Castera élastométrie:pbh du16

1. Laurent CASTERALaurent CASTERA
Service d’Hépatologie,Service d’Hépatologie,
Hôpital Beaujon, Université Paris VIIHôpital Beaujon, Université Paris VII
Alternatives à la PBH :Alternatives à la PBH :
mesure de lmesure de l’’élasticitéélasticité
hépatiquehépatique
DU Hépatites Virales Cytokines et AntivirauxDU Hépatites Virales Cytokines et Antiviraux
Pitie, Paris, 12 Janvier 2016Pitie, Paris, 12 Janvier 2016

2. Méthodes non invasives disponibles
2 approches différentes mais complémentaires
Biomarqueurs
Approche « biologique »
Castera & Pinzani. Lancet 2010; 375: 419-20
Approche « physique »
Elasticité hépatique

3. Mesure de l’élasticité hépatiqueMesure de l’élasticité hépatique
ARFI SSIFibroScan

4. Non-invasive
tests for evaluation
of liver disease
Severity and
prognosis
Tests non invasifs:Tests non invasifs:
le temps des recommandationsle temps des recommandations
Chairmen:
Laurent Castera & Henry Lik Yuen Chan (EASL)
Marco Arrese (ALEH).
Panel members:
Nezam Afdhal (US), Pierre Bedossa (Fr),EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

5. Recommandations:Recommandations:
grading systemgrading system

6. PrincipePrincipe

7. Elastométrie (FibroScanElastométrie (FibroScan))
= 100
x
Biopsie foie
2.5 cm
Volume exploré
4 cm
1 cm ∅

8. %
-5
0
5
Depth(mm)
Time (ms)
0 20 40 60
10
20
30
40
50
60
E = 3.0 kPa
F0
Sandrin et al. UMB 2003; 12: 1705-13
VS = 1.0 m/s
E = 27.0 kPa
F4
VS = 3.0 m/s
PrincipePrincipe
“Plus le foie est dur, plus l’onde se propage vite”Plus le foie est dur, plus l’onde se propage vite”

9. Mesure de l’élasticité hépatique
75 kPa3
15 655.5
Normale
Roulot et al. J Hepatol 2008; 48: 606-13

10. FibroScan en pratiqueFibroScan en pratique
Indolore
Rapide (5 min)
Lit du malade/
consultation
Résultats immédiats
Formation courte
(100 exam.)

11. PrécautionsPrécautions
méthodologiquesméthodologiques

12. La biopsie hépatique:
un « Gold standard » imparfait

13. PBH: un « gold » standard imparfait
Mehta et al. J Hepatol 2009; 50: 36-41.Bedossa & Carrat. J Hepatol 2009; 50: 1-3.
0.99

14. « Spectrum bias »
Ransohoff & Feistein. N Engl J Med 1978; 299: 926-230
Problems of Spectrum and Bias in Evaluating
the Efficacy of Diagnostic Tests
David F. Ransohoff, M.D., and Alvan R. Feinstein, M.D.

15. Poynard et al. Clin Chem 2007; 53: 1615-22.
AUROC standardisation
according to fibrosis prevalence

16. AUROC standardisation
according to fibrosis prevalence
Poynard et al. Clin Chem 2007; 53: 1615-22.
DANA = (2+3+4)/3 – (0+1)/2 = 2,5
F0 20%; F1 20% ; F2 20%; F3 20%; F4 20%
ANA
DANA = (F2+F3+F4)/3 – (F0+F1)/2
DANA = Difference between Advanced
& Non Advanced fibrosis

17. AUROC standardisation
according to fibrosis prevalence
Poynard et al. Clin Chem 2007; 53: 1615-22.
DANA = (2+3+4)/3 – (0+1)/2 = 2,5
F0 20%; F1 20% ; F2 20%; F3 20%; F4 20%
ANA
DANA = (F2+F3+F4)/3 – (F0+F1)/2

18. AUROC standardisation
according to fibrosis prevalence
Poynard et al. Clin Chem 2007; 53: 1615-22.
DANA = (2+3+4)/3 – (0+1)/2 = 2,5
F0 20%; F1 50% ; F2 50%; F3 20%; F4 20%
ANA
DANA = (2+0+0)/1 – (0+1)/1 = 1

19. AUROC standardisation
according to fibrosis prevalence
Poynard et al. Clin Chem 2007; 53: 1615-22.
DANA = (2+3+4)/3 – (0+1)/2 = 2,5
F0 50%; F1 50% ; F2 50%; F3 20%; F4 50%
ANA
DANA = (0+0+4)/1 – (0+0)/1 = 4

