超声弹性成像及超声造影技术评估慢性乙肝肝纤维化程度的临床研究

目的　探讨声触诊组织量化（VTQ）及超声造影（CEUS）技术对慢性乙肝肝纤维化程度的诊断价值。方法　65例慢性乙肝患者分别进行VTQ、CEUS技术检查及肝穿刺活检,获取剪切波速度（SWV）及造影参数：门静脉到达时间（PVAT）、肝动脉到达时间（HAAT）、肝静脉到达时间（HVAT）、肝实质达峰时间（TTP）、肝动脉-肝静脉渡越时间（HV-HAAT）、肝动脉-门静脉渡越时间（PV-HAAT）。根据病理结果分为轻度组12例、中度组23例和重度组30例,比较各组SWV和CEUS参数差异,分析SWV、CEUS参数与肝纤维化程度的相关性,绘制受试者工作特征（ROC）曲线,寻找SWV、CEUS参数诊断重度肝纤维化的截断值,计算曲线下面积（AUC）,评价SWV、CEUS参数对重度肝纤维化的诊断效能,采用DeLong法比较不同检测方法的AUC差异。结果　与轻度组比较,中度组和重度组SWV增大,重度组HVAT、HV-HAAT减小（P＜0.05）;与中度组比较,重度组SWV增大,HVAT、HV-HAAT减小（P＜0.05）。SWV与肝纤维化严重程度呈正相关（rs=0.713,P＜0.05）,HVAT、HV-HAAT与肝纤维化严重程度呈负相关（rs分别为 -0.437、-0.620,P＜0.05）;SWV、HVAT、HV-HAAT诊断重度组肝纤维化（肝硬化）的AUC（95%CI）分别为0.925（0.832~0.976）、0.734（0.610~0.836）、0.804（0.687~0.892）,截断值分别为1.92 m/s、21.02 s、8.23 s;SWV的诊断效能优于HVAT、HV-HAAT（Z分别为2.817和1.987,均P＜0.05）。结论　与CEUS相比,VTQ技术对慢性乙肝肝纤维化程度的诊断效能更佳。     

实时组织超声弹性成像技术评价慢性乙型肝炎患者肝脏纤维化程度的价值

目的探讨实时组织超声弹性成像(RTE)技术评价慢性乙型肝炎患者肝纤维化程度的价值。方法15例健康志愿者(对照组)及30例慢性乙型肝炎患者(病例组)接受RTE检查及APRI值测量,由组织弥散定量分析软件得到弹性图像的定量参数,其结果与肝活检病理的纤维化分期相对照。结果弹性图像的定量参数,包括应变均值(MEAN)、标准差(SD)、蓝色领域%(%ARE-A)、复杂度(COMP)、峰度(KURT)、偏度(SKEW)、对比度(CONT)、均等性(ENT)、复杂度(IDM)、一致性(ASM)、相关性(CORR)、肝纤维化指数(LF index)及APRI值,各纤维化分期之间进行方差分析均有统计学差异(P<0.01或P<0.05),以LF index及APRI值判断S≥S4期绘制ROC曲线,曲线下面积分别为0.905、0.857。结论 RTE技术是一种有价值的评估肝纤维化分期的新方法。     

瞬时弹性成像联合APRI在慢性乙型肝炎肝纤维化诊断中的应用价值

目的 评价瞬时弹性成像(FibroScan) 联合天冬氨酸转移酶(AST)与血小板指数(PLT)的比值(APRI)在判断慢性乙型肝炎患者肝纤维化程度中的作用。 方法 选择152例临床确诊为慢性乙型肝炎患者,进行常规实验室检查、FibroScan检查和肝脏活组织检查,探究FibroScan及APRI的诊断价值,并绘制FibroScan、APRI以及联合诊断模型的受试者工作特征曲线(ROC曲线),分析三者与肝脏纤维化病理分期的相关性。 结果 FibroScan 与 APRI对显著纤维化(S2~S4期)的曲线下面积(AUROC值)和95% 可信区间(95%CI)分别为0.752(0.672~0.832),0.717(0.630~0.805),对S3~S4期的 AUROC值分别为0.937(0.890~0.985),0.911(0.836~0.986),对S4期的AUROC值分别为0.973(0.947~0.998),0.934(0.862~1.000);两者联合后对S2~S4期的AUROC值为0.811(0.732~0.890)。结论 FibroScan联合APRI诊断模型可以进一步提高对显著期肝纤维化的诊断效能,对临床选择抗病毒治疗,干预肝纤维化进程具有一定的指导意义。     

