title: The relationship between transient elastography and histological collagen proportionate area for assessing fibrosis in chronic viral hepatitis.
abstract: BACKGROUND
  Collagen proportionate area (CPA) has a better correlation with hepatic venous pressure gradient (HVPG) than with Ishak stage. Liver stiffness measurement (LSM) is proposed as non invasive marker of portal hypertension/disease progression. Our aim was to compare LSM and CPA with Ishak staging in chronic viral hepatitis, and HVPG in HCV hepatitis after transplantation.
  
  
  METHODS
  One hundred and sixty-nine consecutive patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections pre/post liver transplantation (LT), had a liver biopsy combined with LSM (transient elastography), CPA (biopsies stained with Sirius Red and evaluated by digital image analysis and expressed as CPA) and HVPG (measured contemporaneously with transjugular biopsies in LT HCV patients).
  
  
  RESULTS
  LSM was dependent on CPA in HBV (r (2) = 0.61, p < 0.0001), HCV (r (2) = 0.59, p < 0.0001) and LT groups (r (2) = 0.64, p < 0.0001). In all three groups, CPA and Ishak were predictors of LSM, but multivariately CPA was better related to LSM (HBV: r (2) = 0.61, p < 0.0001; HCV: r (2) = 0.59, p < 0.0001; post-LT: r (2) = 0.68, p < 0.0001) than Ishak stage. In the LT group, multiple regression analysis including HVPG, LSM, aspartate aminotransferase to platelet ratio index (APRI) and Ishak stage/grade, showed that only CPA was related to HVPG (r (2) = 0.41, p = 0.01), both for HVPG ≥6 mmHg (OR 1.34, 95 % CI 1.14-1.58; p < 0.0001) or ≥10 mmHg (OR 1.25, 95 % CI 1.06-1.47; p = 0.007).
  
  
  CONCLUSIONS
  CPA was related to LSM in HBV or HCV hepatitis pre/post-LT. CPA was better related to LSM than Ishak stage. In the LT HCV group, CPA was better related to HVPG than Ishak stage/grade, LSM or APRI. CPA may represent a better comparative histological index for LSM, rather than histological stages.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery UCL, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, UK.
authors.forename: Graziella
authors.initials: G
authors.lastname: Isgro
authors.forename: Vincenza
authors.initials: V
authors.lastname: Calvaruso
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Andreana
authors.forename: Tu Vinh
authors.initials: TV
authors.lastname: Luong
authors.forename: Matteo
authors.initials: M
authors.lastname: Garcovich
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Manousou
authors.forename: Angela
authors.initials: A
authors.lastname: Alibrandi
authors.forename: Sergio
authors.initials: S
authors.lastname: Maimone
authors.forename: Laura
authors.initials: L
authors.lastname: Marelli
authors.forename: Neil
authors.initials: N
authors.lastname: Davies
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Amar Paul
authors.initials: AP
authors.lastname: Dhillon
authors.forename: Andrew Kenneth
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003094:Collagen / Q000032:analysis; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008103:Liver Cirrhosis / Q000473:pathology* / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D055815:Young Adult
chemical_list: D003094:Collagen