20. Poynard et al. Clin Chem 2007; 53: 1615-22.
DANA = 1
DANA = 4
AUC = 0.67
AUC = 0.98
AUROC standardisation
according to fibrosis prevalence

21. Comment utiliserComment utiliser
l’l’élastométrie en pratique?élastométrie en pratique?

22. Mr A… 55 ans VHC+
• Prothèse valvulaire cardiaque en 1975 sous AVK depuis
• Consommation excessive d’alcool
• Poids 90 Kg; Taille 170 cm
• Pas de signes de maladie chronique du foie
• ASAT: 250; ALAT: 200; GGT: 450; Bilirubine totale: 25
• TP: 35%; Facteur V 95%
• Plaquettes: 140 /mm3
• Echographie: foie hyperéchogène

23. RecommandationsRecommandations
Indication dans l’hépatite CIndication dans l’hépatite C
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

24. Utilisation en première intentionUtilisation en première intention
des tests non invasifs chez les patients VHCdes tests non invasifs chez les patients VHC
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

25. Evaluation non invasiveEvaluation non invasive
FibroScan: 28.0 kPa (IQR: 18.5)
FibroTest: 0.85
Ces résultats vous surprennent-ils ?
Ces résultats vous satisfont-ils ?

26. How to interpret FibroScan resultsHow to interpret FibroScan results
manufacturer’s recommendationsmanufacturer’s recommendations
Success rate > 60%
10 validated measures
IQR < 30% median
Castera, Forns & Alberti. J Hepatol 2008; 48: 835-47

27. Applicability of transient elastographyApplicability of transient elastography
Unreliable 15.8%
IQR/LSM > 30%
9.2%
SR < 60%
8.1%
VS < 10
3.1%
Failure 3.1%
Valid shot =
0
Castéra et al. Hepatology 2010; 51: 828-35Castéra et al. Hepatology 2010; 51: 828-35
FibroScan
not applicable
in 20%
of cases
N=13669 examinationsN=13669 examinations
ObesityObesity OperatorOperator
experienceexperience

28. Unreliable
IQR/LSM > 30%
SR < 60%
VS < 10
Failure
Valid shot =
0
XL Probe:XL Probe:
Does it really overcome the limitations of M probe ?Does it really overcome the limitations of M probe ?
XL vs. M
probe:
1% vs. 16%
N= 276 patients with BMI > 28 kg/m2
Myers et al. Hepatology 2012;Myers et al. Hepatology 2012; 55:199-208.
XL vs. M probe:
27% vs. 50%

29. XL Probe:XL Probe: the cut-off issuethe cut-off issue
N= 65 NAFLD patients Myers et al. Hepatology 2012;Myers et al. Hepatology 2012; 55:199-208.
7.8 vs. 6.4 kPa
M vs. XL

30. Boursier et al. Hepatology 2013; 57: 1182-91Boursier et al. Hepatology 2013; 57: 1182-91
N=1165 patients with CLD; 70% HCVN=1165 patients with CLD; 70% HCV
P=NS
How does applicability translatesHow does applicability translates
into accuracy?into accuracy?

31. Boursier et al. Hepatology 2013; 57: 1182-91Boursier et al. Hepatology 2013; 57: 1182-91
N=1165 patients with CLD; 70% HCVN=1165 patients with CLD; 70% HCV
How does applicability translatesHow does applicability translates
into accuracy?into accuracy?

32. Influence of food intakeInfluence of food intake
Arena et al. Hepatology 2013; 58: 65-72Arena et al. Hepatology 2013; 58: 65-72
Mederacke et al. Liver Int 2009; 29: 1500-6Mederacke et al. Liver Int 2009; 29: 1500-6
TE should be performed
in fasting patients

33. Confounders of liver stiffnessConfounders of liver stiffness
summary for clinical practicesummary for clinical practice
Tapper, Castera, Afdhal. Clin Gastroenterol Hepatol 2015;

34. RecommandationsRecommandations
Interprétation de l’Interprétation de l’élastométrieélastométrie
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

35. FibroScan: 21.0 kPa (IQR: 2.3)
• FibroTest: 0.85
Ces résultats vous satisfont-ils?
Evaluation non invasive (2)Evaluation non invasive (2)