超声弹性成像与声辐射力脉冲弹性成像对甲状腺单发实性结节的诊断价值

目的评价超声弹性成像(UE)技术、声辐射力脉冲弹性成像(ARFI)技术对常规超声图像中表现为甲状腺单发实性结节的良恶性鉴别诊断的价值。方法选取2013年12月—2014年7月石河子大学医学院第一附属医院甲状腺单发实性结节患者100例。对100个结节术前分别进行常规超声检查、UE检查及ARFI检查。均行甲状腺结节切除术,并经术后病理证实。UE选用弹性分级,ARFI检测病灶组织的剪切波速度(SWV)。以病理诊断作为金标准,评价3种方法的诊断价值。根据本组甲状腺良、恶性结节SWV值绘制ROC曲线。结果曲线下面积(AUC)为0.960,SWV值最佳诊断点为2.76。诊断甲状腺恶性单发实性结节,常规超声、UE五级评分法以及ARFI法SWV值的灵敏度分别为82.61%(19/23)、82.61%(19/23)、91.30%(21/23),特异度分别为87.01%(67/77)、88.31%(68/77)、93.51%(72/77),阳性预测值分别为65.52%(19/29)、67.86%(19/28)、80.77%(21/27),阴性预测值分别为94.37%(67/71)、94.44%(68/72)、97.29%(71/73)。结论 ARFI技术针对甲状腺恶性单发实性结节的良恶性鉴别诊断能力优于常规超声技术及UE技术,值得临床应用推广。     

超声弹性成像与灰阶超声对肝纤维化的诊断价值比较

目的：比较超声弹性成像与灰阶超声对肝纤维化的诊断价值。方法选择接受肝穿刺活体组织检查的患者100例,同时选择30名身体完全健康的志愿者进行超声弹性成像,比较两组数据。结果超声弹性成像检查出纤维化的概率为83％,高于灰阶超声检查出纤维化的概率为48％（P＜0．05）。结论诊断肝纤维时,超声弹性成像效果很明显,比使用灰阶超声进行诊断更好。     

瞬时弹性成像技术在慢性乙型肝炎患者肝纤维化中的应用价值评价

目的:评价瞬时弹性成像技术在慢性乙型肝炎患者肝纤维化中的应用价值,为临床慢性乙型肝炎的分期及预后提供参考.方法:选取2018年1月-2019年12月间医院收治的47例慢性乙型肝炎患者病例资料,采用肝脏穿刺活检判定肝纤维化分期,并采用瞬时弹性成像技术测定恩替卡韦治疗前后的肝硬度值,比较轻度和中重度肝纤维化患者治疗前后肝硬度值.结果:治疗前经肝脏穿刺活检判得,轻度肝纤维化(S0～S2期)患者31例(S0期0例、S1期9例和S2期22例)和中重度肝纤维化(S3～S4期)患者16例(S3期11例和S4期5例);治疗前后,中重度肝纤维化组患者的肝硬度值均高于同期的轻度肝纤维化组(P＜0.05);两组患者治疗后的肝硬度值则均低于其治疗前(P＜0.05).结论:瞬时弹性成像技术与肝脏穿刺活检具有较好的同步性,可以为慢性乙型肝炎患者肝纤维化的判断提供较为准确的参考.     

