Non invasive methods for detecting ilver fibrosis are substituting to liver biopsy.(particularly for HCV and NAFLD). These methods are laboratory and image based.They have been extensively evaluated, nevertheless, results are still conflicting and some have limitations. In you experience what methods are the most performant?
I would suggest Fibroscan as non invasive screening for liver fibrosis.
I think of a structured evaluation via FibroScan: for example, a review conducted several times by the same physician and a comparison with the findings of at least two other experts. In other words it should create a validated score that takes into account the experience of the individual operator and the technological characteristics of the instrument used.
Dear Chieng jin yu and Dr Sandro Gentile
You mean transient elastography (Fibroscan)? Do you think it is better than Accoustic Radiation Force Impulse elastography (ARFI) or Shear wave elastography?.
Transient elastography has some limitations. As you know it is a blind assessing study. You may measure vascular territories that lead to smaple error. ARFI is an US and Doppler integrated elastography that gives you some advantages: to evaluate the morphological and vascular features, and to select the place where you are going to measure liver stiffness.
Not to forget some laboratory based scores. The most validated is the NAFLD fibrosis score.
I advise you not to limit to transient elastography. You may explore other methods alone or in combination to increase diagnostic performance.
Thank you for your interest.
Dr Diego,
I agreed with you that we shouldn't limit to the fibroscan alone. I do combine the NAFLD fibrosis score together with the fibroscan during the clinical practice.
1°) FibroTest (a-2-macroglobulin, haptoglobin, apolipoprotein A-1, total bilirubin level, and g-glutamyl transpeptidase).
2°) Magnetic resonance elastography.
I think the Fibroscan is the gold standard for evidence of liver fibrosis after liver bipsia
Dear Drs Guiseppe De Rosa and Carlos:
Currently, there is no gold standard noninvasive method for liver fibrosis (substituting to liver biopsy). Laboratory based and image based methods are still been tested. Certainly, transient elastography (Fibroscan) is one of the most used, nevertheless, as I said previously it has some limitations. A recent metanalisis reported that ARFI and Shear Wave elastography has similar global sensitivity and specificity for detecting fibrosis than transient elastography. They differ in detecting intermediate stades of fibrosis. A more recent paper reports that IMR elastography is better than transient elastography in all fibrosis stades.
I think that any elastography method (transient, ARFI, sheat wave, IMR) combined with a laboratory based score should be used in patients in whom liver biopsy is not indicated or justified. Methods should be selected based on experience and accessibility of each center.
Frulio N et al Diagnostic and interventional Imaging 2013;94:515
Imajo K, Kessoku T, Honda Y, et al. Magnetic resonance imaging more accurately classifies steatosis and fibrosis in patients with nonalcoholic fatty liver disease than transient elastography. Gastroenterology 2016;150:626–637.
Probably the combination of Fibroscan and Fibrotest. IRM elastography is indeed better but has restrictions in availability and price.
Dear Chantal
Probably ARFI and NAFLD fibrosis score is bettter.
I think impulse elastography (ARFI) is going to substitute to transient elastography (Fibroscan). (Fibroscan is the brand name of a method based on transient elastography). In my opinion ARFI has more advantages. And NAFLD fibrosis score in my opinion is better than Fibrotest. It is cheaper and more available.
Best regards.
Angulo et al Hepatology 2007;45:846
The most widely diffunded and used in all centres actually because is cheap, easy to use, very reproducible and objectively reproducible in several measures in the same patient along the time
Dear Colleagues, I think that the topic is very challanging and with many practical implications, but I also think that we need further studies, using and comparing different non-invasive methods as the gold standard that remains liver biopsy.
Personal experience and follow-up of patients may provide precious help but are subjective and do not apply more broadly
In past years there have been various attempts to use the scoring systems that included biochemical data routinary to improve the diagnostic probability.
Dear Dr Gentille and colleagues:
I agree with you. Gold standard of diagnosis is liver biopsy. Nevertheless LB is an invasive non-always- inocuos procedure. Certrainly we need more studies that can show us which noninvasive methods, alone or combined, have the best sensitivity and specificity, positive and negative predictive values compared with LB. We have to take into account clinical and epidemiological characterstics of our patients, practice setting, experience of operators, costs and accesibility of methods in order to select, in our clinical practice, which procedures are the most adequate.
Greetings to everybody
Dr Diego Garcia-Compan
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