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Limites : echecLSM failure rates                               n=13369                    80%                    60%      ...
Limites: résultats non fiables                      (n=12 949)  7.2% 15.6%                      15.8%                     ...
Applicabilité de l’élastométrie Echec 3.1%            Non fiable 15.8%                         SR < 60%                  F...
Sonde XL : la réponse aux limites du FibroScan?                Echec sonde XL vs. M :                     1% vs. 16%N= 276...
Sonde XL :  la réponse aux limites du FibroScan?Résultats non fiables sonde XL vs. M :            27% vs. 50%N= 276 patien...
Sonde XL :  la réponse aux limites du FibroScan?                         AUC F2 0.83 vs 0.86 (NS)                         ...
Discordances avec la sonde XL                                  11% N= 210 patients BMI > 28 kg/m2                         ...
La capsule de Glisson:Une enveloppe distensible mais pas élastique!
Facteurs confondantsCongestion                       Inflammation aigueMillonig et al.                        Coco et al. ...
Perspectives
Elasticité hépatique survie sans complicationsN=100 patients CLD                     Robic et al. J Hepatol 2011; 55: 1017...
Elasticité hépatique & survieN=1457 patients VHC   Vergniol et al. Gastroenterology 2011;
Nouvelles techniques             ARFIAcoustic Radiation Force Impulse Imaging              Friedrich-Rust et al. Radiology...
ARFI performances diagnostiques                   Meta-analyse  N=518 patients                      Friedrich-Rust et al. ...
Fibroscan vs ARFI   Castera & Garcia-Tsao. Gastroenterology 2013; 144:19-22
Nouvelles techniques                                       Elasto-RM+90Displacement (µm)-90                    Courtesy of...
Future technologies                MR elastography vs. TE  Transient elastography                      MR elastography    ...
Challengers for measuring liver stiffness            Advantages & disavantages             ARFI                           ...
Nouvelles techniquesSupersonic shear Imaging              Muller et al. UMB 2009; 35: 219-29              Bavu et al. UMB ...
Supersonic shear Imaging (Aixplorer®)  Comparison with TE in Hepatitis C  Significant fibrosis                      Cirrho...
Perspectives: Dépistage de lafibrose dans la population générale ?                Castera L & Pinzani M. Lancet 2010; 375:...
Une aiguille dans une motte de foin ?
Dépistage population générale ?7463 healthy subjects                     1190 healthy subjects         FibroTest          ...
Take Home messages (1)L’élastométrie a été principalement validée dans leshépatites virales mais nécessitent d’étre validé...
Take Home messages (2)La principale limite de l’élastométrie est sonapplicablité limitée (80%) en cas d’obésité.L’élastomé...
Take Home messages (3)Les performances de l’élastométrie sont insuffisantespour remplacer la fibroscopie pour le dépistage...
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Castera pb halternative 4

