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

• 57 years old, male
• 2004 diagnosis of HCV infection
• Contamination unknown
• Genotype 3a, Viral Load 1 200 000 IU/mL
• BMI 28, DM
• No excessive alcohol intake and tobacco use

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Case Report

• Liver biopsy (2005) A1F1 (METAVIR)
• Treatment (2005) PEG INF / RBV NR
• Poor tolerance
• Follow-up / not retreated

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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 ?
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Case Report
January / 2011
FibroScan 11.2 kPa
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Case Report
January / 2011
FibroScan 11.2 kPa
FibroScan 11.2 kPa / 0.9 / 90
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Case Report
8.8
9.6
14.6
FibroScan (kPa)
Liver Fibrosis (METAVIR)
F0-F1
F2
F3
F4
Ziol et al, Hepatology 2005
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Case Report Question 1
What could we conclude ?

1. FibroScan is correct ?
2. Liver Biopsy ?
3. Another non invasive test ?

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Case Report
January / 2011
FibroTest 0.80
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Case Report
January / 2010
Fibrotest Equivalent METAVIR
0.75-1.00 F4
0.73-0.74 F3-F4
0.59-0.72 F3
0.49-0.58 F2
0.32-0.48 F1-F2
0.28-0.31 F1
0.22-0.27 F0-F1
0.00-0.21 F0
FibroTest 0.80
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Case Report
Fibrotest Equivalent METAVIR
0.75-1.00 F4
0.73-0.74 F3-F4
0.59-0.72 F3
0.49-0.58 F2
0.32-0.48 F1-F2
0.28-0.31 F1
0.22-0.27 F0-F1
0.00-0.21 F0
Imbert-Bismuth et al. Lancet 2001 357 2069-75
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Case Report Question 2
What should we propose ?

1. FibroScan and Fibrotest 3/6 months later ?
2. Liver biopsy ?
3. Start new treatment immediately ?

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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

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Case Report
July / 2011
FibroScan 12.0 kPa / 1.2 / 100
FibroTest 0.78
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Case Report Liver Biopsy

• Liver fragment 20 mm and 12 portal tracts

L.B STEATOHEPATITIS Hep C Metavir A0F1
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Case Report
FibroTest (n8524)

• Hemolysis
• Haptoglobin lt 0.30 g/l
• Gilbert
• Bilirubin gt17 µmol/l
• GGTlt 30 UI/l
• Sepsis

False Positives
False Negatives

• Inflammation
• Haptoglobin gt 2.0g/l

Poynard et al. Clin Chem 2004 8 1344-55
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Case Report
FibroScan (n13 369)

• Obesity (BMI gt 30)
• Limited operator experience
• Female
• Age gt 52 ys
• Diabetes
• Hypertension

Limitations
Castera et al. Hepatology 201051 828-35
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STEATOSIS AND LIVER STIFFNESS
Cardoso et al abstract. Hepatology
International 2010
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STEATOSIS DETECTION USING CAP
Beaugrand et at. JVH 2011
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STEATOSIS DETECTION USING CAP
T 236 dB/m, Se0.83, Sp0.73
T 255 dB/m, Se0.94, Sp0.63
T 282 dB/m, Se0.95, Sp1
Cardoso et al, AASLD 2010
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Case ReportTake-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

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Case Report
Fibrotest Equivalent METAVIR
0.75-1.00 F4
0.73-0.74 F3-F4
0.59-0.72 F3
0.49-0.58 F2
0.32-0.48 F1-F2
0.28-0.31 F1
0.22-0.27 F0-F1
0.00-0.21 F0
Imbert-Bismuth et al. Lancet 2001 357 2069-75
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Case Report
10 validated measures
Success rate gt 60
11.2
0.9
14.6
IQR lt 30 median
Castera et al, J Hepatol 2008 48 835-47