Evaluation of the Role of Liver and Splenic Transient Elastography in Chronic Hepatitis C Related Fibrosis

Background: Liver fibrosis is common consequence of chronic HCV infection. Noninvasive assessment is still evolving.

Aim: Evaluate role of liver stiffness measurement (LSM), spleen stiffness measurement (SSM) and their combination (CLSM) using FibroScanTM in assessment of liver fibrosis in CHC patients.

Methods: 420 CHC patients and 40 healthy controls included.Liver, renal function tests, CBC and INR done. Liver biopsy done for all of them except if contraindicated. Fibrosis was graded by Metavir score. Abdominal ultrasonography was done before the FibroScanTM and the liver biopsy. LSM, SSM, and CLSM had doneusing FibroScanTM in the supine position after 6-8 hours fasting.The patient were classified into mild fibrosis (F1-F2, n=248) and significant fibrosis (F3-F4, n=172) group.

Results: There were significant difference (p=0.001) between patients with mild fibrosis (F1-F2) versus patients with significant fibrosis (F3-F4) regarding; the age (35.06 ± 8.63 vs 43.71 ± 7.97 years), serum bilirubin (0.73 ± 0.25 vs 1.26 ± 0.73 mg/dL), serum albumin (4.42 ± 0.32 vs 3.84 ± 0.51 g/dL), platelets (206.81 ±50.55 vs 140.50 ± 53.77×103/μL), platelets spleen ratio (1762.20± 521.26 vs. 1014.64 ± 470.27). Furthermore a significant difference (p=0.001) detected with LSM (6.57 ± 2.62 vs. 23.04± 12.15 kPa), SSM (25.56 ± 5.36 vs 46.19 ± 16.29 kPa), and CLSS (32.13 ± 7.15 vs. 69.23 ± 25.43 kPa) respectively. Thecutoff values of significant fibrosis were 9.15 kPa by LSM (94.8% Sensitivity, 88.3% Specificity, 84.9% PPV, and 96.1.8% NPV), 27.5 kPa by SSM (94.8% Sensitivity, 70.2% specificity,68.8% PPV, and 95.1% NPV) and 40.85 kPa by CLSM (92.4% Sensitivity, 91.1% specificity, 87.8% PPV, and 94.6% NPV).

Conclusion: The measurement of liver, spleen stiffness by FibroScanTM or their combination is convenient for liver fibrosis assessment.