1. Case Report Ana Carolina Cardoso
Hôpital Beaujon – Universite Paris VII - France
Hospital Universitario da Universidade Federal do Rio de Janeiro - Brasil

2. Case Report 57 years old, male 2004: diagnosis of HCV infection
Contamination: unknown
Genotype 3a, Viral Load: IU/mL
BMI: 28, DM
No excessive alcohol intake and tobacco use

3. Case Report Liver biopsy (2005): A1F1 (METAVIR)
Treatment (2005): PEG INF / RBV – NR
Poor tolerance
Follow-up / not retreated

4. Case Report Platelets 170 G/L PT 85 % ALT 102 IU/l AST 93 IU/l
GGT 220 IU/L
BMI: 32
January / 2011
Liver Biopsy ?

5. Case Report
January / 2011
FibroScan® – 11.2 kPa

6. Case Report January / 2011 FibroScan® – 11.2 kPa

7. Liver Fibrosis (METAVIR)
Case Report
FibroScan® (kPa)
8.8
9.6
14.6
Liver Fibrosis (METAVIR)
Previous studies showed that ls values strongly correlate with Metavir score for hepatitis c as seen in this slide. The studies determine that ls cut offs for f1/f2/f3/f4 stages are 7.1, 9.5 and 12.5
F0-F1 F2 F3 F4
Ziol et al, Hepatology 2005 7

8. Case Report – Question 1 FibroScan® is correct ? Liver Biopsy ?
What could we conclude ?
FibroScan® is correct ?
Liver Biopsy ?
Another non invasive test ?

9. Case Report
January / 2011
FibroTest – 0.80

10. Case Report January / 2010 Fibrotest 0.75-1.00 F4 0.73-0.74 F3-F4
Equivalent METAVIR F4
F3-F4 F3 F2
F1-F2 F1
F0-F1 F0
FibroTest – 0.80

11. Case Report Fibrotest 0.75-1.00 F4 0.73-0.74 F3-F4 0.59-0.72 F3
Equivalent METAVIR F4
F3-F4 F3 F2
F1-F2 F1
F0-F1 F0
Alpha-2 macroglobulin
Total Bilirubin
Gamma GT
Apolipoprotein A1
Haptoglobin
Imbert-Bismuth et al. Lancet 2001; 357:

12. Case Report – Question 2 FibroScan® and Fibrotest 3/6 months later ?
What should we propose ?
FibroScan® and Fibrotest 3/6 months later ?
Liver biopsy ?
Start new treatment immediately ?

13. Case Report Platelets 181 G/L PT 90 % ALT 133 IU/L AST 88 IU/L
GGT 130 IU/L
BMI 30 IU/L
July / 2011

14. Case Report July / 2011 FibroScan® – 12.0 kPa / 1.2 / 100%
FibroTest – 0.78

15. Case Report – Liver Biopsy
Liver fragment – 20 mm and 12 portal tracts PT CV
No difference in comparison with previous liver biopsy
L.B: STEATOHEPATITIS + Hep C Metavir A0F1

16. Case Report FibroTest (n=8524) False Positives False Negatives
Hemolysis
Haptoglobin < 0.30 g/l
Gilbert
Bilirubin >17 µmol/l
GGT< 30 UI/l
Sepsis
False Positives
False Negatives
Inflammation
Haptoglobin > 2.0g/l
Poynard et al. Clin Chem 2004; 8:

17. Case Report FibroScan® (n=13 369) Obesity (BMI > 30)
Limited operator experience
Female
Age > 52 ys
Diabetes
Hypertension
Limitations
Castera et al. Hepatology 2010;51:

18. STEATOSIS AND LIVER STIFFNESS
P < 0.001
6.2
8.5
Nao tem impacto negativo na performance diagnostica
Cardoso et al [abstract]. Hepatology International 2010

19. STEATOSIS DETECTION USING CAP
Beaugrand et at. JVH 2011

20. STEATOSIS DETECTION USING CAP
T = 236 dB/m, Se=0.83, Sp=0.73
T = 255 dB/m, Se=0.94, Sp=0.63
T = 282 dB/m, Se=0.95, Sp=1
Cardoso et al, AASLD 2010

21. Case Report Take-Home Messages
FibroScan® and some serum markers are good tools for non invasive evaluation of liver fibrosis and can avoid liver biopsy in many cases.
However discordance can occurs in 25%
10% of the discordances do not have an explanation
Liver biopsy persist as the best standart for these cases

23. Case Report Fibrotest 0.75-1.00 F4 0.73-0.74 F3-F4 0.59-0.72 F3
Equivalent METAVIR F4
F3-F4 F3 F2
F1-F2 F1
F0-F1 F0
Alpha-2 macroglobulin
Total Bilirubin
Gamma GT
Apolipoprotein A1
Haptoglobin
Imbert-Bismuth et al. Lancet 2001; 357:

24. Castera et al, J Hepatol 2008; 48: 835-47
11/04/2017
Case Report
10 validated measures
Success rate > 60%
Results are expressed in kPa.
The median
Only procedures with 10 validated measurements and a success rate of at least 60% and a IQR < 30% of the median value are considered reliable.
11.2
0.9
14.6
IQR < 30% median
Castera et al, J Hepatol 2008; 48: 24