Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 7, 2013; 19(1): 49-56
Published online Jan 7, 2013. doi: 10.3748/wjg.v19.i1.49
Performance of liver stiffness measurements by transient elastography in chronic hepatitis
Giovanna Ferraioli, Carmine Tinelli, Barbara Dal Bello, Mabel Zicchetti, Raffaella Lissandrin, Gaetano Filice, Carlo Filice, Elisabetta Above, Giorgio Barbarini, Enrico Brunetti, Willy Calderon, Marta Di Gregorio, Roberto Gulminetti, Paolo Lanzarini, Serena Ludovisi, Laura Maiocchi, Antonello Malfitano, Giuseppe Michelone, Lorenzo Minoli, Mario Mondelli, Stefano Novati, Savino FA Patruno, Alessandro Perretti, Gianluigi Poma, Paolo Sacchi, Domenico Zanaboni, Marco Zaramella
Giovanna Ferraioli, Mabel Zicchetti, Raffaella Lissandrin, Carlo Filice, Elisabetta Above, Gianluigi Poma, Marta Di Gregorio, Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, 27100 Pavia, Italy
Carmine Tinelli, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Barbara Dal Bello, Department of Pathology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Gaetano Filice, Enrico Brunetti, Serena Ludovisi, Lorenzo Minoli, Mario Mondelli, Alessandro Perretti, Marco Zaramella, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, 27100 Pavia, Italy
Giorgio Barbarini, Willy Calderon, Roberto Gulminetti, Paolo Lanzarini, Laura Maiocchi, Antonello Malfitano, Giuseppe Michelone, Stefano Novati, Savino FA Patruno, Paolo Sacchi, Domenico Zanaboni, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Author contributions: Ferraioli G and Tinelli C designed the study; Ferraioli G, Zicchetti M, Lissandrin R, Dal Bello B performed the research; Tinelli C performed the statistical analysis; Ferraioli G, Zicchetti M, Lissandrin R wrote the manuscript, Tinelli C, Dal Bello B, Filice G and Filice C reviewed the manuscript; Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Lissandrin R, Filice G and Filice C approved the final version; all authors of the Liver Fibrosis Study Group (Above E, Barbarini G, Brunetti E, Calderon W, Di Gregorio M, Gulminetti R, Lanzarini P, Ludovisi S, Maiocchi L, Malfitano A, Michelone G, Minoli L, Mondelli M, Novati S, Patruno SFA, Perretti A, Poma G, Sacchi P, Zanaboni D, Zaramella M) performed the research, reviewed the manuscript and approved the final version.
Correspondence to: Giovanna Ferraioli, MD, Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Via Taramelli 5, 27100 Pavia, Italy. giovanna.ferraioli@unipv.it
Telephone: +39-382-502887 Fax: +39-382-501505
Received: June 12, 2012
Revised: October 24, 2012
Accepted: October 30, 2012
Published online: January 7, 2013
Abstract

AIM: To compare results of liver stiffness measurements by transient elastography (TE) obtained in our patients population with that used in a recently published meta-analysis.

METHODS: This was a single center cross-sectional study. Consecutive patients with chronic viral hepatitis scheduled for liver biopsy at the outpatient ward of our Infectious Diseases Department were enrolled. TE was carried out by using FibroScan™ (Echosens, Paris, France). Liver biopsy was performed on the same day as TE, as day case procedure. Fibrosis was staged according to the Metavir scoring system. The diagnostic performance of TE was assessed by using receiver operating characteristic (ROC) curves and the area under the ROC curve analysis.

RESULTS: Two hundred and fifty-two patients met the inclusion criteria. Six (2%) patients were excluded due to unreliable TE measurements. Thus, 246 (171 men and 75 women) patients were analyzed. One hundred and ninety-five (79.3%) patients had chronic hepatitis C, 41 (16.7%) had chronic hepatitis B, and 10 (4.0%) were coinfected with human immunodeficiency virus. ROC curve analysis identified optimal cut-off value of TE as high as 6.9 kPa for F≥ 2; 7.9 kPa for F≥ 3; 9.6 kPa for F = 4 in all patients (n = 246), and as high as 6.9 kPa for F≥ 2; 7.3 kPa for F≥ 3; 9.3 kPa for F = 4 in patients with hepatitis C (n = 195). Cut-off values of TE obtained by maximizing only the specificity were as high as 6.9 kPa for F≥ 2; 9.6 kPa for F≥ 3; 12.2 kPa for F = 4 in all patients (n = 246), and as high as 7.0 kPa for F≥ 2; 9.3 kPa for F≥ 3; 12.3 kPa for F = 4 in patients with hepatitis C (n = 195).

CONCLUSION: The cut-off values of TE obtained in this single center study are comparable to that obtained in a recently published meta-analysis that included up to 40 studies.

Keywords: Chronic viral hepatitis; Hepatitis C; Liver; Liver biopsy; Liver fibrosis; Elastography; Transient elastography; FibroScan; Ultrasound