实时组织超声弹性成像弹性特征量评价实验兔肝纤维化程度的实验研究

目的分析实时组织超声弹性成像(RTE)技术弹性特征量定量评估肝脏纤维化程度的可行性。方法使用皮下注射硫代乙酰胺的方法,诱导54只新西兰兔肝纤维化作为实验模型组,另8只新西兰兔作为对照组。每隔1²周随机取22周随机取2⁴只实验兔,对兔肝脏行实时组织超声弹性成像检查,获取弹性特征量,包括:应变均值(MEAN)、标准差(SD)、蓝色区域%(AREA)、复杂度(COMP)、峰度(KURT)、偏差(SKEW)、对比度(CONT)、均等性(ENT)、复杂度(IDM)、一致性(ASM)及相关性(CORR)。然后处死实验兔,取肝脏组织进行肝纤维化的病理分期(S04只实验兔,对兔肝脏行实时组织超声弹性成像检查,获取弹性特征量,包括:应变均值(MEAN)、标准差(SD)、蓝色区域%(AREA)、复杂度(COMP)、峰度(KURT)、偏差(SKEW)、对比度(CONT)、均等性(ENT)、复杂度(IDM)、一致性(ASM)及相关性(CORR)。然后处死实验兔,取肝脏组织进行肝纤维化的病理分期(S0^S4期)及分组(轻、中、重度),S0S4期)及分组(轻、中、重度),S0^S1期为轻度肝纤维化(A组),S2S1期为轻度肝纤维化(A组),S2^S3期为中度肝纤维化(B组),S4期为重度肝纤维化(C组)。结果方差分析显示,B、C组MEAN、AREA、COMP、ENT、IDM显著高于A组,差异均有统计学意义(P<0.05);C组SKEW显著高于A组,差异有统计学意义(P<0.05)。结论 RTE弹性特征量有望成为无创评估肝纤维化程度的定量指标。     

超声弹性成像及声辐射力脉冲成像鉴别甲状腺实性结节良恶性的临床价值

目的：探讨超声弹性成像(UE)及声辐射力脉冲成像(ARFI)鉴别甲状腺实性结节良恶性的临床价值。方法2013年5月~2014年7月,选取102例(124个)甲状腺结节患者,并经术后病理证实的124个甲状腺实性结节,对其分别进行常规超声(CU)检查、UE检查、ARFI检查。UE选用弹性分级法,ARFI检测病灶组织的剪切波速度(SWV)。以病理诊断作为金标准,评价3种方法在甲状腺实性结节良恶性鉴别中的灵敏度、特异度及准确度;构建ROC曲线。结果曲线下面积(AUC)为0.960,SWV值最佳诊断点为2.89。诊断甲状腺恶性单发实性结节：CU、UE五级评分法及ARFI法SWV值的灵敏度、特异度分别为69.44%(25/36)、81.81%(72/88);77.78%(28/36)、88.63%(78/88);88.89%(32/36)、93.18%(82/88)。结论UE、ARFI技术均优于CU对甲状腺实性结节性质的判断,而ARFI技术的准确性较高,在鉴别甲状腺实性结节良恶性中有较高的临床价值。     

声触诊组织成像定量技术与声触诊定量技术对乳腺肿瘤诊断效能的比较

目的 比较声触诊组织成像定量技术（VTIQ）与声触诊定量技术（VTQ）对乳腺影像报告和数据系统（BI-RADS）3~5类乳腺肿瘤的鉴别诊断价值。方法 选取2018年9月至2019年10月亳州市人民医院经手术病理证实的BI-RADS 3~5类乳腺肿瘤患者60例,根据术后病理结果分为良性组33例与恶性组27例,分别以术前VTQ及VTIQ弹性成像检查所获取的病灶剪切波速度（SWV）作为观察指标,采用受试者工作特征曲线（ROC）评估两种技术对BI-RADS 3~5类乳腺肿瘤的诊断效能。结果 VTIQ与VTQ技术的有效检出率分别为100%与86.67%（P<0.01）。采用VTIQ检查,良、恶性组SWV均值为（3.79±0.87）m/s、（5.40±0.81）m/s（P<0.01）,以4.29 m/s为鉴别界值,VTIQ技术鉴别诊断乳腺良、恶性肿瘤的敏感性为92.59%、特异性为84.85%;采用VTQ检查,良、恶性组SWV均值为（4.03±0.92）m/s、（4.70±0.72）m/s（P<0.01）,以4.02 m/s为鉴别界值,VTQ技术鉴别诊断乳腺良、恶性肿瘤的敏感性为84.21%、特异性为69.70%;VTIQ与VTQ技术的曲线下面积（AUC）对比提示,VTIQ诊断效能优于VTQ（0.89比0.75）。结论 VTIQ与VTQ技术均可用于BI-RADS 3~5类乳腺肿瘤的鉴别诊断,但VTIQ技术较VTQ具有更高的诊断效能。     

