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Elastography method differentiates early, advanced liver fibrosis stages

Liver stiffness measurement through vibration-controlled transient elastography accurately distinguished between early stages of fibrosis and advanced fibrosis among patients with nonalcoholic fatty liver disease, according to recently published data.

“[Vibration-controlled transient elastography (VCTE)] is a non-invasive point of care tool that can be used in clinical practice for identifying steatosis and advance fibrosis in patients with NAFLD,” Mohammad S. Siddiqui, MD, from the Virginia Commonwealth University, and colleagues wrote. “VCTE may be useful in identifying patients in whom additional histological assessment may be warranted due to the presence of advance fibrosis, while excluding patients without significant fibrosis in whom a liver biopsy may be unnecessary.”

Siddiqui and colleagues enrolled 393 patients from a National Institutes of Health-funded NAFLD study. Patients underwent liver biopsy and VCTE with a median time of 49 days between assessments.

The cross-validated area under receiver operating characteristics of VCTE for classifying fibrosis stage 0 vs. stages 1 to 4 was 0.74 (95% CI, 0.68-0.79); fibrosis stages 0 to 1 vs. stages 2 to 4 was 0.79 (95% CI, 0.74-0.83); fibrosis stages 0 to 2 vs. stages 3 to 4 was 0.83 (95% CI, 0.79-0.87); and fibrosis stages 0 to 3 vs. stage 4 was 0.93 (0.9-0.97).

After optimizing sensitivity and specificity, the researchers determined a cut-off value of 8.6 kPa for differentiating fibrosis stage 0 from stages 1 to 4, stages 0 to 1 vs. stages 2 to 4, and stages 0 to 2 vs. stages 3 to 4; and a cut-off value of 13.1 kPa to differentiate stages 0 to 3 from stage 4.

Among 358 patients with confirmed NASH, VCTE showed a significant ability to detect the presence of NASH per kPa (OR = 1.078; 95% CI, 1.034-1.123) and per dB/m (OR = 1.007; 95% CI, 1.002-1.011).

“In NAFLD, hepatic fibrosis is a key predictor of liver related outcomes and VCTE can be used to detect fibrosis, especially in its advance stage,” the researchers wrote. “Although VCTE is not a confirmatory test, it can help identify patients in whom additional histological assessment maybe warranted, while avoiding liver biopsies in patients with none to minimal fibrosis.” – by Talitha Bennett

Disclosure: Siddiqui reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.