- Email: [email protected]
1071 LIVER STIFFNESS ASSESSMENT BY MEANS OF TRANSIENT ELASTOGRAPHY IN PATIENTS WITH CHRONIC HEPATITIS
POSTERS Patients and Methods: Our retrospective study included 914 patients from 5 countries (10 centers),mean age 55.7±13.1years, with chronic hepatitis C, in which we compared ARFI to LB. In each patient we performed LB (evaluated according to the Metavir score) and ARFI measurements (10 valid measurements – median values were calculated, results expressed in meters/secondm/s). The diagnostic performance of the ARFI elastography was assessed using receiver operating characteristics (ROC) curves that we built for the detection of each stage of fibrosis. Results: From the 914 patients, valid ARFI measurements were obtained in 911 (99.6%) of the cases. On liver biopsy, from the 914p, 61p (6.7%) had F0, 241p (26.4%) had F1, 202p (22.1%) had F2, 187p (20.4%) had F3 and 223p (24.4%) had F4. A direct, strong correlation (Spearman r = 0.65) was found between ARFI measurements and fibrosis (p < 0.0001). The mean liver stiffness values as assessed by means of ARFI (m/s) were: F0=1.09±0.42; F1=1.22±0.41; F2=1.37±0.48; F3=1.70±0.59 and F4=2.23±0.71. We found statistically significant differences between liver stiffness values in case of F0 vs. F1 (p = 0.02), F1 vs. F2 (p = 0.004), F2 vs. F3 (p < 0.0001) and F3 vs. F4 (p < 0.0001). The predictive value of ARFI for various stages of fibrosis is presented in Table 1. Table 1. Fibrosis Cut-off AUROC Sensitivity Specificity PPV NPV Accuracy (m/s) (%) (%) (%) (%) (%) F≥1 F≥2 F≥3 F=4
>1.19 >1.33 >1.43 >1.55
0.779 0.792 0.829 0.842
69.9 69.1 74.8 84.3
80 79.8 81.5 76.3
95.4 87.3 76.3 53.1
16 56.1 79.8 93.7
70.4 72.6 78.2 77.9
Conclusion: ARFI Elastography is a reliable method for predicting different stages of fibrosis in HCV patients, with an accuracy ranging from 70% to 78% and increasing with fibrosis severity. 1071 LIVER STIFFNESS ASSESSMENT BY MEANS OF TRANSIENT ELASTOGRAPHY IN PATIENTS WITH CHRONIC HEPATITIS I. Sporea, R. Sirli, S. Bota, D. Gerhardt, A. Jurchis, A. Popescu, M. Danila. Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania E-mail: [email protected] Background and Aim: Liver biopsy (LB) is still considered to be the gold standard for fibrosis severity in chronic hepatitis. Liver stiffness (LS) measurement by means of Transient Elastography (TE) has been accepted for fibrosis assessment in HCV hepatitis. The aim of our study was to assess the LS values in patients with HBV chronic hepatitis and to compare them with those in patients with chronic HCV hepatitis. Patients and Methods: The study included 645 patients with chronic hepatitis (202 with HBV, and 443 with HCV), in which LS was measured (FibroScan® -Echosens® ) and LB was performed, in the same session (assessed according to the METAVIR score). In each patient 10 valid LS measurements were performed and a median value was calculated and only evaluations with at least 60% success rate and IQR < 30% were considered reliable. Results: Reliable LS measurements were obtained in 196/202 (97%) HBV patients and in 426/443 (96.2%) HCV patients (p = 0.73). A significant direct correlation of LS measurements with fibrosis was found in HCV patients (Spearman’s r = 0.581, P < 0.0001), better than in HBV patients (r = 0.403, P < 0.0001), p = 0.005. Conclusion: In our group, the mean values of LS in patients with chronic B hepatitis were similar to the ones in patients with chronic C hepatitis, for the same stage of fibrosis. LS had better predictive value in HCV than in HBV patients.