36. FibroScan: 21.0 kPa (IQR: 2.3)
 Alpha 2 macroglobuline: 2.5 g/L (1.4 <N< 3.3)
 Haptoglobine: <0.10 g/L (0.75 <N<2.2)
 Apolipoproteine A1: 1.40 g/L (1.15 <N<1.7)
 Bilirubine totale: 25 µmol/L (N<17)
 GGT: 150 IU/L (N<50)
• FibroTest: 0.85
Evaluation non invasive (2)

37. • Hémolyse
• Gilbert
• Sepsis
• Inflammation
FibroTest: limitesFibroTest: limites
Faux positifs Faux négatifs
Poynard et al. Clin Chem 2004 ; 8: 1344-55
N=8524 examens

38. RecommandationsRecommandations
Interprétation des tests non invasifsInterprétation des tests non invasifs
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

39. Mr A… 55 ans VHC+
• FibroTest ininterprétable
• Ne veut pas de biopsie hépatique…
• FibroScan interprétable, en faveur d’une cirrhose

40. Elastométrie : méta-analysesElastométrie : méta-analyses
Chon et al. PLoS ONE 2012
Talwalkar et al. CGH 2007Friedrich-Rust et al. Gastroenterology 2008
Tsochatzis et al. J Hepatol 2011Stebbing et al. APT 2010

41. 14.6
Elastométrie pour le diagnosticElastométrie pour le diagnostic
de cirrhosede cirrhose
3 75
Bien classés 92 %
Ganne-Carrié et al. Hepatology 2006; 44: 1511-7
F = 4
74%
4.5%
misclassified
17%
3.5 %
misclassified
F < 4
96%
83%
(n=1007 patients with various CLD, 165 with cirrhosis)

42. N=1307 patients with viral hepatitis; pre-test probability: 14%
Posttestprobabilitiesofcirrhosis
Degos et al. J Hepatol 2010; 53: 1013-21
64-80%
10%
0-3%
27%
< 7kPa >17kPa12 kPa
Le diagnostic de cirrhose
doit être contextualisé
(probabilités pré-test et post-test)

43. RecommandationsRecommandations
Diagnostic de cirrhoseDiagnostic de cirrhose
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

44. Nouvelles techniques ?Nouvelles techniques ?
ARFI SWE

45. Friedrich-Rust et al. Radiology 2009 ; 252: 595-604
Challengers for measuring liver stiffnessChallengers for measuring liver stiffness
ARFI (VirtualTouch®)ARFI (VirtualTouch®)))
Nightingale et al. UMB 2002 ; 28: 227-35

46. Friedrich-Rust et al. J Viral Hepat 2012 ; 19: 212-9
Diagnostic performancesDiagnostic performances
Meta-analysisMeta-analysis
N=518 patients

47. ARFI: Comparison with TEARFI: Comparison with TE
Meta-analysis: significant fibrosisMeta-analysis: significant fibrosis
Bota et al. Liver Int 2013; in press
N= 1063 patients with CLD; 13 studies
ARFI TE
Se = 74%
Low Low Low Low Low Low
Low Low High Low Low Low
Low Low Low Low Low Low
Unclear Low Unclear Unclear Low Unclear
Low Unclear High Low Low Unclear
Low Unclear Unclear Low Low Low
Low Low Low Low Low Low
Unclear Low Unclear Low Low Low
Low Low Low Low Low Low
TE compared to ARFI elastography. Thisisof relevance show that the correla
(A)
(B)
Fig. 2. Summary sensitivity and specificity of elastographic methodsfor predicting significant fibros
elastography (ARFI) and (B) Transient elastography (TE).
Se = 78%Sp = 83%
Low Low Low Low Low
Low High Low Low Low
Low Low Low Low Low
Low Unclear Unclear Low Unclear
Unclear High Low Low Unclear
Unclear Unclear Low Low Low
Low Low Low Low Low
Low Unclear Low Low Low
Low Low Low Low Low
TE compared to ARFI elastography. Thisisof relevance show that the correlation of LS asses
(A)
(B)
Fig. 2. Summary sensitivity and specificity of elastographic methods for predicting significant fibrosis(A) Acoustic radi
elastography (ARFI) and (B) Transient elastography (TE).
Sp = 84%

