Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan) and real-time tissue elastography.
OBJECTIVE
The aim of this study was to investigate the accuracy of noninvasive tests, e.g. serum fibrotic markers, transient elastography and real-time tissue elastography, in the diagnosis of hepatic fibrosis, and to determine whether they can replace liver biopsy.


METHODS
119 patients with chronic liver disease were included in this study. Serum fibrotic markers including hyaluronic acid, type IV collagen, type IV collagen 7S domain and type III procollagen-N-peptide were measured. Aspartate aminotransferase (AST) and platelet counts were also measured to calculate the AST to platelet ratio index (APRI). Liver stiffness was measured using FibroScan and real-time tissue elastography.


RESULTS
The fibrotic stage, determined by histopathological diagnosis of a liver biopsy sample, did not correlate as well with serum fibrotic markers although it was useful to diagnose liver cirrhosis. However, the stage of hepatic fibrosis correlated well with liver stiffness measured by FibroScan. FibroScan was also a much better predictor of liver cirrhosis than APRI. Furthermore, the levels of liver strain measured by real-time tissue elastography correlated well with liver stiffness (p < 0.05).


CONCLUSIONS
Serum fibrotic markers and FibroScan are useful for distinguishing liver cirrhosis (F4) from chronic hepatitis (F1-F3). In addition, real-time tissue elastography is a novel and promising method to determine the stage of hepatic fibrosis.
Tatsumi
Chie
C
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.
Kudo
Masatoshi
M
Ueshima
Kazuomi
K
Kitai
Satoshi
S
Takahashi
Shunsuke
S
Inoue
Tatsuo
T
Minami
Yasunori
Y
Chung
Hobyung
H
Maekawa
Kiyoshi
K
Fujimoto
Kenji
K
Akiko
Tonomura
T
Takeshi
Mitake
M
D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D024141:Collagen Type IV / Q000097:blood* / Q000737:chemistry; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008107:Liver Diseases / Q000150:complications; D010446:Peptide Fragments / Q000097:blood*; D011347:Procollagen / Q000097:blood*; D017434:Protein Structure, Tertiary; D012680:Sensitivity and Specificity
D015415:Biomarkers; D024141:Collagen Type IV; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D006820:Hyaluronic Acid