超声造影肝实质灌注成像评价肝纤维化分期的实验研究

【摘要】目的探讨超声造影肝实质灌注成像评价肝纤维化分期的价值。方法用硫代乙酰胺法制作肝纤维化大鼠模型。行超声造影检查,获得肝实质灌注参数：峰值强度（LPPI）、达峰时间（LPTP）、曲线下面积（LPAUC）,分析灌注参数与肝纤维化分期的相关性。结果LPPI、LPTP与肝纤维化分期存在一定相关性（r=-0．55。P〈0．001;r=0．62,P〈0．001）,即随着肝纤维化程度的加重,呈IJPPI降低、LPTP延长的趋势;LPAUC与肝纤维严重程度无相关性（r=-0．155,P=0．368）。结论超声造影肝实质灌注成像可间接反映肝纤维化程度,有望成为一种无创诊断肝纤维化的影像学方法。     

Prospective evaluation of transient elastography for the diagnosis of hepatic fibrosis in Asians: comparison with liver biopsy and aspartate transaminase platelet ratio index

Background  Transient elastography (TE) is a reliable non-invasive predictor of hepatic fibrosis, but data on TE in Asians are limited.
Aim  To evaluate prospectively the accuracy of TE for diagnosis of hepatic fibrosis in Asians compared with APRI (aspartate transaminase to platelet ratio index).
Methods  One hundred and twenty consecutive patients who underwent liver biopsy were enrolled. TE (Fibroscan) was performed by two independent operators. Fibrosis was graded by two independent pathologists using the METAVIR classification. Area under receiver operating curves (AUROC) were used to evaluate the accuracy of TE and APRI in diagnosing significant fibrosis (F ≥ 2) and cirrhosis (F4).
Results  Predominant aetiologies were hepatitis B (48%), non-alcoholic steatohepatitis (14%) and hepatitis C (8%). TE was unsuccessful in five patients (4.2%) because of small inter-costal space (three patients), obesity and ascites. There was good correlation between TE and fibrosis ( r  = 0.606). AUROC for diagnosis of significant fibrosis was 0.856 (95% CI 0.779–0.932) for TE and 0.673 (95% CI 0.568–0.777) for APRI. AUROC for diagnosis of cirrhosis was 0.924 (95% CI 0.857–0.990) for TE and 0.626 (95% CI 0.437–0.815) for APRI. Optimal TE value was 9.0 kPa for diagnosis of significant fibrosis and 16.0 kPa for cirrhosis with specificity/sensitivity/PPV/NPV/accuracy of 82.6%/85.2%/80.9%/86.7%/84.1% and 88.9%/82.7%/32.0%/98.8%/83.2%, respectively.
Conclusions  Transient elastography is a reliable predictor of hepatic fibrosis in Asians. Failure of TE in Asians is commonly because of small inter-costal space. TE is superior to APRI for non-invasive diagnosis of hepatic fibrosis and cirrhosis.     

Reliability of liver stiffness measurement in non-alcoholic fatty liver disease: the effects of body mass index

Background Liver stiffness measurement (LSM) using transient elastography (TE) is used to stage fibrosis in patients with liver disease, diagnostic reliability and the factors affecting its performance in patients with non‐alcoholic fatty liver disease (NAFLD) are incompletely understood. Aim To assess LSM. Methods Consecutive NAFLD patients (n = 169), assessed by liver biopsy (Kleiner score), anthropometrical, biochemical and metabolic features, underwent LSM using TE with standard M probe. Results Liver stiffness measurement was not reliable in 23 patients (14%) due to obesity. Among patients with a reliable TE, a LSM value >7.25 kPa was the best cut‐off for predicting significant fibrosis at biopsy (AUC 0.794); however, this cut‐off still failed to rule out F2‐F4 fibrosis in 31% (false‐negative rate) or rule in F3‐F4 in 29% (false‐positive rate). Similarly a LSM value >8.75 kPa was the best cut‐off for severe fibrosis (F3‐F4) (AUC 0.870), with a rate of false‐negatives 24% and of false‐positives 2%. Body mass index was the major determinant of these diagnostic errors in predicting significant and severe fibrosis both by overestimating or underestimating the stage of fibrosis. Conclusions In NAFLD patients, even when liver stiffness measurement is feasible, high BMI values negatively affect the diagnostic reliability. Improved performance of transient elastography could be obtained using specifically designed probes.     

