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Gut. 2007 Jul;56(7):968-73. Epub 2007 Jan 25.

Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease.

Author information

1
Second Division of Gastroenterology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy. mfraquelli@yahoo.it

Abstract

OBJECTIVE:

Transient elastography (TE) is gaining popularity as a non-invasive method for predicting liver fibrosis, but intraobserver and interobserver agreement and factors influencing TE reproducibility have not been adequately assessed. This study investigated these aspects.

SETTING:

Tertiary referral liver unit.

PATIENTS:

Over a 4-month period, 200 patients with chronic liver disease (CLD) with varying aetiology consecutively underwent TE and liver biopsy.

INTERVENTIONS:

TE was performed twice by two different operators either concomitantly or within 3 days of the bioptic procedure (METAVIR classification).

MAIN OUTCOME MEASURES:

Intraobserver and interobserver agreement were analysed using the intraclass correlation coefficient (ICC) and correlated with different patient-related and liver disease-related covariates.

RESULTS:

800 TE examinations were performed, with an indeterminate result rate of 2.4%. The overall interobserver agreement ICC was 0.98 (95% CI 0.977 to 0.987). Increased body mass index (>25 kg/m(2)), steatosis, and low staging grades (fibrosis (F) stage <2) were significantly associated with reduced ICC (p<0.05). Intraobserver agreement ICC was 0.98 for both raters. Using receiver operating characteristic curves, three diagnostic TE thresholds were identified: >7.9 kPa for F>/=2, >10.3 for F>/=3 and >11.9 for F = 4. TE values assessed by the two raters fell within the same cut-off of fibrosis in 88% of the cases for F>/=2, in 92% for F>/=3 and 91% for F = 4.

CONCLUSIONS:

TE is a highly reproducible and user-friendly technique for assessing liver fibrosis in patients with CLD. However, because TE reproducibility is significantly reduced (p<0.05) in patients with steatosis, increased BMI and lower degrees of hepatic fibrosis, caution is warranted in the clinical use of TE as a surrogate for liver biopsy.

PMID:
17255218
PMCID:
PMC1994385
DOI:
10.1136/gut.2006.111302
[Indexed for MEDLINE]
Free PMC Article

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