Ultrasonographic scoring system score versus liver stiffness measurement in prediction of cirrhosis

다국어 초록 (Multilingual Abstract)

Background/Aims: We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis.
Methods: Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4±9.5 y, mean±SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0–F4) were evaluated.
Results: The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0–F3) (P=0.025).
The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS ≥6: LSM ≥17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4.
Conclusions: The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis. (Clin Mol Hepatol 2013;19:389-398)

참고문헌 (Reference)

1 Gaiani S, "What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy" 27 : 979-985, 1997

2 Talwalkar JA, "Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis" 5 : 1214-1220, 2007

3 Nishiura T, "Ultrasound evaluation of the fibrosis stage in chronic liver disease by the simultaneous use of low and high frequency probes" 78 : 189-197, 2005

4 Macías Rodríguez MA, "Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis" 95 : 258-264, 2003

5 Berzigotti A, "Ultrasonographic evaluation of liver surface and transient elastography in clinically doubtful cirrhosis" 52 : 846-853, 2010

6 Coco B, "Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases" 14 : 360-369, 2007

7 Sandrin L, "Transient elastography: a new noninvasive method for assessment of hepatic fibrosis" 29 : 1705-1713, 2003

8 Sagir A, "Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage" 47 : 592-595, 2008

9 Mendoza J, "Transient elastography (Fibroscan), a new non-invasive method to evaluate hepatic fibrosis" 126 : 220-222, 2006

10 Fung J, "The use of transient elastography in the management of chronic hepatitis B" 5 : 868-875, 2011

11 Yun MH, "The effect of the respiratory cycle on liver stiffness values as measured by transient elastography" 18 : 631-636, 2011

12 Zwiebel WJ, "Sonographic diagnosis of diffuse liver disease" 16 : 8-15, 1995

13 Colli A, "Severe liver fibrosis or cirrhosis: accuracy of US for detection-- analysis of 300 cases" 227 : 89-94, 2003

14 Rosenberg WM, "Serum markers detect the presence of liver fibrosis: a cohort study" 127 : 1704-1713, 2004

15 Baik SK, "Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response" 240 : 574-580, 2006

16 Castéra L, "Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C" 128 : 343-350, 2005

17 Silva G, "Portal venous flow (ultrasonography-Doppler) in patients with alcoholic liver cirrhosis" 119 : 530-537, 1991

18 Moore CL, "Point-of-care ultrasonography" 364 : 749-757, 2011

19 Garcia-Tsao G, "Outpatient liver biopsy: how safe is it?" 118 : 150-153, 1993

20 Garcia-Tsao G, "Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis" 51 : 1445-1449, 2010

21 Ziol M, "Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C" 41 : 48-54, 2005

22 Castera L, "Non-invasive evaluation of liver fibrosis using transient elastography" 48 : 835-847, 2008

23 Kim SU, "Liver stiffness measurement in combination with noninvasive markers for the improved diagnosis of B-viral liver cirrhosis" 43 : 267-271, 2009

24 Sporea I, "Liver stiffness measurement by transient elastography in clinical practice" 17 : 395-399, 2008

25 Zheng RQ, "Liver fibrosis in chronic viral hepatitis: an ultrasonographic study" 9 : 2484-2489, 2003

26 Bravo AA, "Liver biopsy" 344 : 495-500, 2001

27 Kim SU, "How can we enhance the performance of liver stiffness measurement using FibroScan in diagnosing liver cirrhosis in patients with chronic hepatitis B?" 44 : 66-71, 2010

28 Lu LG, "Grading and staging of hepatic fibrosis, and its relationship with noninvasive diagnostic parameters" 9 : 2574-2578, 2003

29 Mederacke I, "Food intake increases liver stiffness in patients with chronic or resolved hepatitis C virus infection" 29 : 1500-1506, 2009

30 Seitz JF, "Evaluation of ultrasonography in the diagnosis of cirrhosis. Retrospective studies of 100 consecutive tests" 7 : 734-739, 1983

31 Tüney D, "Diagnosis of liver cirrhosis in children based on colour Doppler ultrasonography with histopathological correlation" 28 : 859-864, 1998

32 Kim KM, "Diagnosis of hepatic steatosis and fibrosis by transient elastography in asymptomatic healthy individuals: a prospective study of living related potential liver donors" 42 : 382-388, 2007

33 Foucher J, "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study" 55 : 403-408, 2006

34 Kim MY, "Damping index of Doppler hepatic vein waveform to assess the severity of portal hypertension and response to propranolol in liver cirrhosis: a prospective nonrandomized study" 27 : 1103-1110, 2007

35 Hung CH, "Correlation between ultrasonographic and pathologic diagnoses of hepatitis B and C virus-related cirrhosis" 38 : 153-157, 2003

36 Arena U, "Acute viral hepatitis increases liver stiffness values measured by transient elastography" 47 : 380-384, 2008

37 전대원, "A study of the awareness of chronic liver diseases among Korean adults" 대한간학회 17 (17): 99-105, 2011