Variability in liver stiffness values from different intercostal spaces

Aim: To investigate the variability in liver stiffness measurement (LSM) values from the fifth, sixth and seventh intercostal space (ICS) and examine whether LSM better predicts significant fibrosis (F2-4) and cirrhosis when LSM is performed at the same site as liver biopsy (LB). Methods: This study enrolled 91 consecutive patients with hepatitis B virus (HBV)-related chronic liver disease (CLD) who underwent both LB and LSM between September 2007 and January 2009. Results: The mean age of the patients was 45.4 years (66 men and 25 women). F1 fibrosis was noted in 12 patients (13.2%), F2 in 28 (30.7%), F3 in 15 (16.5%) and F4 in 36 (39.6%). The mean LSM values from the fifth, sixth and seventh ICS were 11.6, 11.1 and 10.9 kPa respectively. The mean LSM value from the same site as LB was 11.0 kPa. An interclass correlation analysis showed no significant difference in LSM values from the fifth, sixth and seventh ICS and the same site as LB. The area under the receiver operating characteristic curves of LSM values from the fifth, sixth and seventh ICS and the same site as LB for predicting significant fibrosis were 0.815, 0.838, 0.818 and 0.837, respectively, and those for cirrhosis were 0.919, 0.916, 0.907 and 0.913, respectively, with all overlapping confidence intervals. Conclusions: Any LSM value from the fifth, sixth or seventh ICS can predict significant fibrosis and cirrhosis with considerable accuracy without statistical differences regardless of correspondence with LB site in patients with HBV-related CLD.