title: Performance of unidimensional transient elastography in staging non-alcoholic steatohepatitis.
abstract: OBJECTIVE
  Transient elastography (TE) is a noninvasive method for predicting liver fibrosis, mainly validated in patients with viral hepatitis. Information is still limited concerning its performance in non-alcoholic steatohepatitis (NASH) patients. We aimed to assess the value of TE in the prediction of fibrosis stage in NASH as well as the factors determining the discordance between the TE-predicted and the biopsy-proven fibrosis stage in these patients.
  
  
  METHODS
  Liver biopsy and TE were performed on 72 consecutive NASH patients. Fibrosis, lobular inflammation, ballooning and steatosis were evaluated (Brunt system).
  
  
  RESULTS
  Liver stiffness (LS) values ranged from 2.80 to 16.90 kPa. In the univariate analysis, LS was correlated with fibrosis (r=0.661; p<0.0001), steatosis (r=0.435, p<0.0001), ballooning (r=0.385; p=0.001) and lobular inflammation (r=0.364; p=0.002). In multivariate analysis, only fibrosis significantly correlated with LS (p<0.0001). The median (and range) LS values (kPa) according to the fibrosis stages were: 4.90 (2.80-7.30) for F0; 6.15 (4.80-12.50) for F1; 6.90 (3.30-16.90) for F2 and 14.00 (10.70-14.10) for F3, with significant difference between stages, except for F1-F2 (p=0.249). Cut off values were calculated for predicting each fibrosis stage: 5.3 kPa (AUROC=0.879) for F1; 6.8 kPa (AUROC=0.789) for F2; and 10.4 kPa (AUROC=0.978) for F3. Patients with false-positive results had a significantly higher ALT level than those with concordant results (p=0.039).
  
  
  CONCLUSIONS
  In NASH patients, TE allows a reliable assessment and prediction of liver fibrosis, especially in advanced stages. Steatosis, ballooning and inflammation do not influence liver stiffness.
authors.affiliation: Department of Medical Imaging, 3rd Medical Clinic, University of Medicine and Pharmacy, 19-21 Croitorilor Street, 400162 Cluj-Napoca, Romania. monica.lupsor@umfcluj.ro
authors.forename: Monica
authors.initials: M
authors.lastname: Lupsor
authors.forename: Radu
authors.initials: R
authors.lastname: Badea
authors.forename: Horia
authors.initials: H
authors.lastname: Stefanescu
authors.forename: Mircea
authors.initials: M
authors.lastname: Grigorescu
authors.forename: Alexandru
authors.initials: A
authors.lastname: Serban
authors.forename: Corina
authors.initials: C
authors.lastname: Radu
authors.forename: Dana
authors.initials: D
authors.lastname: Crişan
authors.forename: Zeno
authors.initials: Z
authors.lastname: Sparchez
authors.forename: Sorana
authors.initials: S
authors.lastname: Iancu
authors.forename: Anca
authors.initials: A
authors.lastname: Maniu
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult