Non-Alkolik Yağlı Karaciğer Hastalığında Fibrozisin Değerlendirilmesinde Karaciğer Elastografi Point Quantification Ölçümünün Rolü ve Diğer Non-İnvazif Yöntemlerle Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı; yeni bir karaciğer sertlik LS ölçümü incelemesi olan elastografi point quantification ElastPQ yönteminin non-alkolik yağlı karaciğer hastalığında NAFLD kullanılabilirliğinin tespiti ve bu incelemenin diğer non-invaziv karaciğer fibrozis LF incelemeleri ile karşılaştırılmasıdır.Gereç ve Yöntemler: Çalışmaya NAFLD olan ve olmayan 108 hasta alındı. LS ölçümü ElastPQ yöntemi ile yapıldı. Hastalara noninvaziv LF incelemelerinden; AST/Platelet oranı indeksi APRI , Fibrosis-4 FIB-4 indeksi, NAFLD fibrozis skoru, AST/ALT oranı ve BARD skoru değerlendirildi.Bulgular: Karaciğer boyutu, LS, APRI, FIB-4 indeksi, NAFLD fibrozis skoru, AST/ALT oranı ve BARD skoru değerlerinin hepsi NAFLD olan hastalarda olmayanlara göre belirgin olarak yüksekti. Bu parametrelerden sadece LS’ nin NAFLD olma durumunu bağımsız olarak belirlediği saptandı. LS’ da her 0.5 kPa artış NAFLD olma durumunu 2.12 kat artırdığı tespit edildi. LS’ nin NAFLD belirlemesi için ROC analizi yapıldığında, ROC eğri altında kalan alanın 0.967 olduğu ve LS için sınır değer 5 kPa olarak alındığında NAFLD olma riskini %88.9 duyarlılık ve %94.4 özgüllük ile belirlediği saptandı. Ayrıca HbA1c, LDL kolesterol, FIB-4 indeksi, NAFLD fibrosis skoru ve BARD skorunun, LS ile yakın ve bağımsız ilişkili olduğu bulundu.Sonuç: ElastoPQ yöntemi ile ölçülen LS değeri NAFLD varlığını diğer non-invasiv LF incelmelerinden daha iyi ve bağımsız olarak belirler. Aynı zamanda, LS değeri non-invasiv LF belirleyicilerinden FIB-4 indeks, NAFLD fibrozis skoru ve BARD skoru ile yakın olarak ilişkilidir

Anahtar Kelimeler

• Non-alkolik yağlı karaciğer hastalığı, Karaciğer sertliği, Karaciğer elastografi, Non-invaziv karaciğer fibrozis incelemeleri

The Role of Liver Elastography Point Quantification in the Assessment of Fibrosis in Non-Alcoholic Fatty Liver Disease and Comparison with Other Non-Invasive Methods

Abstract

Objective: The aim of this study was to determine the availability of a new liver stiffness LS measurement, the elastography point quantification ElastPQ method, in non-alcoholic fatty liver disease NAFLD and to compare it with other noninvasive Liver fibrosis LF investigations.Material and Methods: A total of 108 patients with or without NAFLD were included in this study. LS measurement was done by the ElastPQ method. Noninvasive LF investigations; the AST/Platelet-ratio-index APRI , Fibrosis-4 FIB-4 index, NAFLD fibrosis score, AST/ALT ratio and BARD score were evaluated. Results: Liver size, LS, APRI, FIB-4 index, NAFLD fibrosis score, AST/ALT ratio and BARD score were all significantly higher in NAFLD patients. It was determined that only LS among these parameters independently determined the NAFLD status. It was found that each 0.5-kPa increase in LS increased the risk of having NAFLD 2.12 fold. When the ROC analysis was performed for the NAFLD determination of the LS value, it was determined that the area under the ROC curve was 0.967, and when the limit value for LS was taken as 5-kPa, the risk of having NAFLD was determined with 88.9% sensitivity and 94.4% specificity. Conclusion: The LS value obtained by ElastPQ has high diagnostic accuracy for NAFLD and performs better than other noninvasive laboratory methods in the assessment of NAFLD. At the same time, the LS value is closely related to the FIB-4 index, NAFLD fibrosis score and BARD score

Keywords

• Non-alcoholic fatty liver disease, Liver stiffness, Elastography, Non-invasive liver fibrosis investigations

Kaynakça

1. 1. Castera L. Diagnosis of non-alcoholic fatty liver disease/ non-alcoholic steatohepatitis: Non-invasive tests are enough. Liver Int 2018; 38:67-70.
2. 2. Schwenzer NF, Springer F, Schraml C, Stefan N, Machann J, Schick F. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol 2009; 51:433-45.
3. 3. Wong VW, Vergniol J, Wong GL, Foucher J, Chan HL, Le Bail B, Choi PC, Kowo M, Chan AW, Merrouche W, Sung JJ, de Lédinghen V. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology 2010; 51:454-62.
4. 4. Myers RP, Pomier-Layrargues G, Kirsch R, Pollett A, Duarte-Rojo A, Wong D, Beaton M, Levstik M, Crotty P, Elkashab M. Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology 2012; 55:199- 208.
5. 5. Lupsor M, Badea R, Stefanescu H, Grigorescu M, Serban A, Radu C, Crişan D, Sparchez Z, Iancu S, Maniu A. Performance of unidimensional transient elastography in staging non-alcoholic steatohepatitis. J Gastrointestin Liver Dis 2010; 19:53-60.
6. 6. Fierbințeanu Braticevici C, Sporea I, Panaitescu E, Tribus L. Value of acoustic radiation force impulse imaging elastography for non-invasive evaluation of patients with nonalcoholic fatty liver disease. Ultrasound Med Biol 2013; 39:1942-50.
7. 7. Sporea I, Bota S, Grădinaru-Taşcău O, Sirli R, Popescu A, Jurchiş A. Which are the cut-off values of 2D-Shear Wave Elastography (2D-SWE) liver stiffness measurements predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method? Eur J Radiol 2014; 83:e118-e22.
8. 8. Sporea I, Bota S, Grădinaru-Taşcău O, Şirli R, Popescu A. Comparative study between two point Shear Wave Elastographic techniques: Acoustic Radiation Force Impulse (ARFI) elastography and ElastPQ. Med Ultrason 2014; 16:309-14.

