title: Assessment of fibrosis by transient elastography compared with liver biopsy and morphometry in chronic liver diseases.
abstract: OBJECTIVE
  Liver stiffness measurement (LSM) with transient elastography (Fibroscan) can accurately diagnose advanced liver fibrosis, but its performance in early liver fibrosis is less satisfactory. We aimed to study the diagnostic performance of LSM for histologic bridging fibrosis and cirrhosis in various chronic liver diseases and to investigate the effects of liver fibrosis distribution on LSM.
  
  
  METHODS
  We prospectively studied consecutive patients with chronic liver diseases undergoing liver biopsy and transient elastography examinations. Morphometric analysis was performed to evaluate the distribution of liver fibrosis.
  
  
  RESULTS
  One hundred thirty-three patients (50% chronic hepatitis B, 14% chronic hepatitis C, and 24% nonalcoholic fatty liver disease) were studied. Morphometric analysis revealed a higher correlation between LSM and pericellular fibrosis (r = 0.43) than periportal (r = 0.21) or perivenular fibrosis (r = 0.25). Area under receiver operating characteristic curve (ROC) of LSM for bridging fibrosis was 0.87 (95% confidence interval, 0.81-0.93) and for cirrhosis was 0.89 (95% confidence interval, 0.83-0.94). Higher LSM was associated with higher serum ALT level. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM. The area under ROC curve of LSM for cirrhosis was lower among patients who had ALT above the upper limit of normal (0.86) as compared with that of patients with normal ALT levels (0.93, P = .03).
  
  
  CONCLUSIONS
  Transient elastography can diagnose severe fibrosis because of its good correlation with pericellular fibrosis. Transient elastography might overestimate liver fibrosis when ALT is elevated.
authors.affiliation: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.forename: Paul Cheung-Lung
authors.initials: PC
authors.lastname: Choi
authors.forename: Anthony Wing-Hung
authors.initials: AW
authors.lastname: Chan
authors.forename: Richard Hoi-Leong
authors.initials: RH
authors.lastname: Chum
authors.forename: Henry Kai-Wing
authors.initials: HK
authors.lastname: Chan
authors.forename: Kenneth Ka-Ki
authors.initials: KK
authors.lastname: Lau
authors.forename: Angel Mei-Ling
authors.initials: AM
authors.lastname: Chim
authors.forename: Karen Ka-Lam
authors.initials: KK
authors.lastname: Yiu
authors.forename: Francis Ka-Leung
authors.initials: FK
authors.lastname: Chan
authors.forename: Joseph Jao-Yao
authors.initials: JJ
authors.lastname: Sung
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001699:Biometry / Q000379:methods*; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D013223:Statistics as Topic
chemical_list: D000410:Alanine Transaminase