Verlauf und zur Beurteilung der Therapieindikation bei Patienten mit chronischen Lebererkrankungen von entscheidender Bedeutung. Die Leberbiopsie gilt immer noch als „Gold”-Standard zur Beurteilung des Leberfibrosestadiums. Allerdings ist die Leberbiopsie eine invasive Methode, deren diagnostische Genauigkeit durch Intra- und Inter-Beobachter-Variabilität und Variabilität der Proben eingeschränkt ist. In den letzten Jahren wurden vermehrt nicht invasive Marker und Verfahren zur Beurteilung des Leberfibrosestadiums evaluiert. Der FibroScan (Echosens, Frankreich) ist ein eigens zur Messung der Lebersteifheit (Liver Stiffness) entwickeltes Gerät, welches sich das Prinzip der transienten Elastografie zunutze macht. Inzwischen (Januar 2007) gibt es 20 Originalpublikationen und 76 Abstracts, in welchen der FibroScan bei verschiedenen Lebererkrankungen evaluiert wurde. Die vorliegende Arbeit gibt eine Übersicht über die bisher publizierten Daten. Die besten Ergebnisse des FibroScans finden sich für die Unterscheidung einer Leberzirrhose versus keiner Leberzirrhose. Durch die Kombination vom FibroScan mit Serumfibrosemarkern kann die diagnostische Genauigkeit auch für die Diagnose einer signifikanten Fibrose (Metavir F ≥ 2) weiter optimiert werden. Ersten Studienergebnissen zufolge scheint der FibroScan auch zur Beurteilung des Therapieansprechens nach einer antiviralen Therapie bei chronischer Hepatitis C Verwendung zu finden. Daneben haben weitere Studien gezeigt, dass die FibroScan-Untersuchung auch zur Einschätzung des Auftretens von Komplikationen einer Leberzirrhose herangezogen werden kann.

Abstract

A precise staging of the degree of liver fibrosis is important for the estimation of prognosis, surveillance and treatment decision in patients with chronic liver diseases. At present, liver biopsy is still the reference standard for the assessment of liver fibrosis. However, it is an invasive method associated with patient discomfort and in rare cases with serious complications. In addition, the accuracy of liver biopsy is limited due to intra- and interobserver variability and sampling errors. Non-invasive markers and methods for the assessment of liver fibrosis have been intensively evaluated in many studies. The FibroScan (Echosens, France) uses the transient elastography principle for the measurement of liver stiffness. At present (January 2007), studies evaluating the FibroScan in a wide range of liver diseases have been published in 20 full papers and 76 abstracts. The present review gives an overview of the current literature. The best results are reported for the differentiation between cirrhosis and no cirrhosis. With the combination of FibroScan and non-invasive serum fibrosis markers, the accuracy for the diagnosis of significant fibrosis (Metavir F ≥ 2) can be further improved. According to recent data the FibroScan can also be useful for the evaluation of treatment response in patients receiving antiviral treatment for chronic hepatitis C. In addition, several studies have shown, that the FibroScan can be applied to estimate the risk of complications associated with liver cirrhosis.

Schlüsselwörter

Leber - Leberfibrose - nicht invasive Fibrosemarker - FibroScan - Elastografie

Key words

liver - liver fibrosis - non-invasive marker of fibrosis - FibroScan - elastography

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