Z Gastroenterol 2014; 52 - P_1_07
DOI: 10.1055/s-0033-1360851

Computer assisted image analysis of hepatic collagen: ASSO-ciations to metavir staging, transient elastography and 13C methacetin metabolism in patients with chronic hepatitis C infection

O Goetze 3, M Breuer 1, J Oellsner 1, R Youssef 3, A Geier 3, M Fried 1, A Weber 2, B Müllhaupt 1
  • 1University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich, Switzerland
  • 2University Hospital Zurich, Institute of Pathology, Zurich, Switzerland
  • 3University Hospital Würzburg, Division of Hepatology, Würzburg, Germany

Background: Ishak and METAVIR scores are the most widely accepted descriptive non quantitative scoring systems for evaluation of fibrosis in patients with chronic hepatitis C infection. The amount of hepatic collagen as a surrogate for fibrous tissue can be measured by computer assisted digital image analysis in histological sections. The aim of this cross-sectional study was to describe the association of hepatic collagen quantification with histological METAVIR staging and with the indirect fibrosis markers transient elastography (FS) and 13C methacetin breath (MBT).

Methods: 60 patients with chronic hepatitis C infection (39 M, 45 ± 12y., BMI 24.2 ± 10.4 kg/m2, n = 12 with HIV coinfection) had Menghini liver biopsies (mean length 33 mm; mean portal tracts 24). Specimens were evaluated by METAVIR staging [F0-F4] and stained with Sirius red for CQ. Liver collagen was expressed as collagen proportionate area (CQ [%]). Liver stiffness (FS [kPa]) was measured by transient elastography (FibroScan, Echosens, France). The MBT was performed with 75 mg 13C-methacetin dissolved and ingested in 50 ml water. The 13C/12C ratio was determined by molecular correlation spectroscopy (BreathID, Exalenz, Israel) as delta over baseline (DOB[‰]) and was expressed as maximal percentage dose rate (PDRmax[%/h]).

Results: METAVIR fibrosis stages, liver stiffness and 13C methacetin metabolism were significantly correlated with collagen proportionate areas in liver biopsies (Pearson correlation coefficients with CQ; F0-F4: r = 0.59; FS: r = 0.59; PDRmax: r =-0.317; for all p < 0.01). Multivariate analysis showed that liver stiffness and METAVIR fibrosis stages were best predictors of hepatic collagen content (β= 1.36 and 0.20, p = 0.02). METAVIR fibrosis stages, liver stiffness and MBT explained 43% of the variance of collagen proportionate areas (p < 0.001).

Conclusion: Hepatic collagen can be objectively quantified by computer assisted analysis. This analysis is correlated with descriptive observer dependend METAVIR staging scores, liver stiffness and 13C methacetin metabolism. Liver stiffness is a better predictor for hepatic collagen content than 13C methacetin metabolism, which reflects both liver fibrosis and hepatic functional capacity.