title: The diagnostic accuracy of Fibroscan for cirrhosis is influenced by liver morphometry in HCV patients with a sustained virological response.
abstract: OBJECTIVE
  Transient elastography (TE) is a validated non-invasive tool to evaluate hepatic fibrosis in patients with hepatitis C virus (HCV) infection. Whether TE may sense changes of liver fibrosis following therapeutic HCV eradication has never been evaluated.
  
  
  METHODS
  37 HCV cirrhotics with paired pre- and post-sustained virological response (SVR) liver biopsies (LB) underwent TE at the time of post-SVR LB. Liver fibrosis was staged with the METAVIR scoring system and the area of fibrosis (%) was assessed morphometrically.
  
  
  RESULTS
  Thirty-three patients had valid TE measurements after 61 (48-104) months from an SVR, and 20 (61%) of them had cirrhosis regression. On post-SVR LB, the median area of fibrosis was 2.3%, being significantly reduced from baseline (p<0.0001). Median TE value was 9.8 kPa being lower in regressed vs. not regressed patients (9.1 kPa vs. 12.9 kPa, p=0.01). TE was <12 kPa in 5 (38%) F4 patients and in 19 (95%) ≤F3 patients (p=0.0007). The diagnostic accuracy of TE for diagnosing F4 after treatment was 61% sensitivity, 95% specificity, 12.3 LR+, 0.4 LR-, and AUROC 0.77. A significant correlation was found between TE and both fibrosis stage (r=0.56; p=0.001) and morphometry (r=0.56, p=0.001) as well as between fibrosis stage and area of fibrosis (r=0.72, p=0001).
  
  
  CONCLUSIONS
  Following therapeutic eradication of HCV, the predictive power of the viremic cut-off of 12 kPa was low as a consequence of liver remodelling and fibrosis reabsorption. LB still remains the only reliable approach to stage liver fibrosis following an SVR.
authors.affiliation: A.M. and A. Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. roberta.dambrosio@unimi.it
authors.forename: Roberta
authors.initials: R
authors.lastname: D'Ambrosio
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
authors.forename: Mirella
authors.initials: M
authors.lastname: Fraquelli
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Rumi
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Donato
authors.forename: Valerie
authors.initials: V
authors.lastname: Paradis
authors.forename: Pierre
authors.initials: P
authors.lastname: Bedossa
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D000998:Antiviral Agents
keywords: CI; Cirrhosis regression; Fibroscan®; HBV; HCV; Hepatitis C virus; IFN; IQR; LB; LR; LS; LSM; Morphometry; RBV; SVR; Sustained virological response; TE; confidence interval; hepatitis B virus; hepatitis C virus; interferon; interquartile ratio; likelihood ratio; liver biopsy; liver stiffness; liver stiffness measurement; ribavirin; sustained virological response; transient elastography