48. ARFI: Comparison with TEARFI: Comparison with TE
Meta-analysis: cirrhosisMeta-analysis: cirrhosis
Bota et al. Liver Int 2013; in press
N= 1063 patients with CLD; 13 studies
ARFI TE
Se = 87%
Bota et al.
Se = 89%
(A)
(B)
Fig. 3. Summary sensitivity and specificity of elastographic methodsfor predicting cirrhosis(A
(ARFI) and (B) Transient elastography (TE).
Sp = 87%
Bota et al.
Sp = 87%
(B)
Fig. 3. Summary sensitivityand specificityof elastographicmethodsfor predicting cirrhosis(A) Acoustic radiatio
(ARFI) and (B) Transient elastography (TE).
Failure: 2.1% vs. 6.6 % (p<0.001)

49. Challenger for measuring liver stiffnessChallenger for measuring liver stiffness
Supersonic shear Imaging (AixplorerSupersonic shear Imaging (Aixplorer®®))
Muller et al. UMB 2009; 35: 219-29
Bavu et al. UMB 2011;37: 1361-73

50. Supersonic shear Imaging (AixplorerSupersonic shear Imaging (Aixplorer®®))
Comparison with TE in Hepatitis B & CComparison with TE in Hepatitis B & C
Ferrraioli et al. Hepatology 2012; 56: 2125-33N= 121 HCV patients
Significant fibrosis
P=0.002
Leung et al. Radiology 2013; 269: 910-8
N= 226 HBV patients

51. Supersonic shear Imaging (AixplorerSupersonic shear Imaging (Aixplorer®®))
ApplicabilityApplicability
Poynard et al. J Hepatol 2013; 58: 928-35

52. Comparaison SWE, TE et ARFI
Cassinoto et al. J Hepatol 2014; 61: 550-7N= 349 patients with CLD
Failure rate
P=NS
AUROC pour cirrhose

53. Challengers for measuring liver stiffnessChallengers for measuring liver stiffness
Advantages & disavantagesAdvantages & disavantages
• Can be implemented on a
regular US machine
• High applicability
• Performance close to TE
• Advantages
ARFI
• Disadvantages
• Further validation needed
• Narrow range of values
• Quality criteria not defined
• Can be implemented on a
regular US machine
• High range of value (2-150 kPa)
• Performance higher than TE ?
• Advantages
SWE
• Disadvantages
• Further validation needed
• Quality criteria?
• Limited data on
reproducibility
Berzigotti & Castera. J Hepatol 2013; 59: 180-2

54. Challengers for measuring liver stiffnessChallengers for measuring liver stiffness
Magnetic resonance elastographyMagnetic resonance elastography
Muthupillai et al. Science 1995; 269: 1854-7
Huwart et al. Gastroenterology 2008; 135: 32-40

55. Huwart et al. Gastroenterology 2008; 135: 32-40.
MR elastography vs. TE
AUROC
0.84 vs 0.99
N= 96 patients with CLD
F≥2 54%; F4 19%
Bohte al. Eur Radiol 2014; 24: 638-48.
N= 85 patients with HBV & HCV
F≥2 30%
AUROC
0.91 vs 0.91

56. RecommandationsRecommandations
Nouvelles techniquesNouvelles techniques
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

57. RecommandationsRecommandations
Suivi de la cirrhoseSuivi de la cirrhose
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

58. Tests non invasifsTests non invasifs
pour le suivi de la cirrhosepour le suivi de la cirrhose
++

59. 1. Fibroscopie pour dépistage VO
2. Echographie 6 mois pour dépistage CHC
3. Traitement antiviral
4. Rien ou autre
Que faites vous ?Que faites vous ?

60. Prédiction HTP & VOPrédiction HTP & VO
Elastométrie : méta-analyseElastométrie : méta-analyse
Shi et al. Liver Int 2013; 56: 62-71
18 studies; N= 3644 patients
HTP VO LVO
AUC: 0.93 AUC: 0.84 AUC: 0.78

61. RecommandationsRecommandations
Dépistage HTPDépistage HTP
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

62. Recommandations Baveno VIRecommandations Baveno VI
dépistage HTPdépistage HTP
De Franchis R & Baveno VI faculty. J Hepatol 2015; 63: 237-64.

63. Elasticité hépatique et CHC
Performance diagnostique
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

64. RecommandationsRecommandations
Dépistage CHCDépistage CHC
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

65. Cas clinique (suite)
• Fibroscopie : normale
• Echo: dysmorphie hépatique ; pas de nodule
• Alfa-foetoproteine: normale

66. RecommandationsRecommandations
Indications du traitement (VHC)Indications du traitement (VHC)
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

67. cas: traitement antiviral
SVR!

68. 1. FibroScan
2. Serum markers
3. Both
4. None or other
How do you monitor liver fibrosisHow do you monitor liver fibrosis
during antiviral treatment ?during antiviral treatment ?

