Brief Articles
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World J Gastroenterol. Jul 21, 2009; 15(27): 3398-3404
Published online Jul 21, 2009. doi: 10.3748/wjg.15.3398
Applicability and variability of liver stiffness measurements according to probe position
Patrick Ingiliz, Kim Pav Chhay, Mona Munteanu, Pascal Lebray, Yen Ngo, Dominique Roulot, Yves Benhamou, Dominique Thabut, Vlad Ratziu, Thierry Poynard
Patrick Ingiliz, Kim Pav Chhay, Pascal Lebray, Yen Ngo, Yves Benhamou, Dominique Thabut, Vlad Ratziu, Thierry Poynard, AP-HP Hospital Group Pitié-Salpêtrière, Hepatology Department, 47-83 Hospital Boulevard, Paris 75651, France
Mona Munteanu, BioPredictive, 40 Bac street, Paris 75007, France
Dominique Roulot, AP-HP, Hepatology Department, Avicenne hospital, Bobigny 93000, France
Author contributions: Ingiliz P, Chhay KP, Munteanu M, Ngo Y and Roulot D performed the majority of the examinations; Lebray P, Benhamou Y and Thabut D coordinated the inclusion of patients; Ratziu V and Poynard T designed the study; Poynard T and Munteanu M performed the statistical analysis; Poynard T and Ingiliz P wrote the manuscript.
Correspondence to: Dr. Patrick Ingiliz, AP-HP Hospital Group Pitié-Salpêtrière, Hepatology Department, 47-83 Hospital Boulevard, Cedex 13, Paris 75651, France. p_ingiliz@web.de
Telephone: +49-176-24031902
Fax: +49-30-130202977
Received: January 9, 2009
Revised: June 5, 2009
Accepted: June 12, 2009
Published online: July 21, 2009
Abstract

AIM: To investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy.

METHODS: The applicability for LSM was defined as at least 10 valid measurements with a success rate greater than 60% and an interquartile range/median LSM < 30%. The LSM variability compared the inter-position concordance and the concordance with FibroTest.

RESULTS: Four hundred and forty two consecutive patients were included. The applicability of the anterior position (81%) was significantly higher than that of the reference (69%) and lower positions (68%), (both P = 0.0001). There was a significant difference (0.5 kPa, 95% CI 0.13-0.89; P < 0.0001) between mean LSM estimated at the reference position (9.3 kPa) vs the anterior position (8.8 kPa). Discordance between positions was associated with thoracic fold (P = 0.008). The discordance rate between the reference position result and FibroTest was higher when the 7.1 kPa cutoff was used to define advanced fibrosis instead of 8.8 kPa (33.6% vs 23.5%, P = 0.03).

CONCLUSION: The anterior position of the probe should be the first choice for LSM using Fibroscan, as it has a higher applicability without higher variability compared to the usual liver biopsy position.

Keywords: Fibroscan; Fibrotest; Liver fibrosis; Variability; Concordance