9. 9. Casey SP, Kemp WW, McLean CA, Topliss DJ, Adams LA, Roberts SK. A prospective evaluation of the role of transient elastography for the detection of hepatic fibrosis in type 2 diabetes without overt liver disease. Scand J Gastroenterol. 2012; 47:836-41.
10. 10. European Association for Study of Liver; Asociacion Latinoamericana para el Estudio del Higado. EASLALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63:237-64.
11. 11. Boursier J, Vergniol J, Guillet A, Hiriart JB, Lannes A, Le Bail B, Michalak S, Chermak F, Bertrais S, Foucher J, Oberti F, Charbonnier M, Fouchard-Hubert I, Rousselet MC, Calès P, de Lédinghen V. Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non-alcoholic fatty liver disease. J Hepatol 2016; 65:570-8.
12. 12. Kettaneh A, Marcellin P, Douvin C, Poupon R, Ziol M, Beaugrand M, de Lédinghen V. Features associated with success rate and performance of FibroScan measurements for the diagnosis of cirrhosis in HCV patients: A prospective study of 935 patients. J Hepatol 2007; 46: 628-34.
13. 13. Foucher J, Castera L, Bernard PH, Adhoute X, Laharie D, Bertet J, Couzigou P, de Lédinghen V. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol 2006; 18:411-2.
14. 14. Bota S, Sporea I, Sirli R, Popescu A, Danila M, Jurchis A, Gradinaru-Tascau O. Factors associated with the impossibility to obtain reliable liver stiffness measurements by means of Acoustic Radiation Force Impulse (ARFI) elastography analysis of a cohort of 1,031 subjects. Eur J Radiol 2014; 83:268-72.
15. 15. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012; 55:2005-23.
16. 16. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38:518-26.
17. 17. Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, Fontaine H, Pol Sl. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest. Hepatology 2007; 46:32-6.
18. 18. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, Enders F, Saksena S, Burt AD, Bida JP, Lindor K, Sanderson SO, Lenzi M, Adams LA, Kench J, Therneau TM, Day CP. The NAFLD fbrosis score: A noninvasive system that identifes liver fbrosis in patients with NAFLD. Hepatology 2007; 45:846-54.
19. 19. Cichoż-Lach H, Celiński K, Prozorow-Król B, Swatek J, Słomka M, Lach T. The BARD score and the NAFLD fibrosis score in the assessment of advanced liver fibrosis in nonalcoholic fatty liver disease. Med Sci Monit 2012; 18:735-40.
20. 20. Harrison SA, Oliver D, Arnold HL, Gogia S, Neuschwander-Tetri BA. Development and validation of a simple NALFD clinical scoring system for identifying patient without advanced disease. Gut 2008; 57:1441-7.
21. 21. Ducancelle A, Leroy V, Vergniol J, Sturm N, Le Bail B, Zarski JP, Nguyen Khac E, Salmon D, de Ledinghen V, Calès P. A single test combining blood markers and elastography is more accurate than other fibrosis tests in the main causes of chronic liver diseases. J Clin Gastroenterol 2017; 51:639-49.
22. 22. Tsai E, Lee TP. Diagnosis and evaluation of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, including noninvasive biomarkers and transient elastography. Clin Liver Dis 2018; 22:73-92.
23. 23. Xiao G, Zhu S, Xiao X, Yan L, Yang J, Wu G. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology 2017; 66:1486-501.
24. 24. Angulo P, Bugianesi E, Bjornsson ES, Charatcharoenwitthaya P, Mills PR, Barrera F, Haflidadottir S, Day CP, George J. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2013; 145:782-9.
25. 25. Koehler EM, Plompen EP, Schouten JN, Hansen BE, Darwish Murad S, Taimr P, Leebeek FW, Hofman A, Stricker BH, Castera L, Janssen HL. Presence of diabetes mellitus and steatosis is associated with liver stiffness in a general population: The Rotterdam study. Hepatology 2016; 63:138-47.
26. 26. Harman DJ, Ryder SD, James MW, Jelpke M, Ottey DS, Wilkes EA, Card TR, Aithal GP, Guha IN. Direct targeting of risk factors significantly increases the detection of liver cirrhosis in primary care: A crosssectional diagnostic study utilising transient elastography. BMJ Open 2015; 5:e007516.
27. 27. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, Ferraioli G, Friedrich-Rust M, Gilja OH, Goertz RS, Karlas T, de Knegt R, de Ledinghen V, Piscaglia F, Procopet B, Saftoiu A, Sidhu PS, Sporea I, Thiele M. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017. Ultraschall Med 2017; 38:377-94.
28. 28. de Lédinghen V, Wong VW, Vergniol J, Wong GL, Foucher J, Chu SH, Le Bail B, Choi PC, Chermak F, Yiu KK, Merrouche W, Chan HL. Diagnosis of liver fibrosis and cirrhosis using liver stiffness measurement: comparison between M and XL probe of FibroScan®. J Hepatol 2012; 56:833-9.
29. 29. Sporea I, Șirli R, Mare R, Popescu A, Ivașcu SC. Feasibility of Transient Elastography with M and XL probes in real life. Med Ultrason 2016; 18:7-10.
30. 30. Ling W, Lu Q, Quan J, Ma L, Luo Y. Assessment of impact factors on shear wave based liver stiffness measurement. Eur J Radiol 2013; 82:335-41.
31. 31. Ferraioli G, Tinelli C, Lissandrin R. Point shear wave elastography method for assessing liver stiffness. World J Gastroenterol 2014; 20:4787-96.
32. 32. Ma JJ, Ding H, Mao F, Sun HC, Xu C, Wang WP. Assessment of liver fibrosis with elastography point quantification technique in chronic hepatitis B virus patients: A comparison with liver pathological results. J Gastroenterol Hepatol 2014; 29:814-9.
33. 33. Mare R, Sporea I, Lupuşoru R, Şirli R, Popescu A, Danila M, Pienar C. The value of ElastPQ for the evaluation of liver stiffness in patients with B and C chronic hepatopathies. Ultrasonics 2017; 77:144-51.
34. 34. Conti F, Serra C, Vukotic R, Fiorini E, Felicani C, Mazzotta E, D’Errico A, Verucchi G, Lenzi M, Andreone P. Accuracy of elastography point quantification and steatosis influence on assessing liver fibrosis in patients with chronic hepatitis C. Liver Int 2017; 37:187-95.
35. 35. Conti F, Serra C, Vukotic R, Felicani C, Mazzotta E, Gitto S, Vitale G, D’Errico A, Andreone P. Assessment of liver fibrosis with elastography point quantification vs other non-invasive methods. Clin Gastroenterol Hepatol 2019; 17(3):510-7.