69. Hezode et al. Aliment Ther Pharmacol 2011; 34: 656-63.
N=91 HCV patients with a prospective follow-up in 5 French centers
Non réponse Eradication virale
Liver stiffness kinetics
during antiviral treatment
BL W4 W12 EOT W24W12
PEG-IFN + RBV 24 or 48 W

70. Non response
Hezode et al. Aliment Ther Pharmacol 2011; 34: 656-63.
N=91 HCV patients with a prospective follow-up in 5 French centers
SVR
Liver stiffness kinetics
during antiviral treatment
Limited value of liver stiffness
monitoring during antiviral treatment
Limited value of liver stiffness
monitoring during antiviral treatment

71. 1. FibroScan
2. Serum markers
3. Both
4. Liver biopsy
5. None or other
How do you monitor liver fibrosisHow do you monitor liver fibrosis
after SVR?after SVR?

72. D’Ambrosio et al. Hepatology 2012; 56: 532-43
Before therapy After SVR
Regression of cirrhosis after SVR

73. Maylin et al. Gastroenterology 2008; 135: 821-9
N=126 HCV patients with SVR and paired liver biopsies pre-post ttt
Regression of cirrhosis after SVRRegression of cirrhosis after SVR

74. N=38 IFN-treated HCV patients with SVR with paired biopsies
D’Ambrosio et al. Hepatology 2012; 56: 532-43
Regression of cirrhosis after SVRRegression of cirrhosis after SVR

75. Kim et al. J Hepatol 2012; 57: 556-63
The Laennec scoring system
Thickness of Septa / Size of Nodule
4a
All cirrhosis are not alike!All cirrhosis are not alike!
4b 4c
Courtesy of Pr P Bedossa

76. Kim et al. J Hepatol 2012; 57: 556-63
N=175 patients with CLD median follow-up: 52.4 mo
Clinical relevance
All cirrhosis are not alike!

77. Kim et al. J Hepatol 2012; 57: 556-63
The Laennec scoring system
Thickness of Septa / Size of Nodule
4a
All cirrhosis are not alike!All cirrhosis are not alike!
4b 4c
Courtesy of Pr P Bedossa

78. Ogawa et al. Antiviral Res 2009; 83: 127-34.
Significant decrease of liver stiffness
values after SVR
N=145 HCV patients (126 ttt) with 4 LSM: BL, EOT, W48, and W96

79. Vergniol et al. J Viral Hepat 2009; 16: 132-40.
N=416 HCV patients (112 ttt) with 3 FibroScan + Fibrotest: BL, EOT, W24.
and last scan is indicated in Fig. 2 according to the viro-
logical response.
The median percentage change between the first and last
Fibrotest in untreated patients and in SVR, RR and NR
Facto
Fibrot
Table
Scan
interv
FibroS
therap
Scan
associ
95% C
betwe
FibroS
Fac
shown
HCV i
initial
rin co
fall in
and 3
10
FibroScan
Fibrotest
%
–5
0
5
0
2.61
–4.7
–15
–10
–10.29
–25
–20
–24.52
–16.77
–30
Untreated NR RR SVR
–29.51
8.67
Fig. 2 Median % changes in FibroScan and Fibrotest values
between the beginning and end of the study in treated
LSM and FT values decrease (%)
according to treatment response

80. Stasi et al. DLD 2013; 45: 840-3.
Decrease of liver stiffness after SVR
in hepatitis C
N=74 HCV patients with a 3 years follow-up

81. N=33 Cirrhotic HCV patients with SVR with paired biopsies
D’Ambrosio et al. J Hepatol 2013; 59: 251-6
Diagnostic accuracy of LSM for fibrosis
regression after SVR in HCV-cirrhosis
Sensitivity 61%
Specificity 95%

82. What do we measure ?What do we measure ?
Confounders of liver stiffnessConfounders of liver stiffness
Tapper, Castera & Afdhal. Clin Gastroenterol Hepatol 2015; 13:60-7

83. Variability of repeated liver stiffness
measurements
Nascimbeni et al. Clin Gastroenterol Hepatol 2015;13: 763-771.e6
531 paired liver stiffness measurements < 1 year from 452 patients

84. RecommandationsRecommandations
Suivi de la cirrhose après guérisonSuivi de la cirrhose après guérison
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

85. “ Quand le foie est dur
le pronostic est mauvais ”
Un peu d’histoire
Socrate (Vème
siècle av J.C)

