The Severity of Steatosis Influences Liver Stiffness Measurement in Patients with Nonalcoholic Fatty Liver Disease (original) (raw)
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Hepatology, 2010
Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in affluent countries. Accurate noninvasive tests for liver injury are urgently needed. The aim of this study was to evaluate the accuracy of transient elastography for the diagnosis of fibrosis and cirrhosis in patients with NAFLD and to study factors associated with discordance between transient elastography and histology. Two hundred forty-six consecutive patients from two ethnic groups had successful liver stiffness measurement and satisfactory liver biopsy specimens. The area under the receiver-operating characteristics curve (AUROC) of transient elastography for F3 or higher and F4 disease was 0.93 and 0.95, respectively, and was significantly higher than that of the aspartate aminotransferase-to-alanine aminotransferase ratio, aspartate aminotransferase-to-platelet ratio index, FIB-4, BARD, and NAFLD fibrosis scores (AUROC ranged from 0.62 to 0.81, P < 0.05 for all comparisons). At a cutoff value of 7.9 kPa, the sensitivity, specificity, and positive and negative predictive values for F3 or greater disease were 91%, 75%, 52%, and 97%, respectively. Liver stiffness was not affected by hepatic steatosis, necroinflammation, or body mass index. Discordance of at least two stages between transient elastography and histology was observed in 33 (13.4%) patients. By multivariate analysis, liver biopsy length less than 20 mm and F0-2 disease were associated with discordance. Conclusion: Transient elastography is accurate in most NAFLD patients. Unsatisfactory liver biopsy specimens rather than transient elastography technique account for most cases of discordance. With high negative predictive value and modest positive predictive value, transient elastography is useful as a screening test to exclude advanced fibrosis. Liver biopsy may be considered in NAFLD patients with liver stiffness of at least 7.9 kPa. (HEPATOLOGY 2010;51:454-462.) See Editorial on page 370.
United European Gastroenterology Journal
Background In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment. Objective To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH). Methods We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeterV2G, FibroMeterV3G, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4). Results Our study cohort contained 186 patients with histologically con...
Alimentary Pharmacology & Therapeutics, 2012
This uncommissioned review article was subject to full peer-review. SUMMARY Background Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of clinical conditions, actually representing an emerging disease of great clinical interest. Currently, its diagnosis requires liver biopsy, an invasive procedure not free from potential complications. However, several non-invasive diagnostic strategies have been proposed as potential diagnostic alternatives, each with different sensitivities and accuracies. Aim To review non-invasive diagnostic parameters and tools for NAFLD diagnosis and to formulate a diagnostic and prognostic algorithm for a better classification of patients. Methods A literature search was carried out on MEDLINE, EMBASE, Web of Science and Scopus for articles and abstracts in English. The search terms used included 'NAFLD', 'non invasive method and NAFLD', 'transient elastography' and 'liver fibrosis'. The articles cited were selected based on their relevancy to the objective of the review. Results Ultrasonography still represents the first-line diagnostic tool for simple liver steatosis; its sensitivity could be enhanced by the complex biochemical score SteatoTest. Serum cytokeratin-18 is a promising and accurate noninvasive parameter (AUROCs: 0.83; 0.91) for the diagnosis of non-alcoholic steatohepatitis (NASH). The staging of liver fibrosis still represents the most important prognostic problem: the most accurate estimating methods are FibroMeter, FIB-4, NAFLD fibrosis score (AUROCs: 0.94; 0.86; 0.82) and transient elastography (AUROC: 0.84-1.00). Conclusions Different non-invasive parameters are available for the accurate diagnosis and prognostic stratification of non-alcoholic fatty liver disease which, if employed in a sequential algorithm, may lead to a reduced use of invasive methods, i.e. liver biopsy.
Biomedical Research-tokyo, 2017
Aims: Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized cause of chronic-liverdisease which may be diagnosed incidentally in asymptomatic patients. Non-alcoholic steatohepatitis (NASH) may cause cirrhosis and hepatocellular carcinoma. To date, no established non-invasive test exists to accurately predict fibrosis in NASH. Although liver biopsy is the gold standard for the diagnosis of NASH, it occasionally has some serious complications. We aimed to compare the diagnostic accuracy of some widely used non-invasive fibrosis scoring systems. Methods: We retrospectively assessed the files of 40 subjects with biopsy proven diagnosis of NAFLD. The subjects were grouped as mild and advanced fibrosis. Demographic, medical historical, and laboratory data were recorded. FIB4 index, APRI-, BARD-, and BAAT-scores were calculated. The agreement between biopsy findings and non-invasive scoring systems was assessed with Kappa statistics. Results: 17 of the patients (58% males...
