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Evaluation and Staging of Liver Fibrosis

Evaluation and Staging of Liver Fibrosis. ECHO January 20, 2017. Disclosure Statement. I have no potential conflicts of interests to report. PATHOGENESIS OF LIVER FIBROSIS. Normal Hepatic SInusoid. Retinoid droplets. Fenestrae. Hepatic stellate cell. Space of Disse.

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Evaluation and Staging of Liver Fibrosis

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  1. Evaluation and Staging of Liver Fibrosis ECHO January 20, 2017

  2. Disclosure Statement I have no potential conflicts of interests to report

  3. PATHOGENESIS OF LIVER FIBROSIS Normal Hepatic SInusoid Retinoid droplets Fenestrae Hepatic stellate cell Space of Disse Sinusoidal endothelial cell Hepatocytes

  4. PATHOGENESIS OF LIVER FIBROSIS Alterations in Microvasculature in Cirrhosis • Activation of stellate cells • Collagen deposition in space of Disse • Constriction of sinusoids • Defenestration of sinusoids

  5. Indications for Liver biopsy • Discordant results • Concurrent forms of liver disease • Other indirect testing is unavailable

  6. percutaneous transjugular Approaches

  7. Liver Biopsy

  8. Inflammation

  9. Taken from Marion Peters, MD talk from April 2013

  10. Non-invasive testing

  11. AST to plt ratio index (APRI) • Method to predict severe fibrosis or cirrhosis • ≥0.7 sens 77% and spec 72% of detecting greater or equal to F2 • 1.0 sens 61% to 76% and spec 64 to 72% for F3/F4 • 2.0 sens 46% and spec 91% for cirrhosis • Recommended to use in combo with other noninvasive markers

  12. FIB-4 • Developed for patients with hcv/hiv coninfection • <1.45 sens 74% and spec 80% for excluding significant fibrosis • >3.25 spec 98% in confirming cirrhosis • In between recom additional method to predict liver fibrosis

  13. Value less <0.2, the neg PV to exclude fibrosis is 98% Value ≥ 0.8 PPV for predicting cirrhosis is 62% Recommend if score >0.2 use adjunct marker of fibrosis to predict cirrhosis Hepascore(Fibroscore)

  14. FibroSure/FibroTest-Acti • Identical tests • Algorithm: age, gender, alpha-2-macroglobulin, haptoglobulin, GGT, apolipoprotein A1, TB, ALT • Neg PV <0.31 for absence of clinical significant fibrosis (F2 and above) 91% • PPV for SF >0.48 61% and at >0.72 was 76%

  15. Contraindications • Gilbert’s disease • Acute hemolysis • Extrahepatic cholestasis • Post transplantation • Renal insufficiency

  16. Liver Fibrosis, FIBRO-ACTI Pan • Good at excluding or confirming cirrhosis but is indeterminate in the middle ranges and adjunct marker of fibrosis would be needed in those situations.

  17. FIBROSpect II • Algorithm using: • Hyaluronic acid • Tissue inhibitor of a metalloproteinase-1 (TIMP-1) • Alpha-2-macroglobulin • >0.42 = F2-F4: sensitivity 80.6% and specificity 71.4% • Good for determining presence of absence of significant fibrosis but not intermediate

  18. Transient Elastography and shear wave Elastography • Transient Elastography (Fibroscan) • Shear wave elastography (ShearWave Elastography)

  19. Vibration is transmitted towards hepatic tissue, the vibrations are followed by pulse echo and their velocities are measured with correlates with liver stiffness • Felt to be very good for estimating F3 and higher

  20. Obesity • Ascites • Hepatic inflammation (acute hepatitis) • Food intake • congestion

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