Non-invasive detection of hepatic amyloidosis: FibroScan, a new tool.

INTRODUCTION

FibroScan, a non-invasive tool for measuring liver stiffness (LS), is not specific to liver fibrosis. Other extra-hepatic conditions may modify the LS value.

OBJECTIVES

Our aim was to examine whether amyloid deposition in the liver may modify LS.

METHODS

LS was measured prospectively in 41 patients with systemic AL amyloidosis (AL) in the French AL Reference Center, comprising: 5 patients with liver involvement (LI) and no cardiac involvement (CI), 11 with CI and no LI, 12 with both LI and CI and 13 with neither (2005 consensus criteria); 26 negative controls, 50 patients infected with Hepatitis C virus (HCV)-infected and 18 AL-free patients with right-sided heart disease ('cardiac controls') were also examined.

RESULTS

Median LS was significantly higher in patients with AL with liver involvement [27.4 (10.3-75) kPa] than in negative controls [4.8 (2.8-11.9) kPa] (p < 0.0001), and patients infected with HCV [(6.8 (2.9-69.1) kPa] (p = 0.001), and tended to be higher than in the 'cardiac controls' [11 (4.1-75) kPa] (p = 0.08). A cut-off value of 17.3 kPa, prioritising specificity, is proposed for routine diagnosis of significant AL liver infiltration.

CONCLUSION

LS > 17.3 kPa is suggestive of AL hepatic disease in patients with non-fibrotic liver changes, and may have diagnostic value in patients with known AL.