Posted By: DDW Daily News
May 17, 2015
In: AASLD, By Society, DDW Daily News,
From biomarkers to imaging technology, clinicians now have an array of alternatives to biopsies when assessing and diagnosing liver disease.
Nezam H. Afdhal, MD, FAASLD, director of hepatology at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School in Boston, will provide an in-depth look at these tools during Monday’s AASLD State-of-the-Art Lecture Non-Invasive Assessment of Fibrosis.
From biomarkers to imaging technology, clinicians now have an array of alternatives to biopsies when assessing and diagnosing liver disease.
Nezam H. Afdhal, MD, FAASLD, director of hepatology at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School in Boston, will provide an in-depth look at these tools during Monday’s AASLD State-of-the-Art Lecture Non-Invasive Assessment of Fibrosis.
Dr. Afdhal said the three objectives for his talk are explaining how to use non-invasive diagnostic tests to stage liver disease; determining candidacy for treatment, particularly for hepatitis B and C; and determining prognosis and outcome in patients with chronic liver disease.
“We will look at all the diagnostic tests — serum markers, ultrasound elastography and magnetic resonance elastography,” he said. “Most people don’t have all of these, but most people have access to some of them. The idea is to say, ‘If this is what you have, this is how best to apply it in clinical practice so that you can get the types of evaluations that you need.’”
Dr. Afdhal will discuss the importance of accurately diagnosing cirrhosis, and then how to apply the AASLD guidelines around that diagnosis to screen for portal hypertension gastropathy and hepatocellular carcinoma.
He will also discuss using the new diagnostic tools for patients with hepatitis C who have advanced fibrosis, including Metavir stage three or four, or stage two with symptoms. Staging is essential when prescribing one of the new antiviral drugs, Dr. Afdhal said, since payors are insisting on that information.
Serum tests range from simple markers such as the nonalcoholic fatty liver disease fibrosis score and the AST to Platelet Ratio Index, to more specialized tests like the HepaScore and FibroSure. The latter tests use specific fibrosis-associated biomarkers to calculate a risk index for the amount of disease.
Vibration-controlled elastography using Fibroscan is another tool. The test sends a sheer wave into the liver and provides a real-time liver stiffness measurement that correlates to the degree of fibrosis.
The beauty of the Fibroscan, Dr. Afdhal said, is that you can perform it the office “and you know the answer in five minutes so you can actually have a real-time discussion with the patient.”
Magnetic resonance elastography is another useful diagnostic tool because it provides a three-dimensional view of the liver and also measures things like the amount of fat and iron in the liver. The downside is that it’s time-consuming for the patient, involves referring them offsite and is significantly more expensive than a Fibroscan.
Please refer to the schedule-at-a-glance in Monday’s issue for the time and location of this and other DDW® events.
“We will look at all the diagnostic tests — serum markers, ultrasound elastography and magnetic resonance elastography,” he said. “Most people don’t have all of these, but most people have access to some of them. The idea is to say, ‘If this is what you have, this is how best to apply it in clinical practice so that you can get the types of evaluations that you need.’”
Dr. Afdhal will discuss the importance of accurately diagnosing cirrhosis, and then how to apply the AASLD guidelines around that diagnosis to screen for portal hypertension gastropathy and hepatocellular carcinoma.
He will also discuss using the new diagnostic tools for patients with hepatitis C who have advanced fibrosis, including Metavir stage three or four, or stage two with symptoms. Staging is essential when prescribing one of the new antiviral drugs, Dr. Afdhal said, since payors are insisting on that information.
Serum tests range from simple markers such as the nonalcoholic fatty liver disease fibrosis score and the AST to Platelet Ratio Index, to more specialized tests like the HepaScore and FibroSure. The latter tests use specific fibrosis-associated biomarkers to calculate a risk index for the amount of disease.
Vibration-controlled elastography using Fibroscan is another tool. The test sends a sheer wave into the liver and provides a real-time liver stiffness measurement that correlates to the degree of fibrosis.
The beauty of the Fibroscan, Dr. Afdhal said, is that you can perform it the office “and you know the answer in five minutes so you can actually have a real-time discussion with the patient.”
Magnetic resonance elastography is another useful diagnostic tool because it provides a three-dimensional view of the liver and also measures things like the amount of fat and iron in the liver. The downside is that it’s time-consuming for the patient, involves referring them offsite and is significantly more expensive than a Fibroscan.
Please refer to the schedule-at-a-glance in Monday’s issue for the time and location of this and other DDW® events.
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