Unified interpretation of liver stiffness measurement by M and XL probes in non-alcoholic fatty liver disease

Gut - Tập 68 Số 11 - Trang 2057-2064 - 2019
Vincent Wai‐Sun Wong1, Marie Irlès2, Grace Lai‐Hung Wong1,3, Sarah Shili2, Anthony W.H. Chan4, Wassil Merrouche2, Sally She‐Ting Shu1,3, Juliette Foucher2, Brigitte Le Bail5,6, Wah‐Kheong Chan7, Henry Lik-Yuen Chan1,3, Victor de Lédinghen2,5
1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
2Centre d'Investigation de la Fibrose Hépatique, Bordeaux University Hospital, Pessac, France
3State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
4Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, New Territories, Hong Kong
5INSERM U1053, Bordeaux University, Bordeaux, France
6Pathology Unit, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
7Department of Medicine, Gastroenterology and Hepatology Unit, University of Malaya, Kuala Lumpur, Malaysia

Tóm tắt

ObjectiveThe latest model of vibration-controlled transient elastography (VCTE) automatically selects M or XL probe according to patients’ body built. We aim to test the application of a unified interpretation of VCTE results with probes appropriate for the body mass index (BMI) and hypothesise that this approach is not affected by hepatic steatosis.DesignWe prospectively recruited 496 patients with non-alcoholic fatty liver disease who underwent VCTE by both M and XL probes within 1 week before liver biopsy.Results391 (78.8%) and 433 (87.3%) patients had reliable liver stiffness measurement (LSM) (10 successful acquisitions and IQR:median ratio ≤0.30) by M and XL probes, respectively (p<0.001). The area under the receiver operating characteristic curves was similar between the two probes (0.75–0.88 for F2–4, 0.83–0.91 for F4). When used in the same patient, LSM by XL probe was lower than that by M probe (mean difference 2.3 kPa). In contrast, patients with BMI ≥30 kg/m2 had higher LSM regardless of the probe used. When M and XL probes were used in patients with BMI <30 and ≥30 kg/m2, respectively, they yielded nearly identical median LSM at each fibrosis stage and similar diagnostic performance. Severe steatosis did not increase LSM or the rate of false-positive diagnosis by XL probe.ConclusionHigh BMI but not severe steatosis increases LSM. The same LSM cut-offs can be used without further adjustment for steatosis when M and XL probes are used according to the appropriate BMI.

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Gut

Tập 68 Số 11

2057-2064

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