Table 1. Mean LS values in HBV and HCV patients Fibrosis
F0 F1 F2 F3 F4
HBV
HCV
p
No. of patients
Mean LS value (kPa)
No. of patients
Mean LS value (kPa)
1 44 103 40 8
7.4 6.3±1.8 7.1±2.5 9.5±2.9 18.4±8.8
5 43 205 136 37
5.2±0.7 5.6±1.9 6.7±2.5 9.9±4.7 18.1±5.5
− 0.08 0.19 0.61 0.96
Table 2. LS predictive value for fibrosis stage Fibrosis
HBV patients
Fibrosis
Cut-off (kPa)
AUROC
Se (%)
Sp (%)
HCV patients Cut-off (kPa)
AUROC
Se (%)
Sp (%)
F1 F2 F3 F4
− 7.8 8.2 13.8
− 0.660 0.766 0.945
− 43 62.5 75
− 84 81.6 96.8
6.4 6.8 8.8 12.6
0.790 0.752 0.810 0.953
60 56.8 59 91.9
100 89.6 85 91.3
1072 ACOUSTIC RADIATION FORCE IMPULSE (ARFI) ELASTOGRAPHY FOR THE ASSESSMENT OF LIVER FIBROSIS IN PATIENTS WITH CHRONIC HEPATITIS B AND C – AN INTERNATIONAL STUDY I. Sporea1 , S. Bota1 , R. Sirli1 , H. Tanaka2 , H. Iijima2 , R. Badea3 , M. Lupsor3 , C. Fierbinteanu-Braticevici4 , A. Petrisor4 , H. Saito5 , H. Ebinuma5 , M. Friedrich-Rust6 , C. Sarrazin6 , H. Takahashi7 , N. Ono8 , F. Piscaglia9 , A. Borghi9 , M. D’Onofrio10 , A. Gallotti10 , M. Peck-Radosavljevic11 , A. Ferlitsch11 , A. Popescu1 , M. Danila1 . 1 Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania; 2 Div. of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan; 3 IIIrd Medical Clinic, University of Medicine, Cluj-Napoca, 4 IInd Medical Clinic and Gastroenterology, University Hospital, Bucharest, Romania; 5 Department of Internal Medicine, Keio University, Tokyo, Japan; 6 Department of Internal Medicine 1, J.W. Goethe University, Frankfurt/Main, Germany; 7 Department of Internal Medicine, 8 Gastroenterology, Saga Medical School, Saga, Japan; 9 Div. Internal Medicine, Department Clinical Medicine, University and General Hospital S. Orsola-Malpighi, Bologna, 10 Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy; 11 Internal Medicine III, Div. of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria E-mail: [email protected] Background and Aim: ARFI Elastography is a new method used mainly for the assessment of liver fibrosis. The aim of this international multicenter study was to compare liver stiffness (LS) measurements by means of ARFI elastography in patients with chronic hepatitis B vs. chronic hepatitis C, according to severity of histological fibrosis (assessed according to the Metavir score). Methods: Our retrospective study included 1095 patients (181 with HBV chronic hepatitis and 914 with HCV) from 10 centers, 5 countries. Liver biopsy and ARFI measurements were performed in each patient. 10 valid ARFI measurements were performed in each patient and median values were calculated, expressed in meters/second (m/s). For statistical analysis we used t-test, 2-way ANOVA test and Fisher Z test using the MedCalc program and WINK Statistical Data Analysis Research Software. Results: The correlation of LS as assessed by ARFI elastography with histological fibrosis was significantly higher in patients with chronic hepatitis C as compared with those with chronic hepatitis B: r = 0.653, p < 0.0001 vs r = 0.511, p < 0.0001 (Fisher Z test=2.66, p = 0.007).
Journal of Hepatology 2012 vol. 56 | S389–S548
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>1.19 >1.33 >1.43 >1.55
0.779 0.792 0.829 0.842
69.9 69.1 74.8 84.3
80 79.8 81.5 76.3
95.4 87.3 76.3 53.1
16 56.1 79.8 93.7
70.4 72.6 78.2 77.9
Conclusion: ARFI Elastography is a reliable method for predicting different stages of fibrosis in HCV patients, with an accuracy ranging from 70% to 78% and increasing with fibrosis severity. 1071 LIVER STIFFNESS ASSESSMENT BY MEANS OF TRANSIENT ELASTOGRAPHY IN PATIENTS WITH CHRONIC HEPATITIS I. Sporea, R. Sirli, S. Bota, D. Gerhardt, A. Jurchis, A. Popescu, M. Danila. Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania E-mail: [email protected] Background and Aim: Liver biopsy (LB) is still considered to be the gold standard for fibrosis severity in chronic hepatitis. Liver stiffness (LS) measurement by means of Transient Elastography (TE) has been accepted for fibrosis assessment in HCV hepatitis. The aim of our study was to assess the LS values in patients with HBV chronic hepatitis and to compare them with those in patients with chronic HCV hepatitis. Patients and Methods: The study included 645 patients with chronic hepatitis (202 with HBV, and 443 with HCV), in which LS was measured (FibroScan® -Echosens® ) and LB was performed, in the same session (assessed according to the METAVIR score). In each patient 10 valid LS measurements were performed and a median value was calculated and only evaluations with at least 60% success rate and IQR < 30% were considered reliable. Results: Reliable LS measurements were obtained in 196/202 (97%) HBV patients and in 426/443 (96.2%) HCV patients (p = 0.73). A significant direct correlation of LS measurements with fibrosis was found in HCV patients (Spearman’s r = 0.581, P < 0.0001), better than in HBV patients (r = 0.403, P < 0.0001), p = 0.005. Conclusion: In our group, the mean values of LS in patients with chronic B hepatitis were similar to the ones in patients with chronic C hepatitis, for the same stage of fibrosis. LS had better predictive value in HCV than in HBV patients.
