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23-12-2010 | Gastroenterology | Article

LSM detects undiagnosed chronic liver disease


Free abstract

MedWire News: Study findings show that liver stiffness measurement (LSM) can detect undiagnosed chronic liver disease in apparently healthy individuals, with the added benefit of a 100% positive predictive value for cirrhosis screening.

"So far, liver biopsy has been the gold standard for the assessment of fibrosis in patients with chronic liver disease," say Dominique Roulot (Avicenne Hospital, Bobigny, France) and co-authors.

"However, in cases of suspicion of non-alcoholic fatty liver disease (NAFLD), liver biopsy is difficult to recommend for apparently healthy patients with normal liver tests, because of its possible complications," they add.

A total of 1190 individuals from the general population, aged 45 years or older, attending for a medical check-up participated in the current study. All patients received LSM, in addition to laboratory tests and medical examinations. Those who scored over 8 kPa on the LSM were referred to a liver unit for further investigations.

Overall, 94 (8.5%) patients had a LSM >8 kPa, including nine patients with a LSM >13 kPa. The researchers note that although LSM values were normal in 4% of patients with perturbed liver tests, these tests came back as normal in 43% of patients with LSM >8 kPa.

NAFLD and alcoholic liver disease (ALD) were diagnosed as the likely causes of chronic liver disease in 52 and 20 patients, respectively. Hepatitis B and C were diagnosed in nine patients, and primary biliary cirrhosis in one patient.

Liver biopsy results confirmed that all of the nine patients with LSM >13 kPa had liver cirrhosis due to ALD or chronic hepatitis B/C. The remaining 18 biopsies showed liver fibrosis in all patients except one who presented with isolated steatosis.

Factors significantly associated with a LSM >8 kPa included being aged 57 years or older, having a body mass index ≥30 kg/m2, elevated waist circumference, diabetes, alanine aminotransferase ≥40 UI/l, and γ-glutamyltranspeptidase ≥45 UI/l.

The researchers say the findings suggest that "a relatively high percentage of liver diseases remain undiagnosed in apparently healthy individuals, and that LSM might contribute to referring these patients to hepatologists."

They conclude in the journal Gut: "If future studies determine that the superior positive predictive value of LSM can be achieved at an acceptable cost, compared with common screening methods, LSM might represent a first-line procedure for the mass screening of liver disease in the general population."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Ingrid Grasmo