Noninvasive scan accurately detects cirrhosis

A novel, noninvasive scanning procedure, known as transient elastography, accurately measured cirrhosis in patients with chronic type B and C viral hepatitis and may offer an alternative to liver biopsy, according to researchers.

Although liver biopsy is the standard technique for assessing liver fibrosis, the procedure is invasive and could lead to complications, sampling errors and variability in reporting. Transient elastography (FibroScan, Echosens) is an outpatient procedure and allows for immediate assessment of liver stiffness.

In a national, multi-center study, Nezam Hassan Afdhal, MD, and Alan Bonder, MD, both of Beth Israel Deaconess Medical Center in Boston, set out to assess the diagnostic accuracy of liver stiffness vs. liver biopsy, as well as the intra and inter operator reproducibility in 748 patients with chronic viral hepatitis. Patients underwent transient elastography before liver biopsy.

The study had two phases — phase 1 aimed to identify the optimal stiffness cut-off values to stages F2 and F4; phase 2 aimed to assess the cut-off values identified during phase 1.

The area under receiver operating characteristic curves for liver stiffness in stage F2 was 0.76 (95% CI: 0.72-0.79) and 0.91 for stage F4 (95% CI: 0.87-0.93). During phase 1, the liver stiffness cut-off values were 8.4 for stage F2 and 12.8 for stage F4.

During phase 2, the cut-off values exhibited a sensitivity of 58% (P<0.001) and specificity of 75% for stage F2 and a sensitivity of 76% (P<0.0001) and specificity of 85% for stage F4.

The intra class correlation coefficient was 0.98 for inter observer agreement (n=26) and 0.95 for intra observer agreement (n=34) with transient elastography.

“What we found, confirms that FibroScan very accurately assesses for the presence of cirrhosis in patients with both types of chronic viral hepatitis,” study participant Stuart C. Gordon, MD, director of the hepatology section at Henry Ford Hospital in Detroit, said in a press release.