Transient elastography in chronic hepatitis B: An Asian perspective

doi:10.3748/wjg.v16.i41.5173

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Nov 7, 2010; 16(41): 5173-5180
Published online Nov 7, 2010. doi: 10.3748/wjg.v16.i41.5173

Table 1 Normal liver stiffness values of transient elastography

	Asian study		European study
	*Kim et al[14]*	*Fung et al[19]*	*Corpechot et al[15]*	*Roulot et al[13]*	*Sirli et al[16]*	*Colombo et al[17]*	*Colombo et al[18]*
Type	Full article	Full article	Letter	Full article	Full article	Abstract	Abstract
No. of subjects	69	28	71	429	144	327	746
Population	Liver and kidney donors	Liver donors	Healthy volunteers	Medical check-up	Healthy volunteers	Blood donors	Blood donors
Liver stiffness (kPa)	4.6 (mean)	4.6 (median)	4.8 (median)	5.5 (mean)	4.8 (mean)	4.9 (mean)	4.4 (median)
95th percentile (kPa)	4.7	-	-	8.6	-	7.8	6.7
BMI (kg/m²)	22.6 (mean)	-	22.5 (median)	25.8 (mean)	-	-	-
Effects on TE
Age	No	-	No	No	No	No	No
Gender	M = F	-	M > F	M > F	M > F	M = F	M > F
High BMI	No	-	No	Increased TE values	No	Increased TE values	No
Metabolic syndrome	-	-	-	Increased TE values	-	-	-
Fatty liver	-	-	-	-	-	Increased TE values	Increased TE values

BMI: Body mass index; TE: Transient elastography.

Table 2 Failure rate of transient elastography measurement

	Asian study				European study
	*Kim et al[14]*	*Chan et al[24]*	*Masuzaki et al[25]*	*Wong et al[26]*	*Ziol et al[2]*	*Marcellin et al[10]*	*Maimone et al[27]*
Etiology	HBV	HBV	HCV	HBV	HCV	HBV	HBV
Total patients (n)	74	1136	876	487	327	202	230
Excluded patients (n)	5	30	10	34	76	29	10
Excluded patients due to TE failure (n)	1	30	10	17	23	14	10
TE failure rate (%)	1.4	2.6	1.1	3.5	7	6.9	4.3
Enrolled patients (n)	69	1106	866	453	251	173	220
Age (yr)	38.9 (mean)	47 (mean)	66.2 (mean)	37 (median)	47.5 (mean)	40.1 (mean)	45.2 (mean)
Male, n (%)	35 (50.7)	-	398 (46.0)	270 (60.0)	155 (61.8)	115 (66.5)	99 (45.0)
BMI (kg/m²)	22.6 (mean)	-	22.5 (mean)	22.4 (median)	23.9 (mean)	24.5 (mean)	-
Failure criteria
Success rate	< 60%	< 60%	< 60%	< 60%	< 60%	< 50%	< 60%
The number of VMs	< 10 VMs	< 10 VMs	< 8 VMs	< 10 VMs	< 10 VMs	< 7 VMs	< 10 VMs

HBV: Hepatitis B virus; HCV: Hepatitis C virus; TE: Transient elastography; BMI: Body mass index; VM: Valid measurement.

Table 3 Characteristics of studies evaluating the performance of transient elastography for the diagnosis of liver fibrosis in patients with chronic hepatitis B

	Type	Country	Total sample (n)	Samplesize (n)	Excluded due to failure		Age (yr)	Male (%)	BMI (kg/m²)	LB length (mm)	Staging
	Type	Country	Total sample (n)	Samplesize (n)	TE (reason)	LB (reason)		Male (%)	BMI (kg/m²)	LB length (mm)	Staging
Kim et al[4]	Original	Korea	194	103	0 (SR < 60%, < 10 VMs)	4 (< 10 mm, < 10 PTs)	Age (yr)	40.0	80.2	23.8	16.7	METAVIR
Chan et al[11]	Original	China	186	161	1 (SR < 60%, < 10 VMs)	22 (< 15 mm, < 6 PTs)	45.0	76.0	24.0	19.0	METAVIR
Kim et al[36]	Original	Korea	130	130	0 (SR < 60%, < 10 VMs)	0 (< 10 mm, < 6 PTs)	42.5	79.2	25.3	14.5	METAVIR
Marcellin et al[10]	Original	France	202	173	14 (SR < 50%, < 7 VMs)	15 (< 10 PTs)	40.1	66.5	24.5	16.6	METAVIR
Chang et al[40]	Abstract	Singapore	35	33	2 (obesity, narrow ICS)	0 (-)	43.0	-	25.6	-	Ishak
Tanwandee et al[41]	Abstract	Thailand	104	104	0 (-)	0 (-)	44.0	63.0	23.6	-	METAVIR
Choi et al[42]	Abstract	Korea	48	48	0 (-)	0 (-)	41.7	58.3	23.3	-	-
Chang et al[43]	Abstract	Singapore	88	84	3 (-)	1 (-)	49.0	71.6	-	-	-

TE: Transient elastography; VM: Valid measurement; LB: Liver biopsy; BMI: Body mass index; SR: Success rate; PT: Portal tract; ICS: Intercostal space.

Table 4 Histologic distribution and the performance of transient elastography for the diagnosis of liver fibrosis in patients with chronic hepatitis B

	n (%)					METAVIR and other scoring system (≥ F2/F4)
	F0	F1	F2	F3	F4	AUROC	Cutoff (kPa)	Se (%)	Sp (%)	PPV (%)	NPV (%)	LR (+)	LR (-)
Kim et al[4]	0	9 (9.9)	33 (36.3)	10 (11.0)	39 (42.9)	-/0.803	-/9.7	-/82	-/62	-/63	-/76	-/4.97	-/0.13
Chan et al[11]	10 (6.2)	27 (16.8)	47 (29.2)	37 (23.0)	40 (24.8)	-/0.93	-/9	-/98	-/75	-/57	-/98	-/1	-/0.01
Kim et al[36]	0	10 (7.7)	37 (28.5)	16 (12.3)	67 (51.5)	-/0.84	-/10.1	-/76	-/81	-/76.1	-/80.9	-/-	-/-
Marcellin et al[10]	16 (9.2)	70 (40.5)	44 (25.4)	29 (16.8)	14 (8.1)	0.81/0.93	7.2/11	70/98	83/75	80/57	73/98	4/1	-/0.01
Chang et al[40]	7 (20.0)	16 (45.7)	F2-3 (5, 14.3)		7 (20.0)	-/-	11.8/-	90/-	78/-	-/-	-/-	-/-	-/-
Tanwandee et al[41]	-	-	-	-	-	0.757/-	6.9/7.3	70/93	79/61	82/31	66/98	-/-	-/-
Choi et al[42]	-	-	-	-	-	0.88/0.86	7.7/10.4	88/79	88/83	-/-	-/-	-/-	-/-
Chang et al[43]	-14.8	-30.7	-14.8	-21.6	-17.1	0.801/-	8.8/-	-/-	-/-	-/-	-/-	-/-	-/-

AUROC: Area under the receive operating characteristic curve; Se: Sensitivity, Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; LR: Likelihood ratio.

Citation: Kim SU, Han KH, Ahn SH. Transient elastography in chronic hepatitis B: An Asian perspective. World J Gastroenterol 2010; 16(41): 5173-5180
URL: https://www.wjgnet.com/1007-9327/full/v16/i41/5173.htm
DOI: https://dx.doi.org/10.3748/wjg.v16.i41.5173