Liver Stiffness Measurement Using XL Probe in Patients With ... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: LIVER

Liver Stiffness Measurement Using XL Probe in Patients With Nonalcoholic Fatty Liver Disease

Wong, Vincent Wai-Sun MD1, 2, 5; Vergniol, Julien MD3, 5; Wong, Grace Lai-Hung MD1, 2; Foucher, Juliette MD3; Chan, Anthony Wing-Hung FRCPath4; Chermak, Faiza MD3; Choi, Paul Cheung-Lung FRCPath4; Merrouche, Wassil MSc3; Chu, Shirley Ho-Ting MSc1, 2; Pesque, Sophie MD3; Chan, Henry Lik-Yuen MD1, 2; de Lédinghen, Victor MD, PhD3

1 Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China

2 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China

3 Centre d’Investigation de la Fibrose Hépatique, Centre Hospitalier Universitaire (CHU) de Bordeaux, Hôpital Haut-Lévêque, Pessac, France

4 Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China

5 These authors contributed equally to this work

Correspondence: Henry Lik-Yuen Chan, MD, Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, 33604 Pessac Cedex, France. E-mail: [email protected]

Correspondence: Henry Lik-Yuen Chan, MD, Department of Medicine and Therapeutics, 9/F, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, China. E-mail: [email protected]

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/A616, https://links.lww.com/AJG/A617, https://links.lww.com/AJG/A629

Received 2 April 2012; accepted 8 August 2012

published online 2 October 2012

Abstract

OBJECTIVES:

Liver stiffness measurement (LSM) by transient elastography is a noninvasive test of liver fibrosis, but cannot be performed in a significant proportion of obese patients. The aim of this study was to evaluate the performance of the new XL probe in patients with nonalcoholic fatty liver disease (NAFLD).

METHODS:

Liver biopsy and paired LSM by both the original M probe and XL probe were performed on 193 consecutive NAFLD patients in France and Hong Kong.

RESULTS:

Compared with M probe, XL probe was more likely to achieve 10 valid measurements (95% vs. 81%; P <0.001) and a success rate of over 60% (90% vs. 74%; P <0.001). The areas under receiver operating characteristics curves of XL probe for F2, F3, and F4 disease were 0.80, 0.85, and 0.91, respectively. XL probe tended to generate lower LSM than M probe in the same patient. At a cutoff of 7.2 kPa, the sensitivity, specificity, positive, and negative predictive values for F3 or greater disease were 78%, 78%, 60%, and 89%, respectively. Discordance of at least two stages between XL probe and histology was observed in 16 (9%) patients. Body mass index (BMI) over 35 kg/m2 was independently associated with discordance (adjusted odds ratio 9.09; 95% confidence interval 1.10–75.43). Reliable measurements by XL probe were obtained in 75% of the overall population and 65% of patients with BMI over 30 kg/m2.

CONCLUSIONS:

LSM by XL probe can be performed successfully in most NAFLD patients, but obesity is associated with less accurate and reliable measurements.