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Castera pb halternative 4

  1. 1. Limites : echecLSM failure rates n=13369 80% 60% 41.7% 40% 24.9% 20% 16.9% 12.4% 8.1% 1.0% 0% < 25 ≥ 25 ≥ 28 ≥ 30 ≥ 35 ≥ 40 (n=4172) (n=3089) (N=1568) (n=967) (n=225) (n=48) BMI (kg/m²) Castéra et al. Hepatology 2010; 51: 828-35
  2. 2. Limites: résultats non fiables (n=12 949) 7.2% 15.6% 15.8% 60.4% 30.5% SR < 60% 8.1% Woman VS < 10 Age > 52 Man > 500 Age < 52 3.1% < 500 BMI > 30 Diabetes exams BMI < 25 exams Hypertension No Diabetes IQR/LSM > 30%No hypertension 9.2% Castéra et al. Hepatology 2010; 51: 828-35
  3. 3. Applicabilité de l’élastométrie Echec 3.1% Non fiable 15.8% SR < 60% FibroScan 8.1% Valid shot = 0 non applicable VS < 10 3.1% dans 20% des cas IQR/LSM > 30% 9.2%N=13669 examinations Castéra et al. Hepatology 2010; 51: 828-35
  4. 4. Sonde XL : la réponse aux limites du FibroScan? Echec sonde XL vs. M : 1% vs. 16%N= 276 patients with BMI > 28 kg/m2 Myers et al. Hepatology 2012; 55:199-208.
  5. 5. Sonde XL : la réponse aux limites du FibroScan?Résultats non fiables sonde XL vs. M : 27% vs. 50%N= 276 patients with BMI > 28 kg/m2 Myers et al. Hepatology 2012; 55:199-208.
  6. 6. Sonde XL : la réponse aux limites du FibroScan? AUC F2 0.83 vs 0.86 (NS) AUC F4 0.94 vs 0.91 (NS) Median: 6.8 vs. 7.8 kPa (p<0.0001)N= 276 patients with BMI > 28 kg/m2 Myers et al. Hepatology 2012; 55:199-208.
  7. 7. Discordances avec la sonde XL 11% N= 210 patients BMI > 28 kg/m2 Myers et al. J Hepatol 2012; 20: 2390-6.
  8. 8. La capsule de Glisson:Une enveloppe distensible mais pas élastique!
  9. 9. Facteurs confondantsCongestion Inflammation aigueMillonig et al. Coco et al. J Viral Hepat 2007J Hepatol 2010 Arena et al. Hepatology 2008 Sagir et al. Hepatology 2008 Cholestase extra-hepatique Millonig et al. Hepatology 2008
  10. 10. Perspectives
  11. 11. Elasticité hépatique survie sans complicationsN=100 patients CLD Robic et al. J Hepatol 2011; 55: 1017-24
  12. 12. Elasticité hépatique & survieN=1457 patients VHC Vergniol et al. Gastroenterology 2011;
  13. 13. Nouvelles techniques ARFIAcoustic Radiation Force Impulse Imaging Friedrich-Rust et al. Radiology 2009 ; 252: 595-604. Lupsor et al. J Gastrointestin Llver Dis 2009; 18: 303-10
  14. 14. ARFI performances diagnostiques Meta-analyse N=518 patients Friedrich-Rust et al. J Viral Hepat 2012 ; 19: 212-9
  15. 15. Fibroscan vs ARFI Castera & Garcia-Tsao. Gastroenterology 2013; 144:19-22
  16. 16. Nouvelles techniques Elasto-RM+90Displacement (µm)-90 Courtesy of Jayant Talwalkar, Mayo Clinic Talwalkar et al. Hepatology 2008; 47: 332-42.
  17. 17. Future technologies MR elastography vs. TE Transient elastography MR elastography AUROC AUROC F≥2 0.84 F≥2 0.99 F=4 0.93 F=4 0.99N= 96 patients with various chronic liver diseases: F≥2 54%; F4 19% Huwart et al. Gastroenterology 2008; 135: 32-40.
  18. 18. Challengers for measuring liver stiffness Advantages & disavantages ARFI MR elastography• Advantages • Advantages • Can be implemented on a • Can be implemented on a regular US machine regular MRI machine • High applicability • High applicability • Performance close to TE • Examination of the whole liver• Disadvantages • Disadvantages • Further validation needed • Furthter validation warranted • Narrow range of values • Requires a MRI facility • Quality criteria not defined • Time-consuming and costly Castera L . Gastroenterology 2012; 142: 1293-302
  19. 19. Nouvelles techniquesSupersonic shear Imaging Muller et al. UMB 2009; 35: 219-29 Bavu et al. UMB 2011;37: 1361-73
  20. 20. Supersonic shear Imaging (Aixplorer®) Comparison with TE in Hepatitis C Significant fibrosis Cirrhosis P=NS P=0.002N= 121 HCV patients Ferrraioli et al. Hepatology 2012; 56: 2125-33
  21. 21. Perspectives: Dépistage de lafibrose dans la population générale ? Castera L & Pinzani M. Lancet 2010; 375: 419-20.
  22. 22. Une aiguille dans une motte de foin ?
  23. 23. Dépistage population générale ?7463 healthy subjects 1190 healthy subjects FibroTest FibroScan Fibrosis (≥2) 2.8 % Fibrosis (≥2) 7.5 % Cirrhosis 0.3% Cirrhosis 0.7% Poynard et al. BMC Gastroenterol 2010 Roulot et al. Gut 2011
  24. 24. Take Home messages (1)L’élastométrie a été principalement validée dans leshépatites virales mais nécessitent d’étre validée dansd’autres etiologies (NAFLD, etc..).La combinaison de l’élastométrie et des marqueurssanguins est la stratégie de choix pour la détection de lafibrose en 1ère intention dans l’hépatite C (HAS).
  25. 25. Take Home messages (2)La principale limite de l’élastométrie est sonapplicablité limitée (80%) en cas d’obésité.L’élastométrie est actuellement la méthode la plusperformante pour le diagnostic de cirrhose mais du faitde sa moins bonne applicabilité ses performances sontcomparables aux biomarqueurs.
  26. 26. Take Home messages (3)Les performances de l’élastométrie sont insuffisantespour remplacer la fibroscopie pour le dépistage desVO.Malgré ses limites, l’élastométrie est une techniqueprometteuse pour le suivi des maladies du foie maisnécessite d’être mieux évaluée de façon longitudinale.Elle a une valeur pronostique au cours de la cirrhose.

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