Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
State Key laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
J Gastroenterol Hepatol. 2019 Jan;34(1):241-248. doi: 10.1111/jgh.14311. Epub 2018 Jun 27.
The Baveno VI Consensus recommends repeating examination in patients with high liver stiffness measurement (LSM) by transient elastography to reduce false-positive diagnosis of advanced liver disease. We tested whether repeating transient elastography can increase the overall diagnostic accuracy.
Ninety-seven patients with non-alcoholic fatty liver disease who underwent two FibroScan examinations within 6 months prior to liver biopsy were evaluated. An LSM cut-off of 7.9 kPa was used to exclude F3-4 fibrosis.
Seventy-eight patients had high LSM at baseline, among whom 27 had low LSM on repeated testing; only four had F3 and none had cirrhosis. In contrast, 31 of 51 patients with high LSM at both examinations had F3-4. Nineteen patients had low LSM at baseline; none of them had F3-4 regardless of the second LSM results. If we took LSM <7.9 kPa at either examination as sufficient to exclude F3-4, the negative predictive value remained high at 91%. The positive predictive value for F3-4 increased from 45% in patients with high LSM at baseline to 61% in those with high LSM at both examinations. Sensitivity analysis using different cut-offs yielded similar results, with 76% of patients with LSM >12 kPa at both examinations having F3-4.
Transient elastography is a highly sensitive screening test to exclude F3-4 fibrosis in non-alcoholic fatty liver disease patients. One-third of patients with high LSM may have normal results on repeated examination. By repeating examination in cases with high LSM, one may spare patients from unnecessary liver biopsy.
Baveno VI 共识建议对肝硬度测量值（LSM）较高的患者重复进行瞬时弹性成像检查，以降低晚期肝病的假阳性诊断。我们检验了重复瞬时弹性成像是否能提高整体诊断准确性。
对 97 例在肝活检前 6 个月内行两次 FibroScan 检查的非酒精性脂肪性肝病患者进行评估。采用 LSM 截断值 7.9kPa 排除 F3-4 纤维化。
78 例患者基线时 LSM 较高，其中 27 例重复检测时 LSM 较低；仅 4 例为 F3，无 1 例为肝硬化。相比之下，51 例两次检查均 LSM 较高的患者中 31 例有 F3-4。19 例患者基线时 LSM 较低；无论第二次 LSM 结果如何，他们均无 F3-4。如果我们将两次检查中任何一次的 LSM＜7.9kPa 作为排除 F3-4 的充分条件，阴性预测值仍高达 91%。F3-4 的阳性预测值从基线时 LSM 较高患者的 45%增加到两次检查时 LSM 较高患者的 61%。采用不同截断值的敏感性分析得出了相似的结果，两次检查 LSM＞12kPa 的患者中有 76%有 F3-4。
瞬时弹性成像检查是一种高度敏感的筛查试验，可用于排除非酒精性脂肪性肝病患者的 F3-4 纤维化。三分之一 LSM 较高的患者可能在重复检查中结果正常。对 LSM 较高的病例重复检查可避免不必要的肝活检。
