34, 35 Numerous studies have shown that this technique is an excellent tool for the detection of advanced fibrosis or cirrhosis, but the results for the prediction of different stages of moderate fibrosis are less conclusive. This technique has the advantage of being noninvasive, http://www.selleckchem.com/products/abc294640.html safe, reproducible, and rapid (it can be performed in less than 10 minutes). However, its interpretation has been recently questioned because liver stiffness measurements have been found
to be impossible to interpret in nearly one of five cases. The main reasons are obesity and limited operator experience.36 Three recent studies have evaluated the relationship between the liver stiffness values and the HVPG in patients with viral or alcoholic cirrhosis, including patients with asymptomatic or compensated cirrhosis.37-39 In these studies, the authors also evaluated whether liver stiffness measurements could predict severe portal hypertension with an HVPG above 10 to 12 mm Hg. A significant correlation was found between the liver stiffness and HVPG whatever the cause of cirrhosis was; the correlation was excellent in patients with HVPG values between 5 and 10 or 12 mm Hg and less strong in patients with an HVPG value above 10 or 12 mm Hg.37 Moreover, in selected patients with variceal bleeding, liver stiffness did not diagnose patients with an HVPG above 20 mm Hg.40 These results suggest that Proteasome inhibitor the extent of
hepatic fibrosis plays a major role in the development of moderate portal hypertension
and has less effect in patients with severe portal hypertension. The receiver operating characteristic curve for the diagnosis of severe portal hypertension ranges from 0.76 to 0.92 with a cutoff of 13.6 to 34.9 kPa.37, 39 In addition, liver biopsy, transient elastography, and HVPG measurements have been performed in patients with recurrent hepatitis C after liver transplantation.41, 42 Both studies found a significant correlation between the two measurements with a 0.93 receiver operating characteristic curve this website for the prediction of severe portal hypertension, which was also correlated with the progression of recurrent liver disease. Although liver stiffness measurement is a new, noninvasive approach for assessing hepatic fibrosis, results also suggest that it may be useful for determining the presence and degree of portal hypertension and particularly for screening patients with severe portal hypertension at risk of developing esophageal varices and other complications. However, more studies are needed in large groups of patients to confirm these findings. There are other, more complex noninvasive markers of hepatic fibrosis. For example, magnetic resonance elastography of the liver and spleen has recently been proposed.43 This method involves evaluating the mechanical properties of soft tissue through the assessment of liver stiffness with MRI.