Reliability of liver stiffness measurement in non-alcoholic fatty liver disease: the effects of body mass index.

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Abstract

Background Liver stiffness measurement (LSM) using transient elastography (TE) is used to stage fibrosis in patients with liver disease, diagnostic reliability and the factors affecting its performance in patients with non-alcoholic fatty liver disease (NAFLD) are incompletely understood. Aim To assess LSM. Methods Consecutive NAFLD patients (n = 169), assessed by liver biopsy (Kleiner score), anthropometrical, biochemical and metabolic features, underwent LSM using TE with standard M probe. Results Liver stiffness measurement was not reliable in 23 patients (14%) due to obesity. Among patients with a reliable TE, a LSM value >7.25 kPa was the best cut-off for predicting significant fibrosis at biopsy (AUC 0.794); however, this cut-off still failed to rule out F2-F4 fibrosis in 31% (false-negative rate) or rule in F3-F4 in 29% (false-positive rate). Similarly a LSM value >8.75 kPa was the best cut-off for severe fibrosis (F3-F4) (AUC 0.870), with a rate of false-negatives 24% and of false-positives 2%. Body mass index was the major determinant of these diagnostic errors in predicting significant and severe fibrosis both by overestimating or underestimating the stage of fibrosis. Conclusions In NAFLD patients, even when liver stiffness measurement is feasible, high BMI values negatively affect the diagnostic reliability. Improved performance of transient elastography could be obtained using specifically designed probes. © 2011 Blackwell Publishing Ltd.
Lingua originaleEnglish
pagine (da-a)1350-1360
Numero di pagine11
RivistaAlimentary Pharmacology and Therapeutics
Volume33
Stato di pubblicazionePublished - 2011

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Body Mass Index
Elasticity Imaging Techniques
Fibrosis
Liver
Area Under Curve
Biopsy
Non-alcoholic Fatty Liver Disease
Diagnostic Errors
Liver Diseases
Obesity

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Pharmacology (medical)
  • Gastroenterology

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@article{52dd239e6a9f4aedac922b9b3b6c19b0,
title = "Reliability of liver stiffness measurement in non-alcoholic fatty liver disease: the effects of body mass index.",
abstract = "Background Liver stiffness measurement (LSM) using transient elastography (TE) is used to stage fibrosis in patients with liver disease, diagnostic reliability and the factors affecting its performance in patients with non-alcoholic fatty liver disease (NAFLD) are incompletely understood. Aim To assess LSM. Methods Consecutive NAFLD patients (n = 169), assessed by liver biopsy (Kleiner score), anthropometrical, biochemical and metabolic features, underwent LSM using TE with standard M probe. Results Liver stiffness measurement was not reliable in 23 patients (14{\%}) due to obesity. Among patients with a reliable TE, a LSM value >7.25 kPa was the best cut-off for predicting significant fibrosis at biopsy (AUC 0.794); however, this cut-off still failed to rule out F2-F4 fibrosis in 31{\%} (false-negative rate) or rule in F3-F4 in 29{\%} (false-positive rate). Similarly a LSM value >8.75 kPa was the best cut-off for severe fibrosis (F3-F4) (AUC 0.870), with a rate of false-negatives 24{\%} and of false-positives 2{\%}. Body mass index was the major determinant of these diagnostic errors in predicting significant and severe fibrosis both by overestimating or underestimating the stage of fibrosis. Conclusions In NAFLD patients, even when liver stiffness measurement is feasible, high BMI values negatively affect the diagnostic reliability. Improved performance of transient elastography could be obtained using specifically designed probes. {\circledC} 2011 Blackwell Publishing Ltd.",
author = "Antonio Craxi and {Di Marco}, Vito and Calogero Camma' and Daniela Cabibi and Salvatore Petta and Giuseppe Butera and Petta",
year = "2011",
language = "English",
volume = "33",
pages = "1350--1360",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Reliability of liver stiffness measurement in non-alcoholic fatty liver disease: the effects of body mass index.

AU - Craxi, Antonio

AU - Di Marco, Vito

AU - Camma', Calogero

AU - Cabibi, Daniela

AU - Petta, Salvatore

AU - Butera, Giuseppe

AU - Petta, null

PY - 2011

Y1 - 2011

N2 - Background Liver stiffness measurement (LSM) using transient elastography (TE) is used to stage fibrosis in patients with liver disease, diagnostic reliability and the factors affecting its performance in patients with non-alcoholic fatty liver disease (NAFLD) are incompletely understood. Aim To assess LSM. Methods Consecutive NAFLD patients (n = 169), assessed by liver biopsy (Kleiner score), anthropometrical, biochemical and metabolic features, underwent LSM using TE with standard M probe. Results Liver stiffness measurement was not reliable in 23 patients (14%) due to obesity. Among patients with a reliable TE, a LSM value >7.25 kPa was the best cut-off for predicting significant fibrosis at biopsy (AUC 0.794); however, this cut-off still failed to rule out F2-F4 fibrosis in 31% (false-negative rate) or rule in F3-F4 in 29% (false-positive rate). Similarly a LSM value >8.75 kPa was the best cut-off for severe fibrosis (F3-F4) (AUC 0.870), with a rate of false-negatives 24% and of false-positives 2%. Body mass index was the major determinant of these diagnostic errors in predicting significant and severe fibrosis both by overestimating or underestimating the stage of fibrosis. Conclusions In NAFLD patients, even when liver stiffness measurement is feasible, high BMI values negatively affect the diagnostic reliability. Improved performance of transient elastography could be obtained using specifically designed probes. © 2011 Blackwell Publishing Ltd.

AB - Background Liver stiffness measurement (LSM) using transient elastography (TE) is used to stage fibrosis in patients with liver disease, diagnostic reliability and the factors affecting its performance in patients with non-alcoholic fatty liver disease (NAFLD) are incompletely understood. Aim To assess LSM. Methods Consecutive NAFLD patients (n = 169), assessed by liver biopsy (Kleiner score), anthropometrical, biochemical and metabolic features, underwent LSM using TE with standard M probe. Results Liver stiffness measurement was not reliable in 23 patients (14%) due to obesity. Among patients with a reliable TE, a LSM value >7.25 kPa was the best cut-off for predicting significant fibrosis at biopsy (AUC 0.794); however, this cut-off still failed to rule out F2-F4 fibrosis in 31% (false-negative rate) or rule in F3-F4 in 29% (false-positive rate). Similarly a LSM value >8.75 kPa was the best cut-off for severe fibrosis (F3-F4) (AUC 0.870), with a rate of false-negatives 24% and of false-positives 2%. Body mass index was the major determinant of these diagnostic errors in predicting significant and severe fibrosis both by overestimating or underestimating the stage of fibrosis. Conclusions In NAFLD patients, even when liver stiffness measurement is feasible, high BMI values negatively affect the diagnostic reliability. Improved performance of transient elastography could be obtained using specifically designed probes. © 2011 Blackwell Publishing Ltd.

UR - http://hdl.handle.net/10447/61941

M3 - Article

VL - 33

SP - 1350

EP - 1360

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

ER -