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

被引:668
作者
Fraquelli, Mirella
Rigamonti, Cristina
Casazza, Giovanni
Conte, Dario
Donato, Maria Francesca
Ronchi, Guido
Colombo, Massimo
机构
[1] Fdn IRCCS Osped Maggiore Policlin M&RE, Div Gastroenterol 2, Milan, Italy
[2] Fdn IRCCS Osped Maggiore Policlin M&RE, AM&A Migliavacca Ctr Liver Dis, Div Gastroenterol 1, Milan, Italy
[3] Univ Milan, Ist Stat Med & Biometria, I-20122 Milan, Italy
关键词
HEPATIC-FIBROSIS; BIOPSY; CIRRHOSIS; VARIABILITY; DIAGNOSIS; STIFFNESS; ACCURACY;
D O I
10.1136/gut.2006.111302
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
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收藏
页码:968 / 973
页数:6
相关论文
共 34 条
[1]   Evaluation of liver fibrosis: A concise review [J].
Afdhal, NH ;
Nunes, D .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2004, 99 (06) :1160-1174
[2]  
[Anonymous], 1986, The Design and Analysis of Clinical Experiments
[3]   Advances in alcoholic liver disease [J].
Arteel, G ;
Marsano, L ;
Mendez, C ;
Bentley, F ;
McClain, CJ .
BEST PRACTICE & RESEARCH CLINICAL GASTROENTEROLOGY, 2003, 17 (04) :625-647
[4]   An algorithm for the grading of activity in chronic hepatitis C [J].
Bedossa, P ;
Poynard, T .
HEPATOLOGY, 1996, 24 (02) :289-293
[5]   Sampling variability of liver fibrosis in chronic hepatitis C [J].
Bedossa, P ;
Dargère, D ;
Paradis, V .
HEPATOLOGY, 2003, 38 (06) :1449-1457
[6]  
BEDOSSA P, 1994, HEPATOLOGY, V20, P15
[7]   STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT [J].
BLAND, JM ;
ALTMAN, DG .
LANCET, 1986, 1 (8476) :307-310
[8]   Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative [J].
Bossuyt, PM ;
Reitsma, JB ;
Bruns, DE ;
Gatsonis, CA ;
Glasziou, PP ;
Irwig, LM ;
Lijmer, JG ;
Moher, D ;
Rennie, D ;
de Vet, HCW .
CLINICAL CHEMISTRY, 2003, 49 (01) :1-6
[9]   Current concepts: Liver biopsy. [J].
Bravo, AA ;
Sheth, SG ;
Chopra, S .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (07) :495-500
[10]  
Brunt EM, 1999, AM J GASTROENTEROL, V94, P2467, DOI 10.1111/j.1572-0241.1999.01377.x