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. 2019 Jan;17(1):156-163.e2.
doi: 10.1016/j.cgh.2018.04.043. Epub 2018 Apr 26.

Vibration-Controlled Transient Elastography to Assess Fibrosis and Steatosis in Patients With Nonalcoholic Fatty Liver Disease

Mohammad S Siddiqui  1 , Raj Vuppalanchi  1 , Mark L Van Natta  2 , Erin Hallinan  2 , Kris V Kowdley  3 , Manal Abdelmalek  4 , Brent A Neuschwander-Tetri  5 , Rohit Loomba  6 , Srinivasan Dasarathy  7 , Danielle Brandman  8 , Edward Doo  9 , James A Tonascia  2 , David E Kleiner  10 , Naga Chalasani  11 , Arun J Sanyal  1 ; NASH Clinical Research Network
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Free PMC article

Vibration-Controlled Transient Elastography to Assess Fibrosis and Steatosis in Patients With Nonalcoholic Fatty Liver Disease

Mohammad S Siddiqui et al. Clin Gastroenterol Hepatol. 2019 Jan.
Free PMC article

Abstract

Background & aims: Vibration-controlled transient elastography (VCTE), which measures liver stiffness, has become an important tool for evaluating patients with nonalcoholic fatty liver disease (NAFLD). We aimed to determine the diagnostic accuracy of VCTE in detection of NAFLD in a multicenter cohort of patients.

Methods: We performed a prospective study of 393 adults with NAFLD who underwent VCTE within 1 year of liver histology analysis (median time, 49 d; interquartile range, 25-78 d), from July 1, 2014, through July 31, 2017. Liver stiffness measurement (LSM) cut-off values for pairwise fibrosis stage and controlled attenuation parameter cut-off values for pairwise steatosis grade were determined using cross-validated area under the receiver operating characteristics curve (AUROC) analyses. Diagnostic statistics were computed at a sensitivity fixed at 90% and a specificity fixed at 90%.

Results: LSM identified patients with advanced fibrosis with an AUROC of 0.83 (95% CI, 0.79- 0.87) and patients with cirrhosis with an AUROC of 0.93 (95% CI, 0.90-0.97). At a fixed sensitivity, a cut-off LSM of 6.5 kPa excluded advanced fibrosis with a negative predictive value of 0.91, and a cut-off LSM of 12.1 kPa excluded cirrhosis with a negative predictive value of 0.99. At a fixed specificity, LSM identified patients with advanced fibrosis with a positive predictive value of 0.71 and patients with cirrhosis with a positive predictive value of 0.41. Controlled attenuation parameter analysis detected steatosis with an AUROC of 0.76 (95% CI, 0.64-0.87). In contrast, the VCTE was less accurate in distinguishing lower fibrosis stages, higher steatosis grades, or the presence of NASH.

Conclusions: In a prospective study of adults with NAFLD, we found VCTE to accurately distinguish advanced vs earlier stages of fibrosis, using liver histology as the reference standard.

Keywords: Controlled Attenuation Parameter; Fibroscan; Fibrosis; NAFLD; Steatosis; VCTE; Vibration Controlled Transient Elastography.

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Conflict of interest statement

Conflicts of Interests: Mr. Van Natta and Drs. Tonascia, Hallman, Dasarathy, Doo, Brandman, and Kleiner report no conflicts of interests.

Figures

Figure 1
Figure 1
Liver Stiffness Measurement According to Fibrosis Stage
Figure 2
Figure 2
Controlled Attenuation Parameter According to Steatosis Grade
See this image and copyright information in PMC

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