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Elastography useful for detecting alcoholic liver fibrosis, cirrhosis

In a prospective study, researchers found that in addition to 2D-shear wave elastography, transient elastography was an effective technique for diagnosing liver fibrosis among adults who were at risk, according to published findings.

“The aim of our study was to determine the diagnostic accuracy of transient elastography and real-time 2D shear wave elastography for the diagnosis of significant alcoholic fibrosis and cirrhosis, using liver biopsy with Ishak score and collagen proportionate area as reference,” the researchers wrote.

A total of 199 patients at risk for chronic alcoholic liver disease (ALD) with alcohol abuse were recruited from two populations: one population had a high-risk probability for cirrhosis found in liver clinics in Southern Denmark (n = 128) and the other were at low risk for cirrhosis found via municipal alcohol rehabilitation centers and the Danish national public health portal (n = 71).

All patients underwent transient elastography (TE) via FibroScan (Echosens, France), 2D shear wave elastography (2D-SWE, Supersonic Aixplorer) and liver biopsy after fasting overnight.

Overall, the researchers did not find any differences in diagnostic accuracy between TE and 2D-SWE. The cut-off values for identifying fibrosis by TE were 9.6 kPa and 10.2 kPa by 2D-SWE. For identifying cirrhosis, TE had a cut-off value of 19.7 kPa and 2D-SWE had a value of 16.4 kPa. 

“In a sensitivity analysis including only patients with Child A cirrhosis, neither diagnostic accuracy nor optimal cut-offs changed,” the researchers wrote.

Negative predictive values were high for both populations, with a “negligible risk of misdiagnosis” due to false negatives. Less than 2% of patients with liver stiffness below the cirrhosis cut-offs showed evidence of cirrhosis by liver biopsy. However, the positive predictive value for cirrhosis was more than 66% in the high-risk group compared with nearly 50% in the low-risk group.

Ongoing alcohol abuse did not appear to affect liver stiffness, whereas alcohol-induced damage to cholangiocytes did.

The median collagen proportionate area (CPA) was 4.1%. It was highly correlated with Ishak grades 2 to 6 (P < .001) and accurately identified individuals with significant fibrosis and cirrhosis. The optimal CPA cut-off value for fibrosis was 4.7% and 8.4% for cirrhosis. No other biopsy descriptors predicted CPA, according to the research.

“Liver stiffness measurement by elastography is a reliable marker of significant fibrosis and cirrhosis in ALD,” the researchers concluded. “When applying cut-off values to stratify the risk of fibrosis and cirrhosis in patients with ALD, the prevalence in the screened population must be taken into account.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.