Medición no invasiva de la fibrosis hepática: elastografía. Experiencia en 1200 estudios

Authors: Mariana Kucharczyk (1) , Joaquín Solari (2) , Fernando Losada López (1) , Lorena Savluk (1) , Carlos Tarzián (1) , Ricardo García Mónaco (1)

Purpose. To report our experience from 1200 transient elastographies and correlate results with different etiologies and
liver biopsy.

Materials and Methods. We performed a retrospective
study of patients undergoing transient elastography (TE)
between 08/2009 and 04/2011. A database was completed
considering clinical and histological data. Body mass index
(BMI) was calculated in all cases. Tests were considered
valid if the success rate was > 60% and the interquartile
range (IQR) was < 30%. We assessed the degree of agreement between TE and histology. We compared biopsy number and sampling with a previous period.

Results. One thousand-two hundred tests were evaluated.
Etiologies: hepatitis C virus (HCV) infection 40%, non-alcoholic fatty liver disease (NAFLD) 20.8%, hepatitis B virus
(HBV) infection 10.7%, cholestasis 9.1%, others 19.4%.
Significant fibrosis (F > 2) was detected in 32.3% of HCV,
32.1% of HBV, 31.5% of NAFLD and 33.4% of cholestasis.
In 154 of 1200 patients we found BMI > 28 kg/m2
, however,
the test was valid in 121 patients. In 34 patients, no valid
results could be achieved because of BMI > 28 kg/m2
and fatty
thoracic belt > 2.5 cm in 33 of them. Simultaneous biopsy
(within 6 months) was performed in 388 patients, with an
overall agreement of 77%. We found a 30% decrease in diffuse
liver biopsies in HCV patients when comparing the period
01/2008 - 08/2009 with 09/2009 - 04/2011. In HCV patients
who underwent liver transplantation (n=21) agreement was
90.4%; 100% with gradient measurement and TE.

Conclusion. We obtained similar results to those reported
in the literature. We found an excellent correlation with
biopsy in HCV transplanted patients. The main limitation
was the fatty thoracic belt > 2.5 cm. The growing number of
TE studies and decreased diffuse liver biopsies reflect the
progressive incorporation of elastography into the diagnostic algorithm of chronic liver diseases.