LIVER ELASTOGRAPHY IN THE PREDICTION OF THE PRESENCE OF HCC
Prognosis of patients with chronic liver disease is determined by the extent and progression of liver fibrosis, which may lead to the development of HCC. Liver stiffness is significantly higher in patients with HCC than in patients without HCC. However, most of the studies found that liver stiffness alone is insufficient to predict the presence or absence of HCC and that it should be associated in a score with other markers. A score developed by Wong et al based on liver stiffness, age, serum albumin and hepatitis B virus DNA level was found to have AUROC’s of 0.83 to 0.89 in the identification of the HCC patients and a very good negative (99.4%-100%) for the exclusion of HCC in patients. In the study conducted by Feier et al, LS was significantly higher (42 kPa vs 27 kPa, P < 0.0001) in the HCC group than in the non-HCC group, but other 3 parameters (alanine-aminotransferase, alphafetoprotein and interquartile range of the LSMs) were added to elastography in a score and the resulted model combining the four variables showed a good diagnostic performance in both training and validation groups, with AUROCs of 0.86 and 0.8, respectively. Jung et al has shown that liver stiffness is also useful as a part of a predictive model that identifies patients that are at risk for late recurrence after curative resection of HCC. On multivariate analysis, patients with older age, male sex, heavy alcohol consumption (> 80 g/d), lower serum albumin, HBe antigen positivity and LSM> 8 kPa were at a significantly greater risk of HCC development.