Direct comparison of the FibroScan XL and M probes for assessment of liver fibrosis in obese and nonobese patients
Direct comparison of the FibroScan XL and M probes for assessment of liver fibrosis in obese and nonobese patients
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DOI：
10.2147/hmer.s45234
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Mueller, Sebastian
中科院分区：
文献类型：
--
作者：
Durango, Esteban;Dietrich, Christian;Mueller, Sebastian
背景：一种新型的纤维扫描XL探针最近被引入并验证用于肥胖患者，其诊断准确性与标准M探针相当。本研究的目的是分析和了解这两种探针在非肥胖患者中的差异，确定这些差异的潜在原因，并开发一种实用的算法，将XL探针的结果转化为M探针的结果。方法和结果：首先在不同刚度（4.8,11和40 kPa）的共聚物模型中直接比较两种探针，然后在来自德国（n = 129）和加拿大（n = 242）中心的371名肥胖和非肥胖患者（体重指数范围，17.2-72.4）中进行比较。两种探针的肝脏硬度值在幽灵中比在患者中相关性更好（r = 0.98比0.82,P < 0.001）。与M探针相比，使用XL探针可以成功测量更多的患者（分别为98.4%和85.2%,P < 0.001），而M探针产生更小的四分位数范围（21%对32%）。M探针测量肝脏硬度的失败不仅见于高体重指数和皮肤-肝包膜距离长的患者，也见于一些非肥胖患者（n = 10），原因是来自皮下脂肪组织的信号被猝灭。与幻影相比，与M探针相比，XL探针在人体中产生的肝脏硬度值始终降低约20%。皮肤-肝包膜距离长和脂肪变性程度高是造成这种不一致的原因。调整XL探针的截止值（F0、F1-2、F3和F4分别为10 kPa）可显著提高两种探针之间的一致性，从r = 0.655提高到0.679。结论：在肥胖和非肥胖患者中，使用XL探针测量肝脏硬度的比例明显高于M探针。然而，XL探头不太准确，需要调整截止值。
Background: A novel Fibroscan XL probe has recently been introduced and validated for obese patients, and has a diagnostic accuracy comparable with that of the standard M probe. The aim of this study was to analyze and understand the differences between these two probes in nonobese patients, to identify underlying causes for these differences, and to develop a practical algorithm to translate results for the XL probe to those for the M probe.Methods and results: Both probes were directly compared first in copolymer phantoms of varying stiffness (4.8, 11, and 40 kPa) and then in 371 obese and nonobese patients (body mass index, range 17.2-72.4) from German (n = 129) and Canadian (n = 242) centers. Liver stiffness values for both probes correlated better in phantoms than in patients (r = 0.98 versus 0.82, P < 0.001). Significantly more patients could be measured successfully using the XL probe than the M probe (98.4% versus 85.2%, respectively, P < 0.001) while the M probe produced a smaller interquartile range (21% versus 32%). Failure of the M probe to measure liver stiffness was not only observed in patients with a high body mass index and long skin-liver capsule distance but also in some nonobese patients (n = 10) due to quenching of the signal from subcutaneous fat tissue. In contrast with the phantoms, the XL probe consistently produced approximately 20% lower liver stiffness values in humans compared with the M probe. A long skin-liver capsule distance and a high degree of steatosis were responsible for this discordance. Adjustment of cutoff values for the XL probe (10 kPa for F0, F1-2, F3, and F4 fibrosis, respectively) significantly improved agreement between the two probes from r = 0.655 to 0.679.Conclusion: Liver stiffness can be measured in significantly more obese and nonobese patients using the XL probe than the M probe. However, the XL probe is less accurate and adjusted cutoff values are required.