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Real-time elastography effectively evaluated fibrosis, portal hypertension in NAFLD

Hepatic fibrosis and portal hypertension were accurately identified through real-time tissue elastography among patients with nonalcoholic fatty liver disease in a recent study.

Researchers performed real-time issue elastography on 181 patients with nonalcoholic fatty liver disease (NAFLD). The first 106 patients were considered the training set; the other 75 the validation set. Hepatic and splenic elastic ratios were determined, plus degree of portal hypertension (PH).

In the training set, median elastic ratios of 2.1 for patients with stage F0 fibrosis, 2.4 for F1, 2.7 for F2, 3.5 for F3 and 4.3 for F4 (P<.0001 for trend) were established. Patients in this subgroup with NAFLD activity scores greater than 5 had a higher median elastic ratio than those with scores less than 4 (2.9 vs. 2.3, P=.0016). Cutoff values were set at 2.47 for stage F1, 2.67 for F2, 3.02 for F3 and 3.36 for F4 fibrosis.

Using these values for the validation cohort produced these results, according to fibrosis stage:

• To exclude stage F2 or greater: NPV 95.7%, sensitivity 92.3%, specificity 89.8%
• To exclude stage F3 or greater: NPV 96.5%, sensitivity 88.9%, specificity 96.5%
• To exclude stage F4 or greater: NPV 100%, sensitivity 100%, specificity 95.3%

AUROC analysis indicated elastography had an accuracy of 0.838 in detecting stage F1 or greater, 0.853 for F2 or greater, 0.878 for F3 or greater and 0.965 for F4. When compared with other systems for early and advanced fibrotic stages, including HAIR, NAFIC, SBI, FIB-4 and BARD score, elastic ratio was found more useful for differentiating between stages and for diagnosing advanced fibrosis.

Univariate analysis indicated multiple parameters as independent predictors for elastic ratio, including perivenular, pericellular, portal and bridging fibrosis; lobular inflammation, hepatocellular ballooning, Mallory body and portal inflammation. Only portal fibrosis was found to be a predictor through multivariate analysis (OR=11.60; 95% CI, 2.13-86.26).

“Real-time tissue elastography reliably identified the early stage of fibrosis in patients with NAFLD,” the researchers concluded. “Thus, it could be a useful tool for evaluating hepatic fibrosis, as well as PH in these patients.”