NEW YORK — Transient elastography correlated with aminotransferase levels in a cross-sectional study of 22 adolescent and young women with Turner's syndrome.
Transient elastography (TE), a novel technique for measuring liver stiffness, has been widely validated as a noninvasive alternative to liver biopsy for evaluating hepatic fibrosis in patients with chronic hepatitis C. It has not been used in Turner's syndrome (TS) patients, in whom liver involvement is common.
Although liver biopsy is the standard method for assessing liver fibrosis, it is an invasive and very expensive procedure that can incur life-threatening complications, and therefore can't be used as a tool to screen or monitor liver function in all TS patients.
TE is a painless procedure in which an ultrasound transducer probe mounted on a vibrator issues a wave through underlying tissues. Pulse-echo ultrasound acquisition is used to follow the propagation of the shear wave and to measure its velocity, which is directly related to tissue stiffness. The stiffer the tissue, the faster the shear wave propagates (J. Hepatol. 2008;48:835-47).
The findings from this small study—which will require replication in a larger number of patients—suggest that TE could be used to identify patients with elevated aminotransferase levels who might qualify for more invasive tests and possibly liver biopsy to better stage the etiology of liver involvement, Dr. Maria Francesca Messina said at a joint meeting of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology.
The procedure could be used to monitor the progression of liver dysfunction in TS patients without exposing them to the significant clinical risks of more invasive procedures, Dr. Messina said.
The 22 TS patients had a mean age of 20.9 years and full pubertal development (spontaneous or pharmacologic). All fasted and underwent TE along with biochemical testing. Six patients were found to have elevated aminotransferase levels.
The mean liver stiffness for the entire group was 4.5 kilopascal (less than 7 kPa is generally considered mild or normal), and was significantly higher among those with elevated transaminase levels compared with those who had normal liver function (6 vs. 4 kPa), said Dr. Messina of the department of pediatrics at the University of Messina (Italy).
The TE device, called FibroScan, is marketed by France-based Echosens International (www.echosens.com
Dr. Messina stated that she has no relevant financial disclosures.