From the Guidelines
Liver elastography is recommended for patients with chronic liver disease, particularly those with chronic hepatitis B or C, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease, and autoimmune hepatitis, to assess the degree of liver fibrosis and monitor disease progression. This recommendation is based on the most recent and highest quality study available, which suggests that liver elastography is a valuable tool in the management of chronic liver disease 1. The procedure should be considered when initial blood tests show abnormal liver function, when there's clinical suspicion of advanced liver disease, or for monitoring known liver conditions. Elastography is also useful before starting antiviral therapy for hepatitis to determine treatment urgency and after treatment to assess improvement. For patients with NAFLD, elastography helps identify those at higher risk of progression to cirrhosis.
Some key points to consider when deciding when to get liver elastography include:
- Clinical suspicion of NAFLD, such as metabolic risk factors, unexplained elevation in liver aminotransferases, or hepatic steatosis on abdominal imaging 1
- Abnormal liver function tests, such as ALT > 20 U/L for women and > 30 U/L for men 1
- Monitoring known liver conditions, such as chronic hepatitis B or C, to assess disease progression and treatment response 1
- Identification of cirrhosis, which should prompt referral to a specialist for cirrhosis-based management, including screening for HCC and esophageal varices 1
The test works by measuring liver stiffness, which correlates with fibrosis severity, allowing for non-invasive assessment that can reduce the need for liver biopsies. Regular follow-up elastography (typically every 1-2 years) is advised for patients with progressive liver diseases to track changes and adjust management accordingly. It's essential to note that liver stiffness measurements on elastography can be influenced not only by fibrosis but also by edema, inflammation, extrahepatic cholestasis, and passive congestion 1.
From the Research
Liver Elastography Recommendations
Liver elastography is recommended in the following situations:
- For the assessment of liver fibrosis in patients with chronic liver disease, as it has been shown to be accurate in detecting advanced liver fibrosis and cirrhosis 2, 3
- For the evaluation of treatment response in patients with chronic liver disease 2
- For the assessment of portal hypertension, including spleen elastography 2
- For the differentiation of non-alcoholic steatohepatitis (NASH) from simple steatosis (SS) 3
- For the prognostic evaluation of liver disease in autoimmune liver disease patients 4
- For the assessment of liver fibrosis stage in HCV and HBV patients, and for distinguishing non-alcoholic steatohepatitis from simple steatosis in non-alcoholic fatty liver disease patients 4
- As a non-invasive alternative to biopsy for the assessment of liver fibrosis and steatosis, with comparable diagnostic accuracy 5, 6
Clinical Applications
Liver elastography has several clinical applications, including:
- Detection of severe fibrosis-cirrhosis and exclusion of significant fibrosis (>or=F2) in chronic viral hepatitis 5
- Assessment of liver fibrosis and steatosis in patients with hepatitis C virus, hepatitis B virus, nonalcoholic fatty liver disease, alcoholic liver disease, or cholestatic diseases 6
- Evaluation of clinically significant portal hypertension and elastographic characterization of focal liver lesions 4