Assessment of fibrosis by transient elastography compared with liver biopsy and morphometry in chronic liver diseases

Background & Aims: Liver stiffness measurement (LSM) with transient elastography (Fibroscan) can accurately diagnose advanced liver fibrosis, but its performance in early liver fibrosis is less satisfactory. We aimed to study the diagnostic performance of LSM for histologic bridging fibrosis and cirrhosis in various chronic liver diseases and to investigate the effects of liver fibrosis distribution on LSM. Methods: We prospectively studied consecutive patients with chronic liver diseases undergoing liver biopsy and transient elastography examinations. Morphometric analysis was performed to evaluate the distribution of liver fibrosis. Results: One hundred thirty-three patients (50% chronic hepatitis B, 14% chronic hepatitis C, and 24% non-alcoholic fatty liver disease) were studied. Morphometric analysis revealed a higher correlation between LSM and pericellular fibrosis (r = 0.43) than periportal (r = 0.21) or perivenular fibrosis (r = 0.25). Area under receiver operating characteristic curve (ROC) of LSM for bridging fibrosis was 0.87 (95% confidence interval, 0.81-0.93) and for cirrhosis was 0.89 (95% confidence interval, 0.83-0.94). Higher LSM was associated with higher serum ALT level. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM. The area under ROC curve of LSM for cirrhosis was lower among patients who had ALT above the upper limit of normal (0.86) as compared with that of patients with normal ALT levels (0.93, P = .03). Conclusions: Transient elastography can diagnose severe fibrosis because of its good correlation with pericellular fibrosis. Transient elastography might overestimate liver fibrosis when ALT is elevated.