Background & Purpose: Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease & liver transplantation and its incidence is increasing even in Asian countries. The gold standard for assessing hepatic fibrosis is liver histology but due to its limitations, noninvasive tests to assess hepatic fibrosis which can be used as alternative to liver biopsy have been developed, such the AST-to-platelet ratio index (APRI), Forns test, FibroTest, transient elastography, fibrometer and hepascore. Methods: In a cross-sectional study, 25 diagnosed NAFLD patients underwent detailed laboratory investigations including the specific non-invasive markers of fibrosis namely, haptoglobin, alpha-2 macroglobulin, apolipoprotein- A1 levels and insulin resistance was calculated by homoeostasis model assessment (HOMA), then patients were subjected to liver biopsy. Results. Out of 25 patients, 19(76%) were male and 6(24%) were females. Nine patients (36%) were diabetic and 21 (84%) were dyslipidaemic. Metabolic syndrome was present in 18(72%), body mass index was increased in 22 patients and waist hip ratio was altered in 22 patients (88%). Using SPSS 10, p value was significant (p = 0.04) for correlation between steatosis and waist/hip ratio and HOMA-IR with inflammation and fibrosis (p = 0.03) but non-invasive markers were not significant in predicting hepatic fibrosis on histology. Conclusion. The non-invasive markers were not significant in predicting hepatic fibrosis on histology in present study. The limitation of the study was small sample size and majority of patients had steatosis only.
World Journal of Gastroenterology, 2014
It is estimated that 30% of the adult population in Japan is affected by nonalcoholic fatty liver disease (NAFLD). Fatty changes of the liver are generally diagnosed using imaging methods such as abdominal ultrasonography (US) and computed tomography (CT), but the sensitivity of these imaging techniques is low in cases of mild steatosis. Alanine aminotransferase levels may be normal in some of these patients, warranting the necessity to establish a set of parameters useful for detecting NAFLD, and the more severe form of the disease, nonalcoholic steatohepatitis (NASH). Although liver biopsy is currently the gold standard for diagnosing progressive NASH, it has many drawbacks, such as sampling error, cost, and risk of complications. Furthermore, it is not realistic to perform liver biopsies on all NAFLD patients. Diagnosis of NASH using various biomarkers, scoring systems and imaging methods, such as elastography, has recently been attempted. The NAFIC score, calculated from the levels of ferritin, fasting insulin, and type Ⅳ collagen 7S, is useful for the diagnosis of NASH, while the NAFLD fibrosis score and the FIB-4 index are useful for excluding NASH in cases of advanced fibrosis. This article reviews the limitations and merits of liver biopsy and noninvasive diagnostic tests in the diagnosis of NAFLD/NASH.
Diagnostics
Background: The purpose of this systematic literature review (SLR) was to evaluate the accuracy of noninvasive diagnostic tools in detecting significant or advanced (F2/F3) fibrosis among patients with nonalcoholic fatty liver (NAFL) in the US healthcare context. Methods: The SLR was conducted in PubMed and Web of Science, with an additional hand search of public domains and citations, in line with the PRISMA statement. The study included US-based original research on diagnostic test sensitivity, specificity and accuracy. Results: Twenty studies were included in qualitative evidence synthesis. Imaging techniques with the highest diagnostic accuracy in F2/F3 detection and differentiation were magnetic resonance elastography and vibration-controlled transient elastography. The most promising standard blood biomarkers were NAFLD fibrosis score and FIB-4. The novel diagnostic tools showed good overall accuracy, particularly a score composed of body mass index, GGT, 25-OH-vitamin D, and ...
Advanced Research in Gastroenterology and Hepatology, 2014
Background & Purpose : Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease & liver transplantation and its incidence is increasing even in Asian countries. The gold standard for assessing hepatic fibrosis is liver histology but due to its limitations, noninvasive tests to assess hepatic fibrosis which can be used as alternative to liver biopsy have been developed. Methods: In a cross-sectional study, 25 diagnosed NAFLD patients underwent detailed laboratory investigations including the specific non-invasive markers of fibrosis namely, Haptoglobin, Alpha-2 macroglobulin, Apolipoprotein- A1 levels and Insulin Resistance was calculated by Homeostasis Model Assessment (HOMA), then patients were subjected to liver biopsy. Results . Out of 25 patients, 19(76%) were male and 6(24%) were females. Nine patients (36%) were diabetic and 21 (84%) were dyslipidemiac. Metabolic syndrome was present in 18(72%), body mass index was increased in 22 patients and waist...