Noninvasive diagnosis of liver fibrosis by ultrasonic transient elastography (Fibroscan)

Abstract

Methods for diagnosing hepatic fibrosis have progressed significantly over the last few years--notably with the appearance of minimally invasive biological tests (which avoid the need for liver needle biopsy but nevertheless require a blood sample). Hepatic ultrasonic transient elastography (Fibroscan) is a new diagnostic method for hepatic fibrosis: it is totally noninvasive and gives an immediate result. Here, we review the currently available data on the use of the Fibroscan. Today's main field of application is chronic, viral hepatitis C, with areas under the receiver operation characteristic curve of 0.79-0.83, 0.90-0.91 and 0.91-0.97 for the diagnosis of F2, F3 and F4 fibrosis (defined according to the Metavir classification system), respectively. Furthermore, the Fibroscan enables the noninvasive diagnosis of cirrhosis (regardless of the latter's aetiology), with positive and negative predictive values of 70-95% and 77-95%, respectively. Chronic viral hepatitis B, HIV-hepatitis C virus and HIV-hepatitis B virus coinfections, alcohol-related liver diseases and intrahepatic cholestatic diseases are the device's other main fields of application in hepatology. Today, the Fibroscan is a reliable alternative for the noninvasive diagnosis of hepatic fibrosis. Various diagnostic strategies and performing cost/benefit analyses are now necessary, to assess fully the value of hepatic elastography relative to biological tests for hepatic fibrosis.

Assessment of Hepatic Fibrosis With Magnetic Resonance Elastography

“…An alternative explanation may be that the limitations of the discrete values used in the histological scoring systems, preventing a true ordinal discrimination between early and intermediate stages (5). However, these results are in agreement with observations from different research groups using ultrasound-based transient elastography (17,(39)(40)(41) and MR Elastography techniques (27-29).…”

A Biomarker Panel for Non-alcoholic Steatohepatitis (NASH) and NASH-Related Fibrosis

“…Furthermore, the next generation of radiologic modalities such as magnetic resonance spectroscopy, contrast-enhanced ultrasound, and dual energy X-ray absorptiometry are unlikely to be applicable to large-scale population screening or to become widely available in the clinical setting [29]. Finally, non-invasive tests to estimate liver stiffness have been tested most in patients with hepatitis C but have not been fully validated in NAFLD patients in whom these tests may be of limited value due to the presence of visceral obesity [30].…”

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…Therefore, increasingly, noninvasive methods of staging liver disease have been developed. The most widely used method is hepatic elastography (FibroScan) [32]. The results of FibroScan give a good correlation with a fibrosis score of less than F2 disease (METAVIR) or with F4 disease (cirrhosis) [33,34] and a recent meta-analysis suggested cut-off points of o7.65 kPa for the former and 413 kPa for the latter [34].…”