86. Garcia-Tsao et al. Hepatology 2010; 51: 1445-9
75 kPa3
5.5 15 65

87. OV grade II / IIIOV grade II / III
2727
AscitesAscites
4949
HCCHCC
5454
BleedingBleeding
6363 kPakPa1212 7575
Foucher et al. Gut 2006; 55: 403-8.
Complications de la cirrhose
711 patients with liver diseases
F3F4 144

88. Liver stiffnessLiver stiffness
Relationship with liver-related eventsRelationship with liver-related events
diagnosed if coincide
the tumor did not
performed. When
examination was rep
Statistical analyses
Data are expresse
median (range), or n(
patientswith and wit
the chi-squared and
predictors of LRE
multivariate Cox pr
used. Hazard ratios
intervals (CIs) are in
characteristic (ROC)
were used to calcul
prediction of LRE d
sensitivity and speci
were expressed in pe
HCC were calculat
value, 0.05 on a t
significant. Statistica
Figure 2. Cumulative incidence rates of LREs based on
stratified LSM values (Kaplan-Meier plot). Patients with LSM
value . 19 kPa were at a significantly greater risk of LREs development
Kim et al. PloSOne 2012;Kim et al. PloSOne 2012; 7: e36676
N=128 HBV patientsF3-F4N=128 HBV patientsF3-F4

89. Liver stiffnessLiver stiffness
Relationship with liver-related eventsRelationship with liver-related events
Kim et al. PloSOne 2012;Kim et al. PloSOne 2012; 7: e36676
N=128 HBV patientsF3-F4N=128 HBV patientsF3-F4
ues in patients with F3 and F4
of patients with F3 and F4 were 9.0
ge, 4.4–57.1) kPa, respectively and
osis stage were significantly higher
15.86 8.8 kPa, P, 0.001). LSM, liver
Figure 4. Incidence of LREs according to fibrosis stage and LSM
values. The incidence of LREs was similar between patients with F3
fibrosis stage and those with F4 (22.2% vs. 13.6%, P= 0.472) whereas it
Fibroscan for Predicting Liver-Related Events

90. Elasticité hépatiqueElasticité hépatique
survie sans complicationssurvie sans complications
Robic et al. J Hepatol 2011;Robic et al. J Hepatol 2011; 55: 1017-24
N=100 patients CLDN=100 patients CLD

91. Elasticité hépatique & survieElasticité hépatique & survie
Vergniol et al. Gastroenterology 2011;N=1457 patients VHCN=1457 patients VHC

92. Elasticité hépatique & survieElasticité hépatique & survie
Corpechot et al. Gastroenterology 2014;N=168 patients CSPN=168 patients CSP

93. Elasticité hépatique & survieElasticité hépatique & survie
Corpechot et al. Gastroenterology 2014;N=168 patients CSPN=168 patients CSP

94. Elasticité hépatique & survieElasticité hépatique & survie
Vergniol et al. Hepatology 2014;N=1025 HCV patientsN=1025 HCV patients

95. Elasticité hépatique & survieElasticité hépatique & survie
Vergniol et al. Hepatology 2014;N=1025 HCV patientsN=1025 HCV patients

96. EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.
RecommandationsRecommandations
Hépatite BHépatite B

97. RecommandationsRecommandations
NAFLDNAFLD
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

98. RecommandationsRecommandations
Alcool autres maladiesAlcool autres maladies
EASL-ALEH Clinical practice Guidelines. J Hepatol 2015; 63: 237-64.

99. Take Home messages (1)Take Home messages (1)
Les méthodes non invasives sont désormais prêtes pour le
« prime time » pour prioriser les patients atteints d’hépatite
C naïfs pour les nouveaux traitements antiviraux.
Elles doivent être interprétées par des spécialistes en
fonction du contexte clinique et des critères de qualité.
L’élastométrie est la technique la plus utilisée car la mieux
validée et la plus performante pour le diagnostic de cirrhose
(meilleure pour l’éliminer que pour le confirmer)

100. Take Home messages (2)Take Home messages (2)
La principale limite de l’élastométrie est sa moins bonne
applicabilité chez les patients obèses.
Les nouvelles techniques comme l’ARFI et la SWE,
permettant de passer outre cette limite, sont prometteuses
avec des performances équivalentes.
Chez les patients ayant une cirrhose virale C guérie, le
suivi par élastométrie n’est pas recommandé dans l’état
actuel des connaissances.