Table 1. Mean LS values in HBV and HCV patients Fibrosis
F0 F1 F2 F3 F4
HBV
HCV
p
No. of patients
Mean LS value (kPa)
No. of patients
Mean LS value (kPa)
1 44 103 40 8
7.4 6.3±1.8 7.1±2.5 9.5±2.9 18.4±8.8
5 43 205 136 37
5.2±0.7 5.6±1.9 6.7±2.5 9.9±4.7 18.1±5.5
− 0.08 0.19 0.61 0.96
Table 2. LS predictive value for fibrosis stage Fibrosis
HBV patients
Fibrosis
Cut-off (kPa)
AUROC
Se (%)
Sp (%)
HCV patients Cut-off (kPa)
AUROC
Se (%)
Sp (%)
F1 F2 F3 F4
− 7.8 8.2 13.8
− 0.660 0.766 0.945
− 43 62.5 75
− 84 81.6 96.8
6.4 6.8 8.8 12.6
0.790 0.752 0.810 0.953
60 56.8 59 91.9
100 89.6 85 91.3
1072 ACOUSTIC RADIATION FORCE IMPULSE (ARFI) ELASTOGRAPHY FOR THE ASSESSMENT OF LIVER FIBROSIS IN PATIENTS WITH CHRONIC HEPATITIS B AND C – AN INTERNATIONAL STUDY I. Sporea1 , S. Bota1 , R. Sirli1 , H. Tanaka2 , H. Iijima2 , R. Badea3 , M. Lupsor3 , C. Fierbinteanu-Braticevici4 , A. Petrisor4 , H. Saito5 , H. Ebinuma5 , M. Friedrich-Rust6 , C. Sarrazin6 , H. Takahashi7 , N. Ono8 , F. Piscaglia9 , A. Borghi9 , M. D’Onofrio10 , A. Gallotti10 , M. Peck-Radosavljevic11 , A. Ferlitsch11 , A. Popescu1 , M. Danila1 . 1 Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania; 2 Div. of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan; 3 IIIrd Medical Clinic, University of Medicine, Cluj-Napoca, 4 IInd Medical Clinic and Gastroenterology, University Hospital, Bucharest, Romania; 5 Department of Internal Medicine, Keio University, Tokyo, Japan; 6 Department of Internal Medicine 1, J.W. Goethe University, Frankfurt/Main, Germany; 7 Department of Internal Medicine, 8 Gastroenterology, Saga Medical School, Saga, Japan; 9 Div. Internal Medicine, Department Clinical Medicine, University and General Hospital S. Orsola-Malpighi, Bologna, 10 Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy; 11 Internal Medicine III, Div. of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria E-mail: [email protected] Background and Aim: ARFI Elastography is a new method used mainly for the assessment of liver fibrosis. The aim of this international multicenter study was to compare liver stiffness (LS) measurements by means of ARFI elastography in patients with chronic hepatitis B vs. chronic hepatitis C, according to severity of histological fibrosis (assessed according to the Metavir score). Methods: Our retrospective study included 1095 patients (181 with HBV chronic hepatitis and 914 with HCV) from 10 centers, 5 countries. Liver biopsy and ARFI measurements were performed in each patient. 10 valid ARFI measurements were performed in each patient and median values were calculated, expressed in meters/second (m/s). For statistical analysis we used t-test, 2-way ANOVA test and Fisher Z test using the MedCalc program and WINK Statistical Data Analysis Research Software. Results: The correlation of LS as assessed by ARFI elastography with histological fibrosis was significantly higher in patients with chronic hepatitis C as compared with those with chronic hepatitis B: r = 0.653, p < 0.0001 vs r = 0.511, p < 0.0001 (Fisher Z test=2.66, p = 0.007).
Journal of Hepatology 2012 vol. 56 | S389–S548
S421