Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B
The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and tra...
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| Published in | Journal of viral hepatitis Vol. 16; no. 1; pp. 36 - 44 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.01.2009
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| Subjects | |
| Online Access | Get full text |
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| Abstract | The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty‐one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1–4), bridging fibrosis (F0–2 vs F3–4) and liver cirrhosis (F0–3 vs F4) was 0.80 (95% CI: 0.68–0.92), 0.87 (95% CI: 0.82–0.93) and 0.93 (95% CI: 0.89–0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis. |
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| AbstractList | The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1-4), bridging fibrosis (F0-2 vs F3-4) and liver cirrhosis (F0-3 vs F4) was 0.80 (95% CI: 0.68-0.92), 0.87 (95% CI: 0.82-0.93) and 0.93 (95% CI: 0.89-0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis.The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1-4), bridging fibrosis (F0-2 vs F3-4) and liver cirrhosis (F0-3 vs F4) was 0.80 (95% CI: 0.68-0.92), 0.87 (95% CI: 0.82-0.93) and 0.93 (95% CI: 0.89-0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis. The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1-4), bridging fibrosis (F0-2 vs F3-4) and liver cirrhosis (F0-3 vs F4) was 0.80 (95% CI: 0.68-0.92), 0.87 (95% CI: 0.82-0.93) and 0.93 (95% CI: 0.89-0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis. The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1-4), bridging fibrosis (F0-2 vs F3-4) and liver cirrhosis (F0-3 vs F4) was 0.80 (95% CI: 0.68-0.92), 0.87 (95% CI: 0.82-0.93) and 0.93 (95% CI: 0.89-0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4kPa (98% sensitivity), 9.0kPa (maximum sum of sensitivity and specificity), 13.4kPa (94% specificity) and 13.4kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis. The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty‐one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1–4), bridging fibrosis (F0–2 vs F3–4) and liver cirrhosis (F0–3 vs F4) was 0.80 (95% CI: 0.68–0.92), 0.87 (95% CI: 0.82–0.93) and 0.93 (95% CI: 0.89–0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis. |
| Author | Choi, P. C.-L. Chan, F. K.-L. Chim, A. M.-L. Chan, A. W.-H. Chan, H. L.-Y. Sung, J. J.-Y. Wong, G. L.-H. Wong, V. W.-S. Yiu, K. K.-L. |
| Author_xml | – sequence: 1 givenname: H. L.-Y. surname: Chan fullname: Chan, H. L.-Y. organization: Institute of Digestive Disease – sequence: 2 givenname: G. L.-H. surname: Wong fullname: Wong, G. L.-H. organization: Institute of Digestive Disease – sequence: 3 givenname: P. C.-L. surname: Choi fullname: Choi, P. C.-L. organization: Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China – sequence: 4 givenname: A. W.-H. surname: Chan fullname: Chan, A. W.-H. organization: Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China – sequence: 5 givenname: A. M.-L. surname: Chim fullname: Chim, A. M.-L. organization: Institute of Digestive Disease – sequence: 6 givenname: K. K.-L. surname: Yiu fullname: Yiu, K. K.-L. organization: Institute of Digestive Disease – sequence: 7 givenname: F. K.-L. surname: Chan fullname: Chan, F. K.-L. organization: Institute of Digestive Disease – sequence: 8 givenname: J. J.-Y. surname: Sung fullname: Sung, J. J.-Y. organization: Institute of Digestive Disease – sequence: 9 givenname: V. W.-S. surname: Wong fullname: Wong, V. W.-S. organization: Institute of Digestive Disease |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/18673426$$D View this record in MEDLINE/PubMed |
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| References | Marcellin P, De Ledinghen B, Dhumeaux D et al. Non-invasive assessment of liver fibrosis in chronic hepatitis B using Fibroscan. Hepatology 2005; 42 (Suppl. 1): 715A-716A. Sandrin L, Fourquet B, Hasquenoph JM et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29: 1705-1713. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007; 45: 507-539. Sagir A, Erhardt A, Schmitt M et al. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008; 47: 592-595. Chan HL, Tse CH, Mo F et al. High viral load and hepatitis B virus subgenotype ce are associated with increased risk of hepatocellular carcinoma. J Clin Oncol 2008; 26: 177-182. Chan HL, Chui AK, Lau WY et al. Factors associated with viral breakthrough in lamivudine monoprophylaxis of hepatitis B virus recurrence after liver transplantation. J Med Virol 2002; 68: 182-187. Hui AY, Chan HL, Wong VW et al. Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model. Am J Gastroenterol 2005; 100: 616-623. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344: 495-500. Foucher J, Chanteloup E, Vergniol J et al. Diagnosis of cirrhosis by transient elastography (Fibroscan): a prospective study. Gut 2006; 55: 403-408. Talwalkar JA, Kurtz DM, Schoenleber SJ et al. Ultrasound-based treatment transient elastography for the detection of hepatic fibrosis: systemic review and meta-analysis. Clin Gastroenterol Hepatol 2007; 5: 1214-1220. Poynard T, Zoulim F, Ratziu V et al. Longitudinal assessment of histology surrogate markers (FibroTest-ActiTest) during lamivudine therapy in patients with chronic hepatitis B infection. Am J Gastroenterol 2005; 100: 1970-1980. Castera L, Negre I, Samii K et al. Pain experienced during percutaneous liver biopsy. Hepatology 1999; 30: 1529-1530. Afdhal NH, Curry M. Technology evaluation: a critical step in the clinical utilization of novel diagnostic tests for liver fibrosis. J Hepatol 2007; 46: 543-545. Bedossa P, Dargère D, Paradise V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003; 38: 1449-1457. Chen CJ, Yang HI, Su J et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006; 295: 65-73. Sebastiani G, Vario A, Guido M, Alberti A. Sequential algorithms combining non-invasive markers and biopsy for the assessment of liver fibrosis in chronic hepatitis B. World J Gastroenterol 2007; 13: 525-531. Arena U, Vizzutti F, Corti G et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology 2008; 47: 380-384. Coco B, Oliveri F, Maina AM et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat 2007; 14: 360-369. Liaw YF, Leung N, Guan R et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2005 update. Liver Int 2005; 25: 472-489. Wong GL, Wong VW, Choi PC et al. Assessment of fibrosis by transient elastography compared with liver biopsy and morphometry in chronic liver diseases. Clin Gastroenterol Hepatol 2008, Epub ahead of print. Bedossa P, Poynard T. An algorithm for grading of activity in chronic hepatitis C. Hepatology 1996; 24: 289-293. Poon TC, Hui AY, Chan HL et al. Prediction of liver fibrosis and cirrhosis in chronic hepatitis B infection by serum proteomic fingerprinting - a pilot study. Clin Chem 2005; 51: 328-335. Fraquelli M, Rigamonti C, Casazza G et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007; 56: 968-973. Ganne-Carrié N, Ziol M, De Ledinghen V et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatology 2006; 44: 1511-1517. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a non-parametric approach. Biometrics 1988; 44: 837-845. Liaw YF, Sung JJ, Chow WC et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004; 351: 1521-1531. 2001; 344 2004; 351 2005; 100 2006; 44 2006; 55 2002; 68 2006; 295 2008; 47 2005; 51 2008; 26 2008 1988; 44 2005; 42 2003; 38 1999; 30 2007; 5 2003; 29 1996; 24 2007; 45 2007; 56 2007; 46 2007; 13 2007; 14 2005; 25 e_1_2_7_5_2 e_1_2_7_4_2 e_1_2_7_3_2 e_1_2_7_2_2 e_1_2_7_9_2 e_1_2_7_8_2 e_1_2_7_7_2 e_1_2_7_6_2 e_1_2_7_19_2 e_1_2_7_18_2 e_1_2_7_17_2 e_1_2_7_16_2 e_1_2_7_15_2 e_1_2_7_14_2 e_1_2_7_13_2 e_1_2_7_11_2 e_1_2_7_10_2 e_1_2_7_26_2 e_1_2_7_27_2 Marcellin P (e_1_2_7_12_2) 2005; 42 e_1_2_7_25_2 e_1_2_7_24_2 e_1_2_7_23_2 e_1_2_7_22_2 e_1_2_7_21_2 e_1_2_7_20_2 |
| References_xml | – reference: Ganne-Carrié N, Ziol M, De Ledinghen V et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatology 2006; 44: 1511-1517. – reference: Talwalkar JA, Kurtz DM, Schoenleber SJ et al. Ultrasound-based treatment transient elastography for the detection of hepatic fibrosis: systemic review and meta-analysis. Clin Gastroenterol Hepatol 2007; 5: 1214-1220. – reference: Arena U, Vizzutti F, Corti G et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology 2008; 47: 380-384. – reference: Sagir A, Erhardt A, Schmitt M et al. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008; 47: 592-595. – reference: Chan HL, Chui AK, Lau WY et al. Factors associated with viral breakthrough in lamivudine monoprophylaxis of hepatitis B virus recurrence after liver transplantation. J Med Virol 2002; 68: 182-187. – reference: Afdhal NH, Curry M. Technology evaluation: a critical step in the clinical utilization of novel diagnostic tests for liver fibrosis. J Hepatol 2007; 46: 543-545. – reference: Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007; 45: 507-539. – reference: Castera L, Negre I, Samii K et al. Pain experienced during percutaneous liver biopsy. Hepatology 1999; 30: 1529-1530. – reference: Sebastiani G, Vario A, Guido M, Alberti A. Sequential algorithms combining non-invasive markers and biopsy for the assessment of liver fibrosis in chronic hepatitis B. World J Gastroenterol 2007; 13: 525-531. – reference: Sandrin L, Fourquet B, Hasquenoph JM et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29: 1705-1713. – reference: Hui AY, Chan HL, Wong VW et al. Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model. Am J Gastroenterol 2005; 100: 616-623. – reference: Liaw YF, Sung JJ, Chow WC et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004; 351: 1521-1531. – reference: Wong GL, Wong VW, Choi PC et al. Assessment of fibrosis by transient elastography compared with liver biopsy and morphometry in chronic liver diseases. Clin Gastroenterol Hepatol 2008, Epub ahead of print. – reference: Chen CJ, Yang HI, Su J et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006; 295: 65-73. – reference: DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a non-parametric approach. Biometrics 1988; 44: 837-845. – reference: Bedossa P, Dargère D, Paradise V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003; 38: 1449-1457. – reference: Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344: 495-500. – reference: Poynard T, Zoulim F, Ratziu V et al. Longitudinal assessment of histology surrogate markers (FibroTest-ActiTest) during lamivudine therapy in patients with chronic hepatitis B infection. Am J Gastroenterol 2005; 100: 1970-1980. – reference: Marcellin P, De Ledinghen B, Dhumeaux D et al. Non-invasive assessment of liver fibrosis in chronic hepatitis B using Fibroscan. Hepatology 2005; 42 (Suppl. 