In the staging of hepatic fibrosis, a FibroScan (transient elastography) value of 18 kPa in a patient with chronic hepatitis C correlates with which Metavir stage?

• A F1: Mild fibrosis without septa
• B F2: Moderate fibrosis with few septa
• C F3: Severe fibrosis with many septa without cirrhosis
• D F4: Cirrhosis ✓

Explanation

In the Metavir staging system applied to FibroScan values in chronic hepatitis C: F0 = <5.8 kPa, F1 = 5.8-7.1 kPa, F2 = 7.1-9.5 kPa, F3 = 9.5-12.5 kPa, F4 (cirrhosis) = >12.5 kPa (some use >13 kPa). A value of 18 kPa confidently indicates advanced fibrosis/cirrhosis (F4). Liver stiffness values above 20-25 kPa may suggest portal hypertension. FibroScan accurately predicts significant fibrosis and cirrhosis with sensitivity ~85-90% for cirrhosis, and has largely replaced sequential liver biopsies for monitoring chronic hepatitis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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