SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SOGNI
Coup de coeur :
 
 
Hepatology
  2015/10  
 
  2015 Oct;62(4):1101-10  
  doi: 10.1002/hep.27844  
 
  The severity of steatosis influences liver stiffness measurement in patients with nonalcoholic fatty liver disease  
 
  Petta S, Maida M, Macaluso FS, Di Marco V, Cammà C, Cabibi D, Craxì A  
  http://onlinelibrary.wiley.com/doi/10.1002/hep.27844/abstract  
 
 

In nonalcoholic fatty liver disease, the influence of severity of steatosis on liver stiffness measurement (LSM) is poorly studied and still debated. We assessed the impact of steatosis severity and its ultrasonographic (US) sign, severe bright liver echo pattern, on LSM values and on transient elastography accuracy for the diagnosis of liver fibrosis in a cohort of consecutive patients with nonalcoholic fatty liver disease. Patients (n = 253) were assessed by clinical, US, and histological (Kleiner score) features. Transient elastography was performed using the M probe. Among patients with low amounts of fibrosis (F0-F1 and F0-F2), median LSM values, expressed in kilopascals, were significantly higher in subjects with severe steatosis (≥66% at liver biopsy) compared to those without (F0-F1 6.9 versus 5.8, P = 0.04; F0-F2 7.4 versus 6.0, P  = 0.001) as well as in patients with severe bright liver echo pattern on US compared to their counterparts (F0-F1 7.3 versus 5.6, P = 0.001; F0-F2 7.6 versus 6.0, P  < 0.001). In subjects without significant fibrosis (F0-F1) and without severe fibrosis (F0-F2), a higher rate of false-positive LSM results was observed in patients with steatosis ≥66% compared to those without (F0-F1 23.6% versus 14.9%, F0-F2 33.3% versus 13.2%) and in patients with severe bright liver echo pattern on US (F0-F1 22.2% versus 15.4%, F0-F2 28.8% versus 15.6%) compared to their counterparts.

Conclusions
In patients with nonalcoholic fatty liver disease, the presence of severe steatosis, detected by histology or by US, should always be taken into account in order to avoid overestimations of liver fibrosis assessed by transient elastography.

 
Question posée
 
La stéatose influence-t-elle la valeur d’élastographie ?
 
Question posée
 
Oui.
 
Commentaires

Une nouvelle étude sur ce sujet débattu. Cette étude utilise une sonde M. Elle retrouve des valeurs d’élastographie plus élevée chez les patients avec une fibrose minime à modérée en cas de stéatose importante à l’histologie ou à l’échographie. En pratique, c’est un élément à prendre en compte.

 
www.snfge.org