Combined Methods for Liver Fibrosis Evaluation
Pp. 103-106 (4)
Ioan Sporea and Simona Bota
Biological tests, elastographic methods alone or in combination can be used
for the non-invasive evaluation of chronic liver diseases, in order to increase their value.
The combination of TE and serological tests offered a good diagnostic performance,
both for significant fibrosis (F≥2) and for severe fibrosis/cirrhosis (F3–F4) diagnosis. A
clinical management algorithm, using the combination of FibroScan and FibroTest as
part of the first-line work-up was developed for liver fibrosis assessment in HCV
patients. By using this algorithm, liver biopsy would have been avoided in the majority
(77%) of patients. In HBV inactive carriers, the combination of TE and FibroTest
allowed the exclusion of significant fibrosis (F≥2) in nearly 80% of cases.
Another useful combination is the one between two elastographic methods (TE and
ARFI), being highly specific for predicting significant fibrosis (F≥2 Metavir). For
predicting F≥2, when LS by means of both TE and ARFI were higher than the proposed
cut-offs, the sensitivity was 93.3%, the positive predictive value was 96.8%, so that in
those patients, liver biopsy could be avoided (60.5% of cases). For predicting cirrhosis
(F4) the results were also very good, with 94.4% specificity, 94.4% negative predictive
value and 91.8% accuracy, so the combined methods are not only able to confirm, but
also to exclude the presence of cirrhosis.
Serological tests, elastography, liver fibrosis, combination methods.
Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 10, Iosif Bulbuca Bv, 300736, Timișoara, Romania