Transient and 2-Dimensional Shear-Wave Elastography Provide Comparable Assessment of Alcoholic Liver Fibrosis and Cirrhosis

Alcohol abuse causes half of all deaths from cirrhosis in the West, but few tools are available for noninvasive diagnosis of alcoholic liver disease. We evaluated 2 elastography techniques for diagnosis of alcoholic fibrosis and cirrhosis; liver biopsy with Ishak score and collagen-proportionate are...

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Vydáno v:	Gastroenterology (New York, N.Y. 1943) Ročník 150; číslo 1; s. 123 - 133
Hlavní autoři:	Thiele, Maja, Detlefsen, Sönke, Sevelsted Møller, Linda, Madsen, Bjørn Stæhr, Fuglsang Hansen, Janne, Fialla, Annette Dam, Trebicka, Jonel, Krag, Aleksander
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.01.2016
Témata:	Adult Aged Area Under Curve Cohort Studies Cross-Sectional Studies Denmark - epidemiology Diagnostic Imaging - methods Elasticity Imaging Techniques - methods Female Humans Incidence Likelihood Functions Liver Cirrhosis - diagnosis Liver Cirrhosis - epidemiology Liver Cirrhosis, Alcoholic - diagnosis Liver Cirrhosis, Alcoholic - epidemiology Male Middle Aged Prospective Studies Risk Assessment Sensitivity and Specificity Severity of Illness Index Denmark Supersonic Shear Imaging Diagnostic Test AUC Noninvasive Methods
ISSN:	1528-0012
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Abstract	Alcohol abuse causes half of all deaths from cirrhosis in the West, but few tools are available for noninvasive diagnosis of alcoholic liver disease. We evaluated 2 elastography techniques for diagnosis of alcoholic fibrosis and cirrhosis; liver biopsy with Ishak score and collagen-proportionate area were used as reference. We performed a prospective study of 199 consecutive patients with ongoing or prior alcohol abuse, but without known liver disease. One group of patients had a high pretest probability of cirrhosis because they were identified at hospital liver clinics (in Southern Denmark). The second, lower-risk group, was recruited from municipal alcohol rehabilitation centers and the Danish national public health portal. All subjects underwent same-day transient elastography (FibroScan), 2-dimensional shear wave elastography (Supersonic Aixplorer), and liver biopsy after an overnight fast. Transient elastography and 2-dimensional shear wave elastography identified subjects in each group with significant fibrosis (Ishak score ≥3) and cirrhosis (Ishak score ≥5) with high accuracy (area under the curve ≥0.92). There was no difference in diagnostic accuracy between techniques. The cutoff values for optimal identification of significant fibrosis by transient elastography and 2-dimensional shear wave elastography were 9.6 kPa and 10.2 kPa, and for cirrhosis 19.7 kPa and 16.4 kPa. Negative predictive values were high for both groups, but the positive predictive value for cirrhosis was >66% in the high-risk group vs approximately 50% in the low-risk group. Evidence of alcohol-induced damage to cholangiocytes, but not ongoing alcohol abuse, affected liver stiffness. The collagen-proportionate area correlated with Ishak grades and accurately identified individuals with significant fibrosis and cirrhosis. In a prospective study of individuals at risk for liver fibrosis due to alcohol consumption, we found elastography to be an excellent tool for diagnosing liver fibrosis and for excluding (ruling out rather than ruling in) cirrhosis.