1): 715A-716A. – reference: Coco B, Oliveri F, Maina AM et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat 2007; 14: 360-369. – reference: Poon TC, Hui AY, Chan HL et al. Prediction of liver fibrosis and cirrhosis in chronic hepatitis B infection by serum proteomic fingerprinting - a pilot study. Clin Chem 2005; 51: 328-335. – reference: Chan HL, Tse CH, Mo F et al. High viral load and hepatitis B virus subgenotype ce are associated with increased risk of hepatocellular carcinoma. J Clin Oncol 2008; 26: 177-182. – reference: Fraquelli M, Rigamonti C, Casazza G et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007; 56: 968-973. – reference: Liaw YF, Leung N, Guan R et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2005 update. Liver Int 2005; 25: 472-489. – reference: Foucher J, Chanteloup E, Vergniol J et al. Diagnosis of cirrhosis by transient elastography (Fibroscan): a prospective study. Gut 2006; 55: 403-408. – reference: Bedossa P, Poynard T. An algorithm for grading of activity in chronic hepatitis C. Hepatology 1996; 24: 289-293. – volume: 44 start-page: 837 year: 1988 end-page: 845 article-title: Comparing the areas under two or more correlated receiver operating characteristic curves: a non‐parametric approach publication-title: Biometrics – volume: 51 start-page: 328 year: 2005 end-page: 335 article-title: Prediction of liver fibrosis and cirrhosis in chronic hepatitis B infection by serum proteomic fingerprinting – a pilot study publication-title: Clin Chem – volume: 100 start-page: 1970 year: 2005 end-page: 1980 article-title: Longitudinal assessment of histology surrogate markers (FibroTest–ActiTest) during lamivudine therapy in patients with chronic hepatitis B infection publication-title: Am J Gastroenterol – volume: 47 start-page: 380 year: 2008 end-page: 384 article-title: Acute viral hepatitis increases liver stiffness values measured by transient elastography publication-title: Hepatology – volume: 24 start-page: 289 year: 1996 end-page: 293 article-title: An algorithm for grading of activity in chronic hepatitis C publication-title: Hepatology – volume: 46 start-page: 543 year: 2007 end-page: 545 article-title: Technology evaluation: a critical step in the clinical utilization of novel diagnostic tests for liver fibrosis publication-title: J Hepatol – volume: 42 start-page: 715A issue: Suppl. 1 year: 2005 end-page: 716A article-title: Non‐invasive assessment of liver fibrosis in chronic hepatitis B using Fibroscan publication-title: Hepatology – volume: 45 start-page: 507 year: 2007 end-page: 539 article-title: Chronic hepatitis B publication-title: Hepatology – volume: 55 start-page: 403 year: 2006 end-page: 408 article-title: Diagnosis of cirrhosis by transient elastography (Fibroscan): a prospective study publication-title: Gut – volume: 30 start-page: 1529 year: 1999 end-page: 1530 article-title: Pain experienced during percutaneous liver biopsy publication-title: Hepatology – volume: 26 start-page: 177 year: 2008 end-page: 182 article-title: High viral load and hepatitis B virus subgenotype ce are associated with increased risk of hepatocellular carcinoma publication-title: J Clin Oncol – year: 2008 article-title: Assessment of fibrosis by transient elastography compared with liver biopsy and morphometry in chronic liver diseases publication-title: Clin Gastroenterol Hepatol – volume: 14 start-page: 360 year: 2007 end-page: 369 article-title: Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases publication-title: J Viral Hepat – volume: 38 start-page: 1449 year: 2003 end-page: 1457 article-title: Sampling variability of liver fibrosis in chronic hepatitis C publication-title: Hepatology – volume: 56 start-page: 968 year: 2007 end-page: 973 article-title: Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease publication-title: Gut – volume: 44 start-page: 1511 year: 2006 end-page: 1517 article-title: 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| Snippet | The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to... |
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| SubjectTerms | Adult Alanine Transaminase - blood Elasticity Imaging Techniques Female hepatitis B virus Hepatitis B, Chronic - pathology histology Humans Liver - pathology liver biopsy liver cirrhosis Liver Cirrhosis - diagnosis Male Middle Aged Retrospective Studies ROC Curve Severity of Illness Index |
| Title | Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B |
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