Transient elastography and biomarkers for liver fibrosis assessment and follow-up of inactive hepatitis B carriers

Background Non invasive methods for fibrosis evaluation remain to be validated longitudinally in hepatitis B. Aim To evaluate longitudinally transient elastography (TE) and biomarkers for liver fibrosis assessment and follow‐up of hepatitis B virus (HBV) inactive carriers. Methods Three hundred and twenty‐nine consecutive HBeAg‐negative HBV patients (201 inactive carriers) who underwent TE, Fibrotest and aspartate to platelet ratio index (APRI) the same day were studied. Results TE (median 4.8 vs. 6.8 kPa, P < 0.0001), Fibrotest (0.16 vs. 0.35, P < 0.0001) and APRI values (0.28 vs. 0.43, P < 0.0001) were significantly lower in inactive carriers than in the remaining patients whereas they did not differ among inactive carriers according to HBV DNA levels. In 82 inactive carriers with repeated examinations, although differences were observed among individual patients, TE values did not differ significantly over time (median intra‐patient changes at end of follow‐up relative to baseline: ?0.2 kPa, P = 0.12). Conversely, significant fluctuations were observed for Fibrotest (+0.03, P = 0.012) and APRI (?0.01, P < 0.05). Eleven inactive carriers (5.5%) had initial elevated TE values (>7.2 kPa) confirmed during follow‐up in two with significant fibrosis (F2 and F3) on liver biopsy. Conclusion Non‐invasive tools, particularly TE, could be useful, in addition to HBV DNA and transaminase levels, for follow‐up of HBV inactive carriers as well as better selection of patients who require a liver biopsy.     

Transient elastography: a valid alternative to biopsy in patients with chronic liver disease

BACKGROUND: Transient elastography is a novel and non-invasive technique for the evaluation of fibrosis in chronic liver disease. Few studies that exist value the efficacy of transient elastography, mainly in hepatitis C virus-infected patients. AIM: To evaluate the effectiveness, objectivity, reproducibility and safety of this technique. METHODS: We included 103 consecutive patients who underwent a liver biopsy in the last 48 months with a wide spectrum of chronic liver diseases. Median stiffness value (expressed as kilopascals - kPa) was kept as representative of the liver elastic modulus. All biopsy specimens were analysed by the same pathologist according to the METAVIR scoring system. RESULTS: Median value of stiffness in patients with mild or moderate fibrosis (FI and FII), and severe fibrosis or cirrhosis (FIII and FIV) was of 7, 4 +/- 5 and 16, 4 +/- 10 kPa, respectively, with a significant difference between them (P < 0.05). The areas under the receiver operating characteristic curves showed the optimal liver stiffness cut-off values for each group. CONCLUSIONS: We found a positive correlation between the liver stiffness found by transient elastography and fibrosis stage on biopsy in all patients, independently of the liver disease aetiology. Transient elastography is an easy, quick to perform and safe non-invasive procedure, reliable for assessing liver fibrosis.     

Dual cut-off transient elastography to assess liver fibrosis in chronic hepatitis B: a cohort study with internal validation

Aliment Pharmacol Ther 2011; 34: 353–362

Summary

Background  Transient elastography has gained popularity to stage liver fibrosis in chronic viral hepatitis, however, diagnostic cut‐offs for severe fibrosis in chronic hepatitis B are poorly defined. Aim  To evaluate an algorithm with two distinct cut‐offs for positive and negative prediction of significant fibrosis and cirrhosis in chronic hepatitis B patients. Methods  Two cohorts of treatment‐naïve patients with chronic hepatitis B (125 training and 92 validations) were consecutively and concurrently examined by percutaneous liver biopsy and transient elastography. Fibrosis was staged by Metavir (significant fibrosis = F ≥ 2; cirrhosis = F4) in ≥2 cm long liver tissue cores. Results  A >13.1 kPa positive and a ≤9.4 kPa negative cut‐off for cirrhosis had a >90% sensitivity and specificity, with an accuracy of 94%. The corresponding cut‐offs for F ≥ 2 were >9.4 and ≤6.2 kPa, thus classifying 56% of patients with an overall accuracy of 90%. In the validation cohort, F4 and F ≥ 2 were predicted by the above transient elastography cut‐offs with an overall accuracy >90%. In 165 patients with higher than upper limit of normal transaminase activity the dual cut‐off algorithm of transient elastography was as accurate as in the 52 patients with normal alanine aminotransferase values in the prediction and exclusion of cirrhosis, only. Conclusions  A dual cut‐off algorithm allowed for correctly classifying both significant fibrosis and cirrhosis in the majority of the patients with chronic hepatitis B, independent of alanine aminotransferase values, thus reducing the need for liver biopsy investigations.     

Magnetic resonance imaging and transient elastography in the management of Nonalcoholic Fatty Liver Disease (NAFLD)

Introduction: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and cirrhosis worldwide and the second most common cause of liver transplantation in major medical centers. Because liver steatosis and fibrosis severity are related to disease morbidity and mortality, the extent of disease, and disease progression, they need to be assessed and monitored. In addition, innovation with new drug developments requires disease staging and monitoring in both phase 2 and 3 clinical trials. Currently, disease assessment in both clinical practice and research is mostly performed by liver biopsy, an invasive, procedure with risks. Noninvasive, highly accurate tests are needed that could be used in clinical trials as surrogate endpoints and in clinical practice for monitoring patients.

Area Covered: We discuss noninvasive tests, transient elastography (TE) with controlled attenuation parameter (CAP), magnetic resonance imaging (MRI), and MR elastography (MRE), summarize the available evidence of their usefulness for assessing steatosis and fibrosis. Therefore they could be used as clinical trials outcomes and in disease monitoring in clinical practice.

Expert Commentary: TE with CAP, MRI and MRE are highly accurate noninvasive diagnostic tools for quantifying hepatic steatosis and fibrosis. Therefore they could be used as clinical trials outcomes and in disease monitoring in clinical practice.     

Diagnosis of liver fibrosis by transient elastography (FibroScan) and non-invasive methods in Crohn's disease patients treated with methotrexate

BACKGROUND: Methotrexate is an effective treatment in Crohn's disease, which may induce liver fibrosis with high cumulative doses. Transient elastography (FibroScan, Echosens, Paris, France) is a new non-invasive rapid, allowing assessment of liver fibrosis by measurement of liver stiffness. AIM: A prospective study to evaluate liver fibrosis with FibroScan and non-invasive biochemical methods in Crohn's disease patients treated with methotrexate. METHODS: Consecutive Crohn's disease patients had evaluation of liver fibrosis with non-invasive methods. Two subgroups of patients were compared: cumulative dose of methotrexate of more than 1500 mg (group 1) and naive for methotrexate (group 2). Liver biopsy was performed in patients with persistent liver enzyme abnormalities or FibroScan value >8.7 kPa. RESULTS: Fifty-four consecutive Crohn's disease patients were fully investigated (45 females, mean age 41 +/- 14 years). Median FibroScan values were similar in group 1 (n = 21) and in group 2 (n = 33), 5.5 and 4.5 kPa, respectively. FibroScan values were not correlated with the cumulative dose of methotrexate. CONCLUSION: In Crohn's disease patients treated with a high dose of methotrexate, significant liver fibrosis is rare and not accurately detected with liver enzymes abnormalities. FibroScan could be recommended and liver biopsy could be performed only with patients with high values and/or with chronic liver enzymes abnormalities.     

Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis

Background  Liver stiffness measurements may have potential for detecting and monitoring hepatic fibrosis in chronic liver disease.
Aim  To study the detection, quantification and progression of hepatic fibrosis in primary biliary cirrhosis by liver stiffness measurements.
Methods  Liver stiffness measurements were generated in 80 patients with primary biliary cirrhosis by applying transient elastography; however, as there were 55 with liver biopsy, histological stage (METAVIR) and liver stiffness measurements were compared only in these 55 patients. The efficiency of liver stiffness measurements in predicting stage of fibrosis was determined from the area under receiver operating characteristics curve analysis.
Results  Of the 80 patients included, 91, 4% were women and their mean age was 56 ± 12 (s.d.) years. A significant correlation was found ( P  < 0.05) between histological fibrosis stage (METAVIR) and liver stiffness measurements. The values obtained from area under receiver operating characteristic curve analysis of liver stiffness measurement data were 0.89 for F  > 2 and 0.96 for F  = 4. Liver stiffness measurements were 9.0 ± 5.3 and 7.9 ± 6.0 kPa for patients followed up more than 5 years and less than 5 years, respectively ( P  > 0.05).
Conclusions  In patients with primary biliary cirrhosis, median values of liver stiffness measurements correlated with histological severity of hepatic fibrosis. Liver stiffness measurements appear to be promising for liver fibrosis detection and quantification, as well as monitoring its progression, in patients with primary biliary cirrhosis. The progression rate of hepatic fibrosis in our primary biliary cirrhosis patients appears to be slow.