AbstractList	Alcohol abuse causes half of all deaths from cirrhosis in the West, but few tools are available for noninvasive diagnosis of alcoholic liver disease. We evaluated 2 elastography techniques for diagnosis of alcoholic fibrosis and cirrhosis; liver biopsy with Ishak score and collagen-proportionate area were used as reference. We performed a prospective study of 199 consecutive patients with ongoing or prior alcohol abuse, but without known liver disease. One group of patients had a high pretest probability of cirrhosis because they were identified at hospital liver clinics (in Southern Denmark). The second, lower-risk group, was recruited from municipal alcohol rehabilitation centers and the Danish national public health portal. All subjects underwent same-day transient elastography (FibroScan), 2-dimensional shear wave elastography (Supersonic Aixplorer), and liver biopsy after an overnight fast. Transient elastography and 2-dimensional shear wave elastography identified subjects in each group with significant fibrosis (Ishak score ≥3) and cirrhosis (Ishak score ≥5) with high accuracy (area under the curve ≥0.92). There was no difference in diagnostic accuracy between techniques. The cutoff values for optimal identification of significant fibrosis by transient elastography and 2-dimensional shear wave elastography were 9.6 kPa and 10.2 kPa, and for cirrhosis 19.7 kPa and 16.4 kPa. Negative predictive values were high for both groups, but the positive predictive value for cirrhosis was >66% in the high-risk group vs approximately 50% in the low-risk group. Evidence of alcohol-induced damage to cholangiocytes, but not ongoing alcohol abuse, affected liver stiffness. The collagen-proportionate area correlated with Ishak grades and accurately identified individuals with significant fibrosis and cirrhosis. In a prospective study of individuals at risk for liver fibrosis due to alcohol consumption, we found elastography to be an excellent tool for diagnosing liver fibrosis and for excluding (ruling out rather than ruling in) cirrhosis. BACKGROUND & AIMSAlcohol abuse causes half of all deaths from cirrhosis in the West, but few tools are available for noninvasive diagnosis of alcoholic liver disease. We evaluated 2 elastography techniques for diagnosis of alcoholic fibrosis and cirrhosis; liver biopsy with Ishak score and collagen-proportionate area were used as reference.METHODSWe performed a prospective study of 199 consecutive patients with ongoing or prior alcohol abuse, but without known liver disease. One group of patients had a high pretest probability of cirrhosis because they were identified at hospital liver clinics (in Southern Denmark). The second, lower-risk group, was recruited from municipal alcohol rehabilitation centers and the Danish national public health portal. All subjects underwent same-day transient elastography (FibroScan), 2-dimensional shear wave elastography (Supersonic Aixplorer), and liver biopsy after an overnight fast.RESULTSTransient elastography and 2-dimensional shear wave elastography identified subjects in each group with significant fibrosis (Ishak score ≥3) and cirrhosis (Ishak score ≥5) with high accuracy (area under the curve ≥0.92). There was no difference in diagnostic accuracy between techniques. The cutoff values for optimal identification of significant fibrosis by transient elastography and 2-dimensional shear wave elastography were 9.6 kPa and 10.2 kPa, and for cirrhosis 19.7 kPa and 16.4 kPa. Negative predictive values were high for both groups, but the positive predictive value for cirrhosis was >66% in the high-risk group vs approximately 50% in the low-risk group. Evidence of alcohol-induced damage to cholangiocytes, but not ongoing alcohol abuse, affected liver stiffness. The collagen-proportionate area correlated with Ishak grades and accurately identified individuals with significant fibrosis and cirrhosis.CONCLUSIONSIn a prospective study of individuals at risk for liver fibrosis due to alcohol consumption, we found elastography to be an excellent tool for diagnosing liver fibrosis and for excluding (ruling out rather than ruling in) cirrhosis.
Author	Fialla, Annette Dam Detlefsen, Sönke Sevelsted Møller, Linda Fuglsang Hansen, Janne Madsen, Bjørn Stæhr Thiele, Maja Trebicka, Jonel Krag, Aleksander
Author_xml	– sequence: 1 givenname: Maja surname: Thiele fullname: Thiele, Maja email: maja.thiele@rsyd.dk organization: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: maja.thiele@rsyd.dk – sequence: 2 givenname: Sönke surname: Detlefsen fullname: Detlefsen, Sönke organization: Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Pathology, Odense University Hospital, Odense, Denmark – sequence: 3 givenname: Linda surname: Sevelsted Møller fullname: Sevelsted Møller, Linda organization: Department of Medicine, Odense University Hospital, Svendborg, Denmark – sequence: 4 givenname: Bjørn Stæhr surname: Madsen fullname: Madsen, Bjørn Stæhr organization: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark – sequence: 5 givenname: Janne surname: Fuglsang Hansen fullname: Fuglsang Hansen, Janne organization: Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark – sequence: 6 givenname: Annette Dam surname: Fialla fullname: Fialla, Annette Dam organization: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark – sequence: 7 givenname: Jonel surname: Trebicka fullname: Trebicka, Jonel organization: Department of Internal Medicine I, University of Bonn, Bonn, Germany – sequence: 8 givenname: Aleksander surname: Krag fullname: Krag, Aleksander organization: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Snippet	Alcohol abuse causes half of all deaths from cirrhosis in the West, but few tools are available for noninvasive diagnosis of alcoholic liver disease. We... BACKGROUND & AIMSAlcohol abuse causes half of all deaths from cirrhosis in the West, but few tools are available for noninvasive diagnosis of alcoholic liver...
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SubjectTerms	Adult Aged Area Under Curve Cohort Studies Cross-Sectional Studies Denmark - epidemiology Diagnostic Imaging - methods Elasticity Imaging Techniques - methods Female Humans Incidence Likelihood Functions Liver Cirrhosis - diagnosis Liver Cirrhosis - epidemiology Liver Cirrhosis, Alcoholic - diagnosis Liver Cirrhosis, Alcoholic - epidemiology Male Middle Aged Prospective Studies Risk Assessment Sensitivity and Specificity Severity of Illness Index
Title	Transient and 2-Dimensional Shear-Wave Elastography Provide Comparable Assessment of Alcoholic Liver Fibrosis and Cirrhosis
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