title: Usefulness of transient elastography by FibroScan for the evaluation of liver fibrosis.
abstract: BACKGROUND
  Liver stiffness measurement (LSM) is used for the assessment of liver fibrosis. However, there is limited data in Indian patients.
  
  
  OBJECTIVE
  The aim of this study was to find the correlation of LSM, aspartate transaminase to platelet ratio index (APRI) with fibrosis as assessed by liver biopsy (LB), and predictors of discordance between LB and LSM.
  
  
  METHODS
  One hundred and eighty-five consecutive patients who underwent liver biopsy and transient elastography (TE) were enrolled. Fibrosis was graded by two independent pathologists using the METAVIR classification. Area under receiver operating curves (AUROC) was used to evaluate the accuracy of transient elastography and APRI in diagnosing significant fibrosis (F>2) and cirrhosis (F4).
  
  
  RESULTS
  Predominant etiologies were hepatitis B (46 %) and hepatitis C (26 %). LSM was unsuccessful in ten patients (5 %) because of small intercostal space (n = 3) and obesity (n = 7). Fibrosis is significantly correlated with LSM (r = 0.901, p = 0.001) and APRI (r = 0.736, p = 0.001). There was a significant difference in median LSM value in patients with no fibrosis (F0) in comparison to patients having mild fibrosis [mild portal fibrosis (F1) + fibrosis with few septa (F2)] (4.5 vs. 7.5 kPa, p = 0.001) and advanced fibrosis [bridging fibrosis that is spreading and connecting to other areas that contain fibrosis (F3) + cirrhosis or advanced scarring of the liver (F4)] (4.5 vs. 19.4 kPa, p = 0.001). Similarly, there was a significant difference in mean APRI value in patients with F0 in comparison to patients having mild fibrosis (F1 + F2) (0.55 ± 0.31 vs. 1.09 ± 0.81, p = 0.001) and advanced fibrosis (F3 + F4) (2.3 ± 1.3, p = 0.001). AUROC for diagnosis of significant fibrosis was 0.98 (95 % confidence interval (CI) 0.963-0.999) for TE and 0.865 (95 % CI 0.810-0.920) for APRI. Optimal TE value was 10.0 kPa for diagnosis of significant fibrosis and 14.7 kPa for cirrhosis with specificity and sensitivity of 89 %, 98 % and 96 %, and 97 %, respectively. On multivariate analysis, total bilirubin and histological activity index (HAI) were identified as an independent predictor of TE inaccuracy.
  
  
  CONCLUSIONS
  LSM is a reliable predictor of hepatic fibrosis in Indian patients. LSM is superior to APRI for noninvasive diagnosis of hepatic fibrosis and cirrhosis, and high bilirubin (10.5 mg/dL) and Ishak HAI grade (>11) were independent predictors of discordance between LB and LSM.
authors.affiliation: Department of Gastroenterology, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110 060, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Sharma
authors.forename: Sashi
authors.initials: S
authors.lastname: Dhawan
authors.forename: Rinkesh
authors.initials: R
authors.lastname: Bansal
authors.forename: Pankaj
authors.initials: P
authors.lastname: Tyagi
authors.forename: Naresh
authors.initials: N
authors.lastname: Bansal
authors.forename: Vikas
authors.initials: V
authors.lastname: Singla
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.forename: Abdul
authors.initials: A
authors.lastname: Matin
authors.forename: Anil
authors.initials: A
authors.lastname: Arora
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases