Nida Rafiq


Authors: Rafiq N, Sohail S, Naz N, Rasheed B,  Shahzad G


Transient Elastography of Liver Fibrosis in Chronic Hepatitis C patients: Diagnostic Importance


To determine the diagnostic accuracy of Transient Elastography of liver in assessing fibrosis in adult chronic Hepatitis C patients keeping liver biopsy as gold standard.

Subjects and Methods:

This cross-sectional study was conducted at the Radiology department of Civil Hospital Karachi, Pakistan from May 2014 to January 2015. Consecutive adult patients aged 18 to 60 years with presence of HCV RNA in serum according to polymerase chain reaction, and minimum of 6 months duration of known Hepatitis C were included in the study.   All patients underwent transient elastography of liver by a consultant radiologist and the Principal investigator. Ten valid measurements were taken and mean value was classified accordingly (F0-F4). The elastography scores were correlated with METAVIR scores of liver biopsy.  Diagnostic accuracy was determined in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).


Transient elastography correctly identified presence of fibrosis in 190 (95.4%) out of 199 patients with fibrosis and ruled out fibrosis in 63 (88.7%) of 71 patients with normal liver on histopathology. The diagnostic accuracy of transient elastography in determining the presence of fibrosis was:  Sensitivity 95.5%, specificity 87.5%, PPV 95.5% and NPV 88.7%. However, for assessing the stage of fibrosis the sensitivity and specificity respectively were 80% and 95.23% for F1, 79.6% and 96.29% for F2, 88% and 96.61% for F3, and 98% and 99.54% for F4.


Transient elastography has high diagnostic accuracy in determining the presence of fibrosis as well as in assessing late fibrosis and cirrhosis (F3-F4).  However, the sensitivity was comparatively less in identification of early fibrosis (F1-F2) in the studied group of patients.

Word count of Abstract: 273 words

Keywords: Transient Elastography (TE), Fibroscan, METAVIR, Liver Fibrosis, chronic hepatitis


Full Text:



Chen S, Sanchez W, Callstrom M, Gorman B, Lewis J, Sanderson S et al. Assessment of Liver Viscoelasticity by Using Shear Waves Induced by Ultrasound Radiation Force. Radiology. 2013;266(3):964-970.

Friedrich-Rust M, Wunder K, Kriener S, Sotoudeh F, Richter S, Bojunga J et al. Liver Fibrosis in Viral Hepatitis: Noninvasive Assessment with Acoustic Radiation Force Impulse Imaging versus Transient Elastography. Radiology. 2009;252(2):595-604.

Pinzani M, Rombouts K. Liver fibrosis: from the bench to clinical targets. Digestive and Liver Disease. 2004;36(4):231-242.

Messina J, Humphreys I, Flaxman A, Brown A, Cooke G, Pybus O et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology. 2014;61(1):77-87.

Jiwani N, Gul R. A Silent Storm: Hepatitis C in Pakistan. Journal of Pioneering Medical Sciences. 2011;1(3):89-91.

Umer M, Bilal M. Hepatitis C, A Mega Menace: A Pakistani Perspective. Journal of Pioneering Medical Sciences. 2012;2(2):68-72.

Jeong W, Lim H, Lee H, Jo J, Kim Y. Principles and clinical application of ultrasound elastography for diffuse liver disease. Ultrasonography. 2014;33(3):149-160.

Papastergiou V, Tsochatzis E, Burroughs AK. Non-invasive assessment of liver fibrosis. Annals of Gastroenterology. 2012;25(3):218-231.

Braticevici CF, Papacocea R, Tribus L and Badarau A (2011). Can We Replace Liver Biopsy with Non-Invasive Procedures?, Liver Biopsy, Dr Hirokazu Takahashi (Ed.), ISBN: 978- 953-307-644-7, InTech, Available from:

Ashraf S, Ahmed SA, Ahmed J, Ali N. FibroScore for the non-invasive assessment of liver fibrosis in chronic viral hepatitis. J Coll Physicians Surg Pak. 2012;22:84–90.

Lewin M, Poujol-Robert A, Boëlle P, Wendum D, Lasnier E, Viallon M et al. Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology. 2007;46(3):658-665.

Castera L. Non-invasive assessment of liver fibrosis in chronic hepatitis C. Hepatology International. 2011;5(2):625-634.

Boursier J, Zarski J, de Ledinghen V, Rousselet M, Sturm N, Lebail B et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57(3):1182-1191.

Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55:403–408.

Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Filice G, Filice C. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: A pilot study. Hepatology. 2012;56(6):2125-2133.

Zarski J, Sturm N, Guechot J, Paris A, Zafrani E, Asselah T et al. Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: The ANRS HCEP-23 study. Journal of Hepatology. 2012;56(1):55-62.

Scott DLevy M. Liver transient elastography (Fibroscan®): a place in the management algorithms of chronic viral hepatitis. Antiviral Therapy. 2010;15(1):1-11.

Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. Journal of Hepatology. 2008;48(5):835-847.

Ying, H., Lu, L., Jing, D., & Ni, X. (2016). Accuracy of transient elastography in the assessment of chronic hepatitis C-related liver cirrhosis. Clinical & Investigative Medicine, 39(5), E150-E160. Retrieved from

Mobarak L, Nabeel MM, Hassan E, Omran D, Zakaria Z. Real-time elastography as a noninvasive assessment of liver fibrosis in chronic hepatitis C Egyptian patients: a prospective study. Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology. 2016;29(3):358-362. doi:10.20524/aog.2016.0033.

Chon YE, Choi EH, Song KJ, Park JY, Kim do Y, Han KH, Chon CY, Ahn SH and Kim SU: Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: A meta analysis. PLoS One 7: e44930, 2012.

Chen J, Talwalker JA, Yin M, Glaser KJ, Sanderseon SO, Ehman RL. Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology 2011; 259:749-56.

Wang Y, Ganger DR, Levitsky J, Sternick LA, McCarthy RJ, Chen ZE, et al. Assessment of chronic hepatitis and fibrosis: Comparison of MR elastography and diffusion-weighted imaging.Am J Roentgenol 2011; 196:553-61.


  • There are currently no refbacks.

© Copyright PJR 2008-