title: A prospective evaluation of the role of transient elastography for the detection of hepatic fibrosis in type 2 diabetes without overt liver disease.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) is a major risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and subsequently hepatic fibrosis. Transient elastography (TE) is a rapid, reproducible non-invasive test that may be appropriate as a screening tool for the presence of hepatic fibrosis.
  
  
  OBJECTIVE
  Assess the utility of TE as a screening tool for the presence of hepatic fibrosis in a T2DM population with no known liver disease.
  
  
  METHODS
  T2DM patients without known liver disease were included. Patients were assessed with TE in addition to biochemical parameters.
  
  
  RESULTS
  A successful TE evaluation could be obtained in 74 of 81 (91%) included subjects. Of these, 26 (35%) had a liver stiffness measurement (LSM) ≥ 7.65 kPa. Sixteen of these subjects had confirmatory liver biopsies with significant (≥ F2 fibrosis) present in 12 (75%) and cirrhosis diagnosed in 2 subjects. 15/16 (94%) had histological steatohepatitis. Compared with those with a lower LSM, subjects with an LSM ≥ 7.65 kPa had higher ALT levels (38.0 ± 21.7 vs 26.1 ± 11.1 U/L, p = 0.021) and increased prevalence of hepatic steatosis by ultrasound (85% vs 63%, p = 0.005).
  
  
  CONCLUSIONS
  Significant hepatic fibrosis in the T2DM population is frequently under-recognized. TE may be a feasible tool for the screening of T2DM patients for the presence of hepatic fibrosis.
authors.affiliation: Departments of Gastroenterology, Alfred Hospital, Melbourne, Vic, Australia.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Casey
authors.forename: William W
authors.initials: WW
authors.lastname: Kemp
authors.forename: Catriona A
authors.initials: CA
authors.lastname: McLean
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Topliss
authors.forename: Leon A
authors.initials: LA
authors.lastname: Adams
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Roberts
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D001706:Biopsy; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D018709:Statistics, Nonparametric; D055105:Waist Circumference
chemical_list: D000410:Alanine Transaminase