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Elastography accurate for the diagnosis of alcoholic liver fibrosis

In a prospective study, researchers found elastography to be effective for diagnosing liver fibrosis and cirrhosis among patients at risk for liver fibrosis due to alcohol consumption.

“This study is perhaps the largest to explore the use of Fibroscan and [2-dimensional shear wave elastography] to screen for advanced fibrosis and cirrhosis,” Suthat Liangpunsakul, MD, associate professor of medicine and of biochemistry and molecular biology at the Indiana University School of Medicine, and colleagues wrote in an accompanying editorial. “The findings from this study are an important impetus for attempts at identifying patients at an earlier stage of [alcoholic liver disease].”

Suthat Liangpunsakul

The cohort consisted of 199 consecutive adults with ongoing or prior alcohol abuse without known liver disease, who underwent same-day transient elastography (FibroScan), 2-dimensional shear wave elastography (Supersonic Aixplorer) and liver biopsy after an overnight fast.

Patients were grouped according to fibrosis risk due to alcohol consumption: one group had high pretest probability of cirrhosis recruited from liver clinics in South Denmark and another lower-risk group was recruited from alcohol rehabilitation centers and the Danish national public health portal, according to the research.

Overall, transient elastography and 2-dimensional shear wave elastography were both accurate in identifying patients in each group with significant fibrosis (Ishak score greater than 3) and cirrhosis (Ishak score greater than 5) with an area under the curve of at least 0.92. There was no difference in diagnostic accuracy between the two tests.

The cutoff values for transient elastography were 9.6 kPa for identifying fibrosis and 19.7 kPa for cirrhosis. The cutoffs for 2-dimensional shear wave elastography were 10.2 kPa for fibrosis and 16.4 kPa for cirrhosis. The negative predictive values were high for both groups. However, positive predictive values for cirrhosis were greater than 66% in the high-risk group compared with 50% in the low-risk group.

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

Disclosure: The researchers report no relevant financial disclosures.