How is hepatitis C (hep C) infection staged?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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Answer

A liver stiffness test (FibroScan) is available as a noninvasive method of staging liver disease in persons with chronic hepatitis C. Obesity, female sex, operator inexperience, and age older than 52 may give invalid results. Falsely high estimates of liver fibrosis have also been reported with acute inflammation and recent food intake.

On December 17, 2014, the FDA gave marketing approval for the Hepatiq radiologic image processing system. [72, 73] The software application uses quantitative analysis of nuclear medicine liver-spleen images to determine the severity of liver disease and to predict clinical outcomes. [73] The developer noted that Hepatiq "automates the Quantitative Liver Spleen Scan (QLSS) that has been proven to be an accurate predictor of clinical outcomes in the recently concluded HALT-C [epatitis C ntiviral ong-term reatment against irrhosis] trial." [73] The HALT-C trial was a multicenter, randomized controlled study that evaluated whether long-term interferon would suppress HCV, prevent progression to cirrhosis, prevent liver cancer, and reduce the need for liver transplantation. [74]

In a study that compared abdominal computed tomography (CT) and laboratory data from 469 HCV-infected patients with those of histopathlogic METAVIR fibrosis scores, investigators found that the use of multiparametic CT evaluation of HCV-associated liver fibrosis further improved its diagnostic performance over that of individual parameters. [75] These parameters included hepatosplenic volumetrics, texture features, liver surface nodularity (LSN) score, and linear CT measurements, as well as the fibrosis-4 (FIB-4) score and aspartate transaminase-to-platelets ratio index (APRI). The diagnostic performance of LSN plus FIB-4 scores approached that of panels with more parameters and compared favorably with elastography. [75]


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