Noninvasive tests for cirrhosis may help to avoid liver biopsy

Oct 01, 2007

Newer ultrasound and magnetic resonance (MR) imaging tests yield encouraging initial results in diagnosing fibrosis (scarring) and cirrhosis of the liver, according to three studies in the October issue of the journal Clinical Gastroenterology and Hepatology.

With further research, these and other non-invasive imaging techniques may reduce the need for biopsies—procedures done to obtain a tissue sample—to determine the presence and severity of fibrosis and cirrhosis.

Two of the three new papers evaluated techniques of elastography—tests that evaluate reactions to ultrasound vibrations or energy waves as a means of measuring the elasticity or stiffness of the liver tissue. Lower elasticity (or higher stiffness) corresponds to increased fibrosis or scarring. When fibrosis becomes severe, it signals the presence of cirrhosis.

Dr. Jayant A. Talwalkar and colleagues of Mayo Clinic College of Medicine, Rochester, Minn., analyzed the current evidence on ultrasound-based transient elastography—the approach that has received the most research attention to date. Based on data from 18 previous studies, the ultrasound test was highly accurate in identifying patients with cirrhosis, defined as severe (stage IV) fibrosis of the liver. About 90 percent of patients with cirrhosis were correctly identified by ultrasound-based transient elastography. The test was somewhat less accurate in detecting less-severe fibrosis.

Because the studies used differing cutoff points, the analysis could not establish the true accuracy of this emerging technology. The researchers highlight the need for additional high-quality studies including patients with liver fibrosis ranging from mild to severe.

Dr. Meng Yin and colleagues, also of Mayo Clinic College of Medicine, evaluated a different approach to measuring liver elasticity/stiffness: MR elastography. Although the principle is the same as with the ultrasound technique, MR elastography measures reactions to mechanical shear waves, rather than ultrasound vibrations.

The researchers performed MR elastography in 50 patients with chronic liver disease and 35 normal volunteers. The test was nearly 100 percent accurate in identifying patients with any degree of liver fibrosis, including those with mild fibrosis. With further study, Dr. Yin and colleagues believe MR elastography could be a useful initial test for fibrosis—avoiding the
discomfort and risks of liver biopsy for many patients, while potentially increasing the reliability of diagnosis.

Dr. Chen-Hua Liu and colleagues of National Taiwan University Hospital, Taipei, evaluated a different ultrasound technique for measuring fibrosis. Using widely available duplex Doppler ultrasound equipment, they measured the characteristics of blood flow in the vessels in and around the liver in patients with chronic hepatitis C—an increasingly important cause of fibrosis and cirrhosis.

The results showed that a specific measure of blood flow in the spleen—the splenic artery pulsatility index (SAPI)—was highly accurate in identifying fibrosis and cirrhosis. The authors believe that, with further study, the SAPI could also be a useful indicator of fibrosis/cirrhosis in other groups of patients with kidney disease.

Cirrhosis and related complications are responsible for over 40,000 deaths per year in the United States, with direct health care costs of more than $1 billion. Several trends are likely to produce further increases in death and disease from cirrhosis, including the aging of the population; the epidemic of obesity, which leads to nonalcoholic fatty liver diseases; and the emergence of liver disease among patients with chronic hepatitis C.

Traditionally, liver biopsy has been the "gold standard" technique for diagnosing fibrosis and cirrhosis. However, in addition to pain and a risk of bleeding and other complications, liver biopsy is a costly technique that is prone to sampling errors. The new non-invasive imaging techniques may provide a useful new set of tools not only for diagnosing liver fibrosis and cirrhosis, but also for evaluating the effectiveness of new treatments for early-stage fibrosis.

"Application of current imaging modalities may help to define the presence of cirrhosis and even fibrosis in patients with suspected liver disease," commented Dr. C. Mel Wilcox, Editor of CGH. "Using Doppler ultrasound and MRI, these investigators found these modalities to be accurate and reproducible in detecting fibrosis and cirrhosis. Look for more studies using these non-invasive imaging studies, and perhaps others in the future."

Source: Elsevier

Explore further: ICU fatalities linked to after-hours discharge

add to favorites email to friend print save as pdf

Related Stories

New Target Identified for Scleroderma Therapy

Jun 14, 2010

(PhysOrg.com) -- Investigators at Northwestern University Feinberg School of Medicine have identified the molecule Egr-1 (early growth response factor 1) as a new therapy target for scleroderma, an autoimmune disease for ...

Study confirms accuracy of transient elastography in NAFLD

Jan 27, 2010

Researchers from France and Hong Kong determined that transient elastography (TE), a noninvasive, ultrasonic imaging modality, can be accurately performed in the majority of patients with nonalcoholic fatty liver disease ...

Fatty liver disease can lead to heart attack

Apr 19, 2011

Because of the prevalence of obesity in our country, many Americans are expected to develop a serious condition called non-alcoholic fatty liver disease (NAFLD), which can lead to cirrhosis, fibrosis